Yesterday Auntie JoLai took us to the pool with some new friends. Some of the friends were girls but some were boys. Mama, I don't know why but sometimes if girls are there I feel kind of funny in my tummy. And also I can't stop laughing or being silly. Isaiah kind of is the same way but 'cept he gets quiet and just smiles a lot. Even though he's not shy.
But it's only with some girls, Mama. Not all girls.
Like, not you, okay? Just some girls. Not all. Just some.
Love,
Zachary, Age 6 and 3/4
P.S. I asked Auntie JoLai about why it makes my tummy feel tickly and she said to ask you.
The conversation usually goes something like this:
"You went to medical school in Nashville?"
"Sure did."
"You were at Vanderbilt?"
"No. . . . actually, I went to Meharry."
"Me. . .harry? Hmmm."
"Yes. Meharry Medical College. It's a historically black medical school and dental school. One of the oldest and most prestigious."
"Oh, yeah. That's right. Meharry. Okay, cool."
"Yeah. Cool."
This beautiful and bright young woman is one of our newest interns at Emory. She is also a recent graduate of Meharry Medical College--my alma mater. More than likely, she was the one saying those words during orientation this past week just as I did many moons ago.
This picture was taken in my home on Friday afternoon. Yep. Right on the couch in my sunroom. As soon as we met, I gave her my phone number and we talked about the fact that we had Meharry in common. Which meant we were automatic family in more ways than the parts that were already obvious.
And what's cool is that she believed me.
She sent me a text on Friday morning asking if we could meet. And you know what? I invited her straight into my home. Sure did. And I did that because I wanted her to know early on that --as long as she was here and as long as I was here, too -- that the light here will always be on for her. And that she will always have a soft place to land.
Always.
I didn't always have that. In fact, during most of my residency I didn't have that at all. But she will. And not just from me, but from others, too. Because it makes a difference.
It does.
You know what? I felt recharged when I saw her standing in that crowd of interns. Like I wanted to shadow box in a corner and come out swinging even harder. It's funny. Knowing that she is here makes me want to do better, to set an even higher standard for myself, and to just. . .I don't know. . .go hard, man. Because my mama and my daddy taught me to always remember that what I do is always about more than just me. Meharry taught me that, too.
Yeah, man. I already have a lot of reasons to go hard. But today, she is just one more reason.
your words don't burn me anymore
Been meaning to tell you
but I guess it's clear to see
Don't be mad--it's just a brand new kind of me
Can't be bad--I found a brand new kind of free
~ Alicia Keys.
An elderly woman was perched on the end of a bedside chair. Her neck was layered in pearls and her stocking-covered legs were crossed tightly at the ankles. Perhaps it was a bit too humid for the high-end suit she was wearing but it did match her severe chignon and carefully applied makeup. The ring fingers on both hands were adorned with sparkling diamond rings.
All of it oozing of privilege.
In walked a team of doctors. All in hospital-issued scrubs and white coats. One person leading them in a longer white coat called shots while the others immediately began doing the things that younger doctors and student doctors do. They were caring for the patient in concert as that nattily dressed matriarch looked on.
And all of it was fine and good. It was.
Then, one of those team members stepped toward the side of the bed near that chair. This young student doctor with a beautiful cocoa complexion and hair pulled back into an equally elegant bun. The only difference is that hers involved a network of African braids. And this student doctor, my advisee, made careful, confident eye contact with the patient and also her loved one.
And all of that part was fine and good, too.
That women glanced over at that student doctor and offered her a tight-lipped smile. Swinging those same crossed legs sideways, she twisted her torso and reached out for the bedside rolling table. In one subtle motion, she then nudged it in the direction of that young student doctor. The Coco-esque one gestured toward the cocoa-complexioned one and spoke in a gravelly, Southern voice.
"Are you here to pick up the lunch tray?" she asked.
And that student, who (like her colleagues) was holding gauze in her hands and who was dressed identically to the five other caregivers in that room, looked around from side to side to confirm that this woman in her St. John's suit was speaking to someone else.
Problem is, she wasn't.
"Excuse me?" My advisee gave that reply quietly--yet deliberately. And she did that because she wanted to give this woman the benefit of the doubt. Like, she didn't want to be "that person" -- you know, the one that immediately thinks that all things are rooted in some racial slight. This was the point where that woman was supposed to turn beet red and then vehemently apologize for mistaking this young doctor-to-be who was clad in the same tell-tale uniform as the others as something she wasn't.
And.
Let's be clear. There is nothing wrong with being the person who IS responsible for retrieving lunch trays. Nothing at all. But it hurt my heart when my student told me about this moment and it hurt my heart even more to realize that here we are in the sixth month of two thousand and thirteen with a black family in the White House for the second term in a row. . . a family that includes two grown black people-- both of whom graduated from Harvard freaking Law no less -- and that this brilliant and accomplished woman (who also happens to be an alum of an equally prestigious undergraduate institution) had to be sized up in this way. As less than her potential. As what this woman perhaps deemed as "the help."
And yes. That was more about that woman and her limited world view than my student. And yes, perhaps people like her and maybe Paula Deen really are good souls at their very center which I will not argue. But even when you know things like that and can tell yourself such things, it's hard.
It is.
And no. I was not there physically. I wasn't. But from the way she told me that story, I feel like I was. I feel like I was there and, in a way, I was there since I've had similar experiences myself.
