An image to counter some of the awful in the world.

Early Christmas morning, 2014

****
Happy Sunday.

Christmas eve.

Yesterday was a good day. Poopdeck and JoLai flew in from LAX last night and came to our home as always. Everyone was in good spirits as we rode from the airport. Harry was at home burning in the kitchen and the kids were building some kind of fort to show their grandfather immediately upon his arrival. Christmas music was on every radio station--even the rap stations--and every single building seemed to have lights twinkling just so. I felt glad to be riding in a car with my loved ones headed home to more loved ones during the most wonderful time of the year.

Yup.

Harry asked me to stop by the neighborhood CVS to get something to drink with dinner. JoLai and I jumped out of the car and scurried inside to complete this "honey-do" before pulling into the home front. Dad chilled in the car rocking out to some Nat King Cole which was perfectly fine with him. One container of sweetened iced tea later and countless "remember that time when" stories, too, we headed up to the checkout counter--the only thing standing between us and the very, very awesome Christmas eve that surely awaited us.

I grabbed my receipt and turned toward JoLai. Just as I did, I saw what appeared to be a surgeon or a resident walking by in a fleece jacket embroidered with "Emory Surgery" on the front. "Uggh. He must have had to take call," I told JoLai. "I remember those days. Call at Christmas.That sucked." She nodded in acknowledgement because she remembered those years that I was there and they were all here thanks to my schedule as a resident physician.

Just then, the surgeon got a bit closer to me. I realized that I knew him; he'd been a student at Emory before going on to his graduate training.

"Hi, Dr. Manning," he said with a smile. Although he appeared a bit tired, the smile was genuine. I'd been around hospital people enough to know what a person who'd worked all day on a tough shift looked like. This was exactly the case.

I was glad when his name came to me right away. "Hey there, Steven. Merry Christmas to you."

"Thanks," he said. Again, authentically chipper. Which, to me, was surprising given the obvious reality of him having to work over the holidays. He was alone. And in his hand was a 20 oz. Diet Coke. This was a pretty big contrast to my gallon of Arizona iced tea for many and the freckle-faced kindred on my arm.

"On call for Christmas, huh?"

"Yeah. Just leaving the VA, actually."

"Oooph. I remember those days. But residency will be behind you before you know it."  I looked up toward his eyes and hoped to be at least quasi-encouraging. "Pay now, enjoy later, right?"

Instead of responding with a predictable head nod, Steven's expression softened for a moment. Then he said this:

"It's okay. At least I'm not the person who has to have surgery on Christmas eve. You know? It could be worse."

And I swear to you, this is what this young, second year, post-Christmas eve shift surgical resident said to me before taking a big swig of his Diet Coke. His words made me stop in my tracks and just stare at him. I let his words filter through my brain and trickle into my heart.

"Wow." That's all I could think to say initially. Mostly, I just looked at him incredulously. I mean, this was a second year surgical resident and it was DECEMBER. Look up "burn out" in the dictionary and his picture should be right here along with every other PGY2 resident training in the winter time.

But this wasn't the case. It just wasn't.

"Yeah. One of my attendings told me that once and it always stuck with me. It might not be fun to be on call on Christmas eve or Christmas, but it's not as bad as being the person who needs surgery on Christmas eve or Christmas."

I was still standing in the same place with my eyes trained on his. I pressed my lips together and took a big drag of air through my nostrils. "Man. That gives me some real perspective. Every single time that I took call or worked on Christmas as a resident that never occurred to me. You've really given me something to chew on. Thanks."

He offered back a lopsided shrug and smile in response. I could tell he wasn't trying to be heavy. This was just the perspective he'd chosen to embrace while caring for human beings during the most wonderful time of the year.

Dang.

"Merry Christmas again. And thanks for the good word."

Steven waved good bye and turned to head down the toothpaste and toiletries aisle. Just before disappearing he paused and said, "Hey--will this get me on the blog?"

I laughed out loud. "Will it?"

"Yes! I've been waiting to make the blog forever." We all collectively laughed, including my sister.

"Consider it done," I replied with a chuckle. "But, you know. . . every blogworthy moment has to have photographic evidence."

And with that, my sister pulled out her phone and immortalized the moment. She sure did.

After that, JoLai and I joined Poopdeck who had now moved on to Sam Cooke from the symphony hall of that locked car; the same one that swooped us around the corner to a home filled with the aroma of home cooked comfort foods and the sounds of children laughing. And I guess Steven went back to drinking his cola in between answering pages before eventually falling asleep on his couch. And during all of this, without question, somebody somewhere was getting prepped for emergency surgery. . . .

. . . .on Christmas eve.

Yeah.

***
Merry Christmas. I hope your days remain as merry and bright as possible.

This post reminded me of this one from a Thanksgiving in the hospital. It's one of my mom's favorites and is a story that grounds me the same way Steven's words did.

Top Ten: Random Rules on a Rainy Monday.

Lots in my head but with very little rhyme or reason to it. Tonight I'm thinking about some extremely unimportant and random rules in my life--some of which I've already defined and others of which I could use some input from smart people like you. Life needs rules, people. Rules, I say!