Yep.
You know? On the bright side, I feel proud that there was a mechanism for my advisee to process this. That she had my cell phone number and that without flinching, she knew that it was okay to text me and call me to talk about this critical incident. Yes, this critical incident. This critical incident that pretty much flew under the team's radar or at least was not made to be the critical incident that it was. Partly because these things happen more than folks realize. And when they do, sometimes you realize that on that day you are just too tired to go marching on Washington. Or that you have exams or just shit on your mind or just . . .just. . .yeah.
Grrrr. I keep replaying it all in my head. Over and over, you know. Wishing I could find that woman and say things like:
No, lady. My student was NOT there to get the damn lunch tray. She was there to do what every other one of those people who happened to look like you and not her were there to do. And let me tell you, lady, that if she WAS there to get that tray that she still would have been equally as amazing and wonderfully and fearfully made. Which means that whether she was a future physician or not, she was just as good as you.
Maybe even better considering that ignorant comment.
Ignorant. That's what it was. And yes, I am rambling and unpacking because there is just stuff on my mind. Stuff that relates to my race and what it means and how it feels to sometimes be looked through instead of at. Or when someone doesn't realize what it means to someone like me to even have these opportunities or to get to this point. A point where my name gets recorded next to accolades previously not given to people of color and how it feels when the magnitude of it all is not realized.
By others that is.
Sometimes it's subtle like someone just sort of shrugging off some big thing that has happened. Or like them not even noticing that the big thing that has happened was big -- not just because it was big but because in context of who you are that makes it even bigger. And also bigger than just you.
Yes. That. Like how it feels when I see Michelle Obama walking across a stage. It is more than just the fact that she is smart and confident and amazing. For me, it is more. And it gets all weird when you start trying to explain all that to people, you know? Explain how it feels to see her and what it says to me about my own potential. But then there is this hope that I can find a way to communicate that. To communicate that it's not just that she is the awesome First Lady but that she is an African-American woman, too. And that's a big deal. A really, big fucking deal.
Sorry for the f-bomb.
Yes, lady. Haven't you turned on a television? Or opened your eyes? Or have you simply assigned Michelle Obama as some kind of alien, not applicable to all of the little sisters running behind her on the trail that she and others like her are blazing every single day?
Sigh. I don't know. I don't.
Oh, and in case you're wondering? When my student clarified who that woman was talking to? The Coco-esque one let her know that it was exactly what my student perceived it to be. That, in this woman's mind, the only reason why a young black woman would be at her loved one's bedside was to clear the lunch tray out of the room.
I'm not sure what I would have said if I had been there. I'm not. But knowing me, I would have wanted to say something. And it would have likely been fueled by anger and would not have involved any part of the high road, that's for sure. Which is probably why I would have just ended up saying nothing once I thought it through.
Yep.
But right now? This is what I'm mostly saying. And what I'm saying is to myself and to my student and not that woman at all:
"Don't be mad. Be excellent."
And as someone striving to be excellent, I'd want that lady in her Coco Chanel baubles to know that I'm not above either moving a lunch tray or at least finding who can -- especially if it makes the person lying in that hospital bed feel more at ease. But I'm also not beneath being the one trained and qualified to be that same patient's doctor. No, ma'am, I am not. And I won't let someone else reduce me--or any of my learners--to feeling anything otherwise. No matter how much privilege that someone else knows. Because that? That's the worst kind of identity theft there is.
Yeah, man.
Now excuse me while I focus on my patients. And my potential.
I'll leave you with words from another really cool First Lady:
"No one can make you feel inferior without your consent."
~ Eleanor Roosevelt.
Word.
That's all I got today. Thanks for listening, okay?
***
Happy Friday.
Now playing on my mental iPod. . . . .
(And no, this didn't happen at Grady. But really, it could have happened anywhere.)
I'm sorry that I haven't written you for a few days. Mostly it's because we've been busy doing stuff. Today we played some golf with Grandpa but we also went swimming. This is why we just went ahead and wore our swim trunks to the golf course.
Mom, did you know that you're s'posed to wear special clothes to the golf course? Like they want you to have on a collar-shirt and maybe something that isn't swim trunks. Sort of like a school uniform. Did you know that, Mom?
Grandpa said he DID know. He also said that when you get senior citizen like he is that you just kind of do what you want. Mom? I a little bit think this is why he keeps wearing that fanny pack. A little bit I do.
Love,
Isaiah, Age 8
P.S. I am doing my best to teach Zachary how to play golf. I keep telling him that he can't move the ball with his hand after he hits it but he sort of doesn't really listen and does what he wants. Do you think maybe he is a little bit senior citizen like Grandpa?
I saw this young person recently who was broken. His life had been hard and the childhood that he'd recently left behind was still covered with soot and grime. His eyes were laced with tears and shadows from years and years of crying himself a river of muffled lullabies in dark rooms.
"You need help," I said. "I'm so glad you came today because you need help."
And, see, that battered up child was still there. Right in front of me. Cringing in a corner and conflicted about what "help" even meant. But it was obvious that this encounter wasn't by accident. At least, it wasn't to me.
"I'll be okay." Those were the words I heard slipping out of his lifeless mouth. They were so tiny, so defeated and anemic.
"I worry that you won't be."
"I will be, though. I have no choice but to be."
And something about that broke my heart into a million pieces. That young face so pristine yet so damaged. I kept looking and noticing. I saw perfect lines on a forearm telling even more of that story of self hatred and self mutilation. I felt my eyes beginning to sting and my face warming up. I knew. I knew then I needed to push.
"Let me tell you something." His eyes widened at that statement. Like he wasn't sure what was about to happen next. "Listen to me. You deserve to be happy. You are worth the help someone has to offer you. You are. I know sometimes you might not feel that way but you are." I patted my chest. "I don't deserve to be happy any more than you do. You are . . . you are worth it.Worth whatever effort it will take to get you what you need."
Every time I said those words "worth it" his face crinkled. His eyes were squeezed tight and it looked like he wanted to shake his head no. Like hearing a person telling you lies that you don't want to hear. The more I spoke, the more he did that. Eventually a rush of tears pushed out onto his cheeks. One after the next.
"Please. Believe me when I say that, okay? You are worth our time and our attention. Let us get you some help. Please."
And you know what? That's exactly what happened. A door opened. And someone walked through it finally unafraid. Or maybe still afraid but at least he walked through. One step closer to the help he so clearly needed and deserved.
No. This doesn't mean that all of those demons have disappeared. It doesn't at all. But I know for certain that you have to start somewhere.
Me? I start with trying to see myself in my patient's eyes. Nothing is more important to me than mattering. Nothing at all. So on this day I tried to give my patient what my parents gave to me. And what they taught me to give to my own children. A belief that I could fly.
How? With eyes full of expectation and triumph. A listening ear and a soft, patient expression. And especially, a reminder that each person deserves these things just as much as anyone else.
Including me.
I hope my patient knew. I hope he knew that I truly believed that, with a chance, he could fly. My prayer tonight is that someday he believes it, too.
***
See, I was on the verge of breaking down
Sometimes silence can seem so loud
There are miracles in life I must achieve
but first I know it starts inside of me
If I can see it
then I can do it
if I just believe it
there's nothing to it
I believe I can fly. . . .
~ from "I believe I can fly."
Happy Monday. Now playing on my mental iPod. . . something about my patient made me hear this all day.
Quote of the day: "Being awesome does not prevent heart disease." ~ Me.
Hey there. I was just thinking of you good people today and thought I'd go ahead and fill your brains with the unimportant random minutia swirling through my head tonight. Yes! The more random the better. Because that's just where I am right now.
Wrote a little top ten about it. Like to hear it? Here it go!
#10 Paula Deen.
Well, just damn. There is a lot to say about Miss Paula and the whole debacle of her dropping the n-bomb and then freely admitting to doing so like "whatev." But here's what I'm thinking mostly: No person is immune from falling from glory. No one. So Paula Deen's crash and burn reminds me to make smart choices and to never take myself too seriously.
Mostly I just felt disappointed in her because even though I don't call myself a fan, I never turned the channel away from her or anything. What I do like is the fact that I've read some good, healthy dialogue from people of all hues talking about this. And dang. Folks that look like P-Deen are more mad at her than the folks she was trying to oppress. Kind of like how I get mad at the women pulling out each other's weaves on Real Housewives of Atlanta.
Rule: No matter what your story, you can fall from glory if you do dumb stuff. Thank you, Paula Deen, for reminding me to work harder at not doing dumb stuff.
#9 The OWN Network.
I heard a radio personality saying that Oprah's OWN network should be called the ON-YOUR-OWN network because the channel is too hard to locate on your local cable listings. Here in Atlanta it's channel 131. Which is kind of random. He was saying. "Damn, couldn't Oprah afford a better channel than 131? Bravo is 70, MTV is 50. No other good channel is even near 131!"
That kind of made me LOL.
#8 Original Riddle written by yours truly.
Question: Why did the television break up with the VCR? Answer: He was too much of a playa.
Ha ha ha *cough* ha ha ha ha
My friend Wendy A. said I shouldn't say "VCR" because it makes the joke incomprehensible to anyone under the age of 30. So if you're all young like that, just say "BLUE RAY" instead when you tell it.
*you're welcome*
Oh yeah. Here's another that I didn't make up but that makes me giggle.
Question: Why does Snoop Dogg carry an umbrella? Answer: Fa drizzle. (To which you should then follow up with, "Fa shizzle.")
Hee hee. *takes bow* I'll be here all week!
#7 Harry and his couch.
Dude. Why is it that the BHE is willing to lay on the couch for twenty-seven hours whilst enduring severe dehydration until I walk past him so that he can say, "BABE! CAN YOU GET ME SOME WATER?" Or some whatever it is that is two feet away that he waited for me to come out to get?
Grrrr.
So now there's this whole passive-aggressive tip-toeing I do when I come by the couch to go to the kitchen while he's out there. Why? I do not know. I just do. Because I'm sort of annoyed by the fact that even if it's been seventy seven hours of him watching Duck Dynasty, at no point in it does the thirst reach a point so critical that he gets up to get it himself. EVER.
Dude. I'm all like CUT. IT. OUT.
Yesterday I commando crawled to the living room to get my purse because I didn't want a bunch of orders. That's bad, huh? And okay. The man is rarely on his couch because he works really, really hard but still. What's up with that? And what's worse is that no matter how quietly I try to sneak past him, he always hears me and thinks of AT LEAST ONE THING he needs me to "do him a favor and get."