And so, I bring you:

THE TOP TEN QUASI-IMPORTANT RULES THAT I HAVE EITHER MADE ALREADY OR THAT I AM TRYING TO MAKE AT THIS MOMENT WITH YOUR HELP. 

Like to hear 'em? Here they go!

#10  The Rule on not hazing people you haven't talked to in a while

With the holiday season comes phone calls from folks you haven't spoken to in some time. And inevitably, at least one of the people you speak with will spend the first twelve minutes of the first phone call they've had with you for the last twelve months hazing you about how you haven't called, emailed, texted, visited--you name it. Here's what I have to say about that:

Cut. It. Out.

Sometimes it's right out in the open.  "You haven't called me. My feelings are hurt." That's mostly awkward and--dare I say it? Annoying. But most times it's super passive-aggressive which is exponentially more annoying.

Case in point:

"Hey there!"

"Whaaaaat? You answered the phone? I can't BELIEVE it. I thought you might have died or moved to outer space. I wondered if I even had a [niece, nephew, friend, cousin, neighbor] at this number any more!"

"Uhhh, yeah. . .okay. So how are you?"

"I'm okay. But it's a good thing I AM okay. If I wasn't doing good or was on my death bead YOU wouldn't have known. Ha ha!"

"Yeah. Okay."

What you're really saying in your head is: "Ha ha, hell."

Ugggh. Then there's the:

"So and so asked me about you and I told them that you don't fool with any of your old friends like me." 

My chin reflexively hits the "end call" button when this happens. Or drops my phone under my care seat.

So here's the rule: Just say "hi" and keep it moving. If someone has pissed you off enough to have you feeling some type of way when you call--then DON'T. Please. For the love of all that is pure, if you do call--just fight the urge to lament about not talking.  Not only is it unpleasant, it is never, ever welcomed. (Nor is it an effective way to get someone to call more. )

Cut. It. Out.

#9   The Rule on bathing your kids (or not bathing them.)

I need to know something. What is the rule on kids bathing? My kids have somehow come up with this very convoluted system that was not authorized by my husband or me. Essentially they have decided that in the winter, they shower or bathe every OTHER day. Zachary explains that it is because you don't sweat so much and your skin can get too dry. Isaiah doesn't even bother with an explanation.

They do have one caveat: If you had practice for a sport that night, you need a shower. But only if it is the kind of sport that makes you stinky. For example, a golf lesson gets you a pass. Now. Come summer, the rules are different. Showers every day--unless you didn't go outside.

Sigh.

I want to know what y'all are doing. Also I want to know if you just let your kids have at it in the shower or are you policing the scrub down situation? I am finding that my son Isaiah will use an entire bottle of shampoo on his afro but will neglect to wash his feet with soap. "They get clean from standing in the shower."

Uhhh okay.

#8  The Rule on certain Video Games

Okay. So there's this video game that my kids recently got turned onto called "Animal Jams." And by recently I mean in the last few days. It's on the National Geographic website which has to be safe, right? Well. I noticed that my kids--particularly my older one who isn't into things like Madden--seemed to be spending an AWFUL lot of time playing this game. Like, it took him away from Minecraft which absolutely is the equivalent of an act of God.

So yesterday Isaiah is asking me all these questions like, "What does BRB mean?" or "Mom! Does IKR mean 'I know, right?'"

So I'm all like, "Dude. Who are you talking to?" And it turns out that this is like one of these multiplayer on line games where you're basically hanging out and chatting with people--but as animal avatars. I immediately felt uncomfortable with that. I started doing my homework and discovered that, duh, all kinds of shadiness goes down on this game the longer your kids play it. And so. I basically shut  it on down and made it a "no."

Have you guys made any rules on certain video games? Which ones? If you have or haven't how do you control this sort of thing?

#7  The Rule on notifying people when you're in their town

This is another holiday thing. People come to towns and get busted off of social media.

"Hey! You in the ATL? WTH???"

And, of course, by the time the person gets the message they're back home. Or worse still in town but feeling guilty.

I think the rule is that it's cool to get a phone call but there shouldn't be pressure to go over the river and through the woods to see you. Atlanta is humongous. Someone might be in, like, Acworth or Peachtree City--both of which are nearly 45 minutes to an hour out of Atlanta proper. I'm the friend that is cool with the phone call and delighted if it leads to us seeing one another. But I do my best not to haze folks.

See #10.

What do y'all think about this? What's the rule? Am I tripping? People over 40 know a lot of people, man. It's hard sometimes. Especially in a town like Atlanta.

#6  The Rule on Group Texting

Let the record show: I am NOT against the group text. But. I am not a fan of being group texted along with seventy five people that I don't know. Especially when seventy four of them respond and they come as random individual texts to me alone that make no sense.

"Yeah girl! I feel you!"  from 678-555-1212

And I'm like, "Uhhhh, okay."

Furthermore, there needs to be a rule on who can be on texts together. Like, I made the mistake of sending a text to four women friends--three of whom are my sorority sisters that all know one another and the other my best friend who is not a member of our sorority nor is she familiar with the other three. Two months later, a text comes to that same thread that assumed it was all Tuskegee Deltas.