*insert side eye roll*
Some days I preemptively strike and just bring water and snacks in there and plop them on the ottoman in front of him. And that makes him really happy when I'm The Good Wife. But that's only on some days when I'm feeling all nicey-nicey.
#6 The Four Agreements.
Have y'all read this book? It's really kind of cool once you get past the heavy parts at the beginning. You know how those kinds of self-helpy books can start out. Cryptic and spiritual where you aren't sure you can go on. But this one is worth muddling through to get to the good parts. In a nutshell, it's saying that people who wish to be authentic or whatever should make four agreements with themselves:
1. Be impeccable with your word. 2. Don't take things personally. 3. Don't make assumptions. 4. Always do your best.
My favorite is number 4. Always do your best. I need that reminder sometimes, man. I like number 1, too. Reminds us to pay attention to the power of the tongue. It can spread magic -- the beautiful kind or the black kind.
The book is short. If you dig this kind of thing, peep it out. Very thought provoking stuff. My sister friend and med school classmate Yolanda W. gave it to me. I love that girl because she's always giving me good things to think about so that I can better myself.
Here's us earlier last week when I gave a talk she invited me to give at Morehouse School of Medicine:
#5 Shot versus Drink.
I asked a group of medical students this question:
"If an attending physician was having dinner with you and offered to buy a round of shots for the team, would that bother you? Would it be any different than if he or she just had a glass of wine or a cocktail with dinner?"
Some of them said if the month was a good month and they weren't at work that it wouldn't bother them either way. And me, I was all appalled and balking at the shot thing saying it's TOTALLY different. And they were all like, "How? It's all alcohol."
Hmmm.
My brow is mad furrowed on this one. I think people take shots for one reason and one reason only. Imagine me chatting with you over dinner and randomly ordering a shot and taking it midsentence. Hello? That's my opinion. But they made good points saying, "Who's to say that the same shouldn't be said about all alcohol?"
What do y'all think?
#4 Dark Girls documentary.
I watched this on the ON-YOUR-OWN network tonight and it kind of depressed me. Essentially this show was about all of the issues with skin complexion and our people. And all people sort of. Lots of it was super true. But it also painted this picture as if every dark-skinned sister is battling some serious self hatred about being dark brown.
Hmmm.
I know a LOT of darker skinned girls who *LOVED* having that as a calling card. Especially when I was in high school. I have a friend that I used to call "Chocolate Drop" who looooooved that nickname so much that she wrote it everywhere. But maybe she was dealing with those demons and I didn't know it. I guess I just wanted them to show some of the girls I knew from school who loved their cocoa complexions. A lot of them were "it girls" at my school for sure.
What did y'all think about this? (Those who found the channel.)
#3 Spanx-ings
Ha ha ha. Harry was asking me about Spanx the other day. He wanted to know if they have FULL BODY Spankings or what. And he called it "spanking" like wearing Spanx had an action verb version.
Ha.
So I asked why and his answer? "One of my frat brothers said he hugged this girl who looked really good in this sundress and it felt like she had on armor underneath there." And we just laughed and laughed.
I then pulled up all of the permutations of Spanx-ings on line so that he could see how hard core it really gets. We also discovered that there is a whole line of man Spanx. Which makes sense sort of.
I guess. Um, yeah.
#2 Gangsta.
I am really big fan of the voice texting mechanism on the iPhone. I love that Siri has mastered lots of slang. I was in an epic texting exchange with JoLai tonight as I often am. And I said that something was "gangsta" and Siri spelled it exactly as such. "GANGSTA." Not to be confused with "gangster."
Love that.
We were talking about the GANGSTA questions Oprah was asking Cissy Houston in her interview about Whitney. And to those that don't understand the meaning of "gangsta" just know that it has so many meanings. It's just when you're bold about something. Like audacious even. Which makes people say, "Dang. That's gangsta."
(See Paula Deen admitting to using the n-word and other derogatory slurs------> GANGSTA.)
JoLai and I have just started a new team. It's called TEAM SJGR. Anyone who is bull-ishing in any part of their life that they need to stop bull-ishing on can join. But particularly the focus is health. HEALTH. So a lot of the focus is going to be on healthy eating and lifestyle. And getting serious.
Why?
Because last week SJGR. Tony Soprano's middle school aged son found him dead after a heart attack. Yes. James Gandolfini. He was larger than life on and off of the screen. And yes, we loved his character which made us love him. But even more, I bet his son loved him.
He was a big dude. He was. And I am not sure what Mr. Gandolfini's health deal was but I know the number one killer ended his life. The same one that robbed me of my beloved big sister. And you know what? I heard that and said, "SHIT JUST GOT REAL." Being awesome does not prevent heart disease. It does not.
Did y'all catch that?
BEING AWESOME DOES NOT PREVENT HEART DISEASE.
And so. JoLai and I have decided that we won't keep pretending like it is. Like us being awesome and lovable is enough to protect our hearts from a Western diet and a family history. Period. End of story.
We welcome any and everyone to join us. But only if you are ready to stop bull-ishing. Cause on Team SJGR the realness will be all up in your face like Tony Soprano.
Stay tuned for that.
And now a photodump from last week for your viewing pleasure.
Transitional Year Residents' End of Year Gathering
Mahmoud's last clinic session -- one of my F.R.'s of all time.
Meeting Mahmoud's mom who was visiting from Libya at IM Residency graduation
Going away breakfast with another graduating resident Sandeep--another of my FRs!
Girlfriend time on Friday with former Grady doctor and good friend Frieda!
At church today -- our dear friends' baby was baptized/dedicated today!
Good looking Omega men. . .whew!
He kind of made my ovaries hurt for a baby. Kind of but not really.
When Dr. L gave Dr. W. chlamydia. (Okay, okay, a stuffed replica of it.)
Pia C.--another FR--(fave resident) on her LAST DAY OF CLINIC!!
That's all I got. Tomorrow is the first day of orientation for our new interns. Good times ahead.
*Random rambling and unpacking ahead. Proceed at your own risk.
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~ Your body
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Okay, so check it. I was talking to a patient not too long ago who wanted to lose weight. Badly. At least she said she did. She playfully suggested we give her some pills or some kind of fast fix to help her along. She was in her late thirties/early forties and probably about twenty-five to thirty pounds overweight. Young and motivated, she told me about all that she's been doing to shed those unwanted pounds.
"I'm working out with a trainer now. Really it's like a boot camp program and I've been doing it now for about two months. I watch what I'm eating for the most part but I'm still not really losing much weight. But girrrrrl, I'm trying so y'all need to help me out!" She laughed after that part and raised her eyebrows. After that, she was on to the next topic.
But in my head, I wasn't.
I often say to my patients and others that the weight thing is tricky. For the most part, I believe that it is. For some, their whole lives have been hallmarked by a curvaceous or husky build and the idea of slimming down into some altogether new body habitus isn't even a real, true consideration. Like. . the aim is for something respectable yet attainable. . . something closer to the green like the grass on the other side of the fence. And that? That thinking makes it tricky. It does.
The other tricky part is the whole self image thing. To really declare war on a spare tire, you have to admit that you aren't satisfied with who you are. And this is a real tug of war for all of us already, right? At least, it is for me. Not necessarily with weight, but in general. Striving to be satisfied with yourself is always a work in progress if you ask me.
See, that woman I was seeing seemed to be very confident. And she had every right to be. She had three nearly adult children who were contributing to society and to their household. Her employment was satisfying and she'd enjoyed longevity there. And she had the smoothest, prettiest skin that I'd seen in ages highlighted by eyes framed in delicately applied individual eyelashes. Her hair was freshly coiffed and her hands recently manicured. And I believed what she said about her workouts. This was someone who seemed to love herself.
But she needed to lose weight. Her blood pressure was high. She'd already developed some insulin resistance and was officially pre-diabetic. And her back was starting to hurt her some. She needed to kick things into higher gear.
And so, I told her just that. I pointed out that she'd kept all of her appointments and that it was obvious that she cared for herself. Then I asked her if she was ready to get serious about losing weight.
"I have been serious for the last ten years!" she laughed. But she was only partially joking.
"My feeling is that you can get even more serious. Are you prepared to do that?"
She narrowed her eyes and curled her lips. "I'm listening."
That's when I told her what my best friend Lisa D. told me she uses as a mantra to her patients in clinic almost every day:
"We lose weight in the kitchen. We get fit in the gym."
And that? That was where we spent the remainder of that visit.
Okay. I need to unpack about this. I need us to have a dialogue about this notion of weight management and how it happens and what at least partially has to take place for that trunk to have a little less junk.
First, I already acknowledged the complexities of weight and how it ties to self image. I mean, no I didn't address it fully because an entire blog could be (and probably somewhere is) dedicated to just that. But I'm saying that I don't want to be insensitive to "the struggle" by shrugging my own narrow shoulders and acting like I know what it's like to carry seventy five extra pounds. I don't. But I do think I have an idea of at least some of the paradigm shift that must, must, must take place for weight to get managed once and for all.
Now. There is a caveat. People who are in their twenties? They are still in that metabolism range where they can regularly enjoy things like deep dish pizza and fettucini alfredo without the least bit of concern. That's that age that allows you to do whatever the eff you choose as long as you're working out. In other words, when you're young like that, that's usually enough.
But when you get out of your twenties? As the Grady elders say, "that dog don't hunt." No, it does not. And the older you get, the more that becomes painfully true.
The truth: You just can't move enough to manage your weight. You can't. Sustained weight management happens on the fork and the spoon. Period, end of story.
Now. Step one is simply accepting that truth. Not tricking yourself into thinking that you can out run a big ass by solely hitting the gym. That's step one. Because you won't. Not if you're over thirty. You won't.
Will you benefit from that exercise? Of course! Your heart health asks that you do about thirty minutes or so of activity that raises your heart rate. And if you step out of your front door and go for a brisk walk or if you meet up with a trainer or walk on your treadmill or run with a group or whatever it is you do, that's wonderful. It truly is. So don't think I'm saying don't exercise. I'm just saying, don't exercise thinking that THIS is the way that you will fit into your clothes. Because it's not.
I should also say that, whether you're a betting person or not, if you were to place your nickel down to bet on the thing most likely to cause you death or disability, it would hands down be your heart. So moving with that in mind is very, very important. Move to stay alive. To keep your heart happy and healthy. And yes, managing your weight helps your heart tremendously, but you have to do everything in your power to try to see at least cardiovascular exercise as FOR. YOUR. HEART. NOT. YOUR. BUTT.
*rolls neck, pops knuckles, getting loose*
Okay. Now I'm really ready to unpack.
Here is what I'm suggesting. Every single time you think about weight loss, connect it to your kitchen and your plate. Think about the guacamole you are about to dunk that chip into and the margarita you intend to wash it down with. Visualize the twenty grams of fat per bite and the six hundred calories per drink. Then imagine your metabolism like the little hourglass or spinner icon on your computer. The older and less muscular you are, the slower that sucker runs. And the more you eat, the more you "freeze up" your computer.
Does it mean NEVER eat your favorite foods? No. But it does mean that you have to make a decision. Either you're serious or you're not. Exercise helps. But without fork-and-spoon management, count on a pop-up screen telling you "Program Not Responding."
Yes! Program Not Responding. It's not responding because of the fork and the spoon. Or because of those bites, licks and tastes that we *think* don't count but do. (I'm definitely a bites, licks, and tastes person.)
So, here's what everyone who desires to lose or manage their weight should ask themselves today: Am I serious or not? Period. If the answer is yes or even maybe, read on.
Check the cupboards. What's in there? Salty snacks? Pop Tarts? An assortment of cereals? Open the fridge. What's in there? Skim milk? Whole milk? Veggies? Chicken wings? Guacamole?
Look at it all and make a decision. What is in there that you absolutely love? And by love I mean that you can knowingly enjoy all five thousand calories of without a trace of guilt? Like that thing that is so yummy that, hands down, you always think it's "worth it." Turns out that it isn't most things. Usually that list is short and often the things that are making us booty-licious aren't the things we absolutely love. It's just the things that are absolutely . . .there.
There.
So GET. THEM. OUT. OF. THERE. Get them out if you're serious. Toss it, chunk it, do what you have to do. That is, if you're serious. If not, just keep on tricking yourself into thinking that paying that $80 per hour trainer will do the trick. But don't be surprised when your program isn't responding.
And let me just quickly say that I'm not referring to those who have medical reasons that make weight loss difficult. I'm not talking about the very small percentage of people who take steroids or who have uncontrolled hypothyroidism or some other metabolic issue. For those folks, the playing field is different so that's not what I'm talking about. I'm talking about ALL of the rest of us who don't fit into that category. So let's just get this out of the way before someone mentions it.
And one other thing? For anyone who has ever wondered: There has never once in the history of radiographic images been a case of proven "BIG BONED-EDNESS" as a valid explanation for being overweight. No sir, no ma'am. (I'm a doctor so trust me on that fact. For reals.)
Wait--where was I?
Oh. Yeah. So my patient was drinking a Mickey Dee's sweet tea in clinic that day. Yes. And she told me that she loves-loves-loves that sweet tea. Which I told her is fine as long as she recognizes how many calories are in it. She had no idea. Neither did I, so we looked it up right then and there.
"230," I told her. Yes. 230 calories. In that drink. Which, for me, just isn't freakin' worth it. I mean I, too, love a good sweet tea every now and then. But I'd rather eat my 230 calories than drink them. I think of all of the foods I can enjoy for that many calories and I just make the decision that, for me, sweet tea isn't good enough for me to make it an allowance.
So I suggested that she mix it half sweet/half unsweet (which you can do in the McDonald's drive through.) Or get unsweet and add Splenda. Or get full sweet and KNOW that you are drinking a meal along with your meal so don't be mad when your program doesn't respond.
"But I have kids in my house. And they play sports and are growing and . . . "
I hear that a lot. Reasons for pantries filled with temptations that are linked to children and teenagers. But guess what? They'll get over it. You feeling good about yourself is far better for them than being able to grab a plate full of potato chips and salsa on a whim. So when they complain, tell them "Oh well." And also tell yourself that you are actually probably helping THEM with their future food relationship.
Is this making sense? I hope so.
I went for a run yesterday and it felt good. I ran almost four miles and my legs felt strong and able. And the whole time, I was telling myself:
This is for your heart. Especially for your heart. You have a strong family history of heart disease so this is important to you. Not just to fit into your pre-baby jeans. I mean, yes, things tighten up somewhat when you run like this. But know that this--what you're doing now--is mostly for your heart more than anything else. And to maintain the weight that you desire, that part depends mostly on what you do after you finish this run and walk into your kitchen.
And that's some real talk. You know? When I got inside of the house, I didn't really want to eat anything bad. That's a great by product of exercise. But sometimes you can feel so good that you tell yourself that you *deserve* something more. Something yummy. Something bad. And next thing you know these allowances have added up.
Yep.
This is why you see heavy people running long distances like marathons and such. You wonder: How can someone run 26.2 miles and still have love handles? It's because of the fork that's why. And the spoon. And the bites, the licks, the tastes, and the sips. And if you don't believe me when I say that no one over 35 can outrun a big ass? Just go and cheer on the sidelines of any marathon. You will see that it is possible to run an 8 minute mile and to simultaneously be significantly overweight.
Sigh. I know. This sounds mean. It sounds like the kind of admonishment that we all hate getting because we sort of know it already. But you know? I don't think of it as something we know already. Magazines and advertisements for fitness clubs always focus on how the body will look. Names like "bikini bootcamp" or "summer bum-bum workout" trick people into thinking that for just the cost of enrollment that they will get to the six-pack promised land. When they won't.
Maya Angelou said "When you know better, you do better." But we are wired to think differently than this so it's hard. And, to quote a good friend of mine, "Damn. Food is just good." So knowing better doesn't always translate to doing better in this instance. You have to know better and then decide that you are ready to get serious. And you know? Sometimes you just aren't ready for all that. You aren't. And I get that. But if your main goal was weight loss and you really, really wanted to shed weight, instead of shelling out duckets for a trainer, spend that money on planning the right meals. Because no matter how sweaty you are while you eat that five-dollar-footlong from Subway, mayonnaise is still mayonnaise and white bread with refined sugar is still just that.
See I'm unpacking about this because I struggle with it, too. Even though I said those things while I was running, it was hard to make myself believe it. The fourth mile came out of vanity and really wasn't about my heart. Even though I was telling myself otherwise.
Okay--one other caveat about the whole food and exercise thing when it comes to weight loss: Weight training. That is definitely a part of exercise (especially as you get older) that can help you to lose weight and burn fat more effectively. The stronger your large muscle groups are, the more effective your body burns calories. So squats, lunges, lat pulls and all of those things? A thumbs up when it comes to weight loss.
Ultimately, all of this should be about heart health I suppose. Like, at some point, we should all want to manage our weight to protect ourselves from the absolute number one killer of human beings in this country. Because, yeah, losing weight (especially around your mid-section) is super important to lowering cardiovascular risk. But if needing to zip up the dress you bought for your high school reunion motivates you more than fear of heart disease, then I say go with whatever will get you serious.
And to those who already have this figured out because they got serious a while back? Good for y'all. But a whole lot of folks are still works in progress. I'd even imagine for the fittest among us it's an ongoing battle that has its highs and its lows.
Yep.
Look, man. We lose weight in the kitchen. We get (cardiovascular) fitness in the gym. Period.Want to lose weight? Get serious about the fork and mouth. Otherwise YOU arethe only person to blame when you keep on rebooting your hard drive over and over again. . . . only to find that. . . . despite your best efforts. . . . the program's still not responding.
So what will you do? Click cancel or end the non-working task and start over? It's up to each of us to decide.
***
Happy Friday.
Now playing on my mental iPod. . . . De La Soul's Me, Myself, and I which is who has to be held accountable for all of this stuff.
I am sure that you are wondering what's going on here in California so I will tell you.
1. We went swimming for a lot of hours. Like waaay more than you let us go for. 2. We had some Sprite which Papa said was no big deal even if it's soda. Even when I told him Mom doesn't let us have sodas. He said to ask you if you got to have sodas and see what you say. 3. Zachary lost one of his new sandals. I didn't though.
That's all. Okay, bye.
Love,
Isaiah, Age 8
P.S. Did you drink sodas sometimes when you were eight? If you did, Mom, then that's kind of not that fair.
This morning me and Isaiah played some chess. Even though Isaiah really, really knows how to play chess, I used the trick that Papa told me about called 'timidation. That's where you look like you are gonna checkmate even though you kind of don't know what to do next. Papa says if you look tough enough the other person gets timid.(That's why it's called 'timidation.)
You know what? 'Timidation works.
Love,
Zachary, Age 6 (and a half)
P.S. Papa says 'timidation works with other stuff, too. He said to ask you what stuff.
I was talking to a man in clinic the other day. A big, strong man in his sixties with a deep voice and a throaty laugh. His muscle tone rivaled that of a teenager and at one point in the visit, he even pulled up his sleeve to flex a bicep for proof.
"Man, I bet I can still do more push ups than this young guy can do!" He gestured over to his resident doctor with a challenging twinkle in his eye. His doctor quickly waved his hands in full surrender, laughing out loud and assuring our patient that he was correct in that assumption.
"I even got the six pack still." Our patient pulled up the side of his t-shirt with one hand and pointed to his abdominal muscles with the other.
"Wow, sir. That's impressive!" His resident doctor couldn't help but release an incredulous chuckle when he said that. And me, I just smiled at the entire exchange because this patient and his doctor were enjoying one another and I think that's therapeutic.
"Do you exercise a lot?" I asked.
"I'm jest a doer," he said. "I get outside and mow the lawn, chop some wood, do some projects around my yard and other folks' yards. Do some push ups with my grandsons and sometimes run outside and play some football with 'em when these knees ain't bothering me."
"That's awesome." And I said that because it was pretty awesome to hear of the kinds of easy, everyday activities that had helped a man who was nearly old enough to get a social security check maintain a body like this. Kind of like he'd figured something out that we hadn't.
"How many grandkids do you have?" I always like knowing these things. We'd already reviewed the plan with him and were on to the pleasantries--which is often my favorite part of the visit.
"Nine of 'em. Five grandsons and four granddaughters. And love 'em all to pieces."
"That's so cool that you play football with your grandsons."
"Yep. All them grands is athletic like they granddaddy. I play basketball with 'em and even play some volleyball with my oldest granddaughter. She ain't thank ol' granddaddy could spike that ball but I had somethin' for her!" He laughed out loud and mimicked a spiking motion when he said it. We all joined in and laughed with him.
"You are the first granddaddy I've ever met who spikes a volleyball and has six pack abs. That's for certain!"
"You shoulda seen me when I was a young dude. I had a twelve pack back then!"
And this was how this part of the visit went. Fluffy, confluent laughter and animated gestures. Us asking and him telling and all of it bringing us closer to better understanding exactly who our patient really is.
His voice had this musical quality to it. Mostly southern but almost like a radio personality. And since his resident doctor was still entering in orders and preparing the after visit summary, I decided to ask a few more small-talky questions since I was enjoying hearing about his life so much.
"I like your voice, sir. Where are you from?"
"Right here, baby. Rights HERE!" He pointed at the floor. "I'm a Grady baby."
I playfully bowed before him. "Oh. . .man, that makes you royalty."
"Is that right?"
"You know it!"
"Did you play any sports in school or after?" I was curious about this, too. Any sixty-something year old man who was diving for a volleyball and tackling his grandsons in the front yard had to have a good sports story behind all of that.
"Sho' did. All day e'ry day! Played it all and was good at everything. You ever met somebody like that? Just pick up any sport and good at it?"
I smiled when he said that because we've often said this about our son Zachary. "Yes, sir. I know just what you mean."
"Yeah, well that was me. I could play anything you put in front a' me. Some of my grands is the same way. Bet one of 'em gon' make it to the pros long as they figure that school part out."
I nodded when he said that because he was right about the school part. I wondered if there was more to that, but not for long because he went on.
"Tha's what did me in. Well, that and the times, you know? I got all the way up to the eleventh and couldn't do nothing past third grade level. That held me back real bad. I was gon' play baseball or football at one of the colleges but couldn't because of that."
I furrowed my brow and leaned my chin into my hand. "Because you had trouble with your school work?"
"It was more than trouble. I can't read or write. Well--I take that back--I can write my name and some numbers down. That's about it. And them schools back then just pushed me on along. And when them college people came to talk to me they give you papers to look at and fill out. I was too shamed to say I can't read none of this. And it ain't like I could take it home and get mother or daddy to do it 'cause they ain't read none neither."
The resident doctor froze on the keyboard midstroke and looked at his patient. "Do you still not read or write?" he asked.
"Nope. No more than basic stuff. Like real, real basic stuff."
I have no idea what prompted me to ask this next question but I guess he'd just been so open that I felt comfortable digging a bit deeper. "What is it like. . . .I mean. . . you know. . . to . . "
He didn't make me finish that awkward query. "To not know how to read or write? Man! It's terrible! Terrible, do you hear me?" He shook his head hard and for the first time his face grew serious. His eyes became distant and quiet. So did his voice. "My biggest fear. . . . my biggest fear is the day one of my grandbabies look at me and ask me, 'Granddaddy, what do that spell?'" He wiped his hand over his face and sighed hard.
I didn't know what to say. But really, what was there to say? This man had gone up to the eleventh grade without being literate. He'd been failed by a system and the whole thing sucked. Every bit of it.
"But you know what? I got hustle in me so I always made it happen. And usually I ain't had no problem admitting to folks that I don't read and write so I always managed to do stuff that don't require all that. I made my living and been jest fine."
"That's good," I said.
"It's jest that them grands came along and something about telling them that they granddaddy don't read or write? My voice jest go silent. Like I want them to feel proud a' they granddaddy, you know? And they are. Proud a' how they granddaddy do for them and do stuff with them like other granddaddies can't. I hate the thought of them being disappointed in me 'bout something basic as that."
"My bet is that there's nothing you could do to make them not be proud of you."
"I reckon you're right, Miss Manning. But that's still hard."
"I know." I wrinkled my nose and shook my head quickly when I said that. "I mean--I don't know. But I think it sounds really hard."
He sighed and gave his head one nod. "Yeah."
Instead of giving him a pre-printed after visit summary, we spent more time explaining the plan and the follow up appointments. We went to the social worker and looked on line for literacy programs and made a plan to explore programs for teaching adults to read. And our patient seemed genuinely excited about all of it. Even more excited than he was to show us his six pack abs.
Here is what I know for sure: Every single patient has a story all their own. Filled with experiences and triumphs and tragedies. Packed with thoughts and fears and beliefs and goals. And all of it is there just waiting for us to explore it, ask about it, hear about it. The journey becomes richer. The caring relationship blossoms into something symbiotic.
This moment with this granddaddy was just one tiny piece of my day in clinic the other day. It is a slice of humanity--the kind you have to slow down to savor.
Grandma told me to tell you that next time you need to pack me some headphones for the airplane ride. At first I said I didn't need any because I could just play my video game on silent. Then Grandma said that the headphones aren't for the game, it's so that the person sitting next to you won't keep talking your head off when you don't feel like talking.
But don't worry because she said if you don't have some headphones you could just play possum which means act like you're asleep. I kind of think Grandma does that when she's at home, too.
Love,
Isaiah, age 8
P.S. You can play my Wii if you want while I'm gone.
Among the stars above
Maybe not, if it wasn't for your love
Smiling faces all around
Like when a king has just been crowned
A battle has been won
That I'd have lost
If it wasn't for your love
A fairy tale unfolds
More true than stories I've been told
At last my chance to shine
And all in perfect time
The life I once dreamed of
Who'd have thought?
If it wasn't for your love
And oh the wonderful surprise!
To have a light so bright it blinds
It blinds my eyes
And finally I see how it feels to live a dream
But would I have touched the sky?
Ever flown so high?
No not I. . .
if it wasn't for your love . . .
. . .your love
~ Heather Headley
***
Happy Father's Day. Thank you to all of the fathers out there who, through their consistent and unselfish love, give there kids a fighting chance in this life.
Now playing. . . . . . warning: May require Kleenex (at least it does when I hear it while looking at these photos. . ha ha ha.)
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?