Whoops.

Okay. So the rule is this:  Try to limit people who don't know each other being on the same threads. More than like seven people feels very uncozy, man. Reply ONLY to who sent it--especially if five of the numbers aren't listed as names in your phone. Those are my immediate rules.

Some folks don't want to be group texted at all. I wouldn't go that far. But what do you think? What's your rule on group texts?

#5  The Rule on Smart Phone Wars

I feel like the people I know with Galaxy phones (read: THE BHE) love to argue with you about how it is better than the Apple iPhone. While I do agree that the camera on the Galaxy is BOSS, it still has one major flaw: It isn't an Apple.

I admit. I've gulped down the Apple Kool Aid. But can we all just agree to have the anti-Apple people stop busting us over the head with the reasons why they jumped ship? Or never boarded ship?

I'm just saying.

#4  The Rule on the "Read" Stamp on the iPhone

Speaking of the iPhone.

Hey. Did y'all know that the default setting on the Apple iPhone for text messaging is to include this thing at the end of your text messages that indicates that you've seen it and read it? So like, if you're busy and you see it but you don't immediately respond, you look like you're ignoring the text. And if you are ignoring the text, then the person knows it.

Uhhh yeah.

So unless you are perfect with your rapid response situation with texts, I'd recommend going in your settings and shutting that off. Unless you want to be in a #10 conversation all over again.

*You're welcome*

#3  The Rule on Santa's Representatives

My kids are somewhere in between believing in Santa and not believing in Santa. I think the first thing to go, though, is the level of respect they offer to the Santa representatives found in malls, special events and gatherings. For lack of any better way of saying it, my children have pretty much decided that the "fake Santas" can kick rocks.

Maaaan, please.

We were at our annual "Breakfast with Santa Claus" event with our Atlanta Chapter of Jack and Jill earlier this month. In walks Brother Santa in his suit and a legit white beard growing out of his face. The kids were dressed all super cute in sweaters and "holiday attire." That line formed quick for the photo ops and I was hoping and praying that the Manning boys would do their mom a solid just this one time.

Not.

"Seriously, mom?"

That's all Isaiah said when I asked if he'd go take a photo. That is, right before he began breaking down how confusing it is for children to have these fake Santas with real beards, fake beards, brown skin, white skin, real bellies, and pillow bellies. "I bet he doesn't look anything like the old fashioned Santa in that old outfit."   At which point I began imagining Santa in a red and white Adidas warmup suit with six pack abs.

Next I tried the Z man who said, "Yeah, I'm good."

I got all excited like, "Really? You'll do it? You're good!? Yay!!"

Zack squinted his eyes and cocked his head sideways while eating a chocolate covered fruit on a stick. "Uhhhh. . . . no, mom. I meant I'm good on the whole fake Santa thing. We don't believe in the fake Santa Clauses."

The people behind him were on the way to see fake Santa.

Sigh.

You know what? I don't think my kids have ever shown love to the Santa reps. Like ever. What do you guys do with this? What's the rule on fake Santas. I don't fight to keep that dream alive at all. And I'm losing steam on the other Santa, too.

I'm just saying.

#2  The Rule on Christmas Trees and Decorations

Are you guys #teamrealtree or #teamfaketree?

When I lived in Shaker Heights, Ohio, real trees were against the law because they were a fire hazard. Not even kidding.  For the last two or three years, I've had a real tree and have loved it.

And.

Who buys the real swags and wreathes? I always admire them but have never gone out to get one. I always think it's something super rich and hoity, toity people do. But I'm probably dead wrong on that.

But that isn't the real question: The real question is--what is the rule on Christmas decorations coming down? I always thought before the New Year. But what do you guys think? And also what's the rule on the inflatable holiday items? Inflated all day or dead and flat during the day? I think I might be #teaminflatedallday.

Just curious. The deflated Santas and Frostys creep me out.

#1   The Rule on School Work over the break

When kids are on holiday and summer breaks, how much school related stuff should be required of them? Like, should they be reading an hour per day and limiting video games? Or should they just be able to do whatever the hell they want to do? I'm somewhere in the middle on this. I think the BHE is team #whateverthehellyouwanttodo.

I need somebody to weigh in. Especially people with grown kids that turned out alright. Also tell me whether or not I'm a horrible parent for letting my kids stay up until 10:30 during the break. (They're up right now.) I need a reality check, for real.

Bonus one:

I'm also still debating the rule on the "bold lip." Does a bold lip mean minimal accessories and other makeup? Or what? Or do you just do whatever makes you feel fierce? Hmmmm. And also what's the rule on how many wears a formal can get in the same city? This red dress should be retired and hung up in Philips Arena based upon number of wears.

But it is a great dress. That I can still fit. So will probably wear it again no matter what y'all say. LOL.


Looking forward to your insights.

***
Happy Monday.

No place like home.

"When I think of home I think of a place

where there's love overflowing

I wish I was home, I wish I was back there

with the things I've been knowing."

~ from The Wiz

Those situations usually seem so hypothetical. Even though I work at Grady and know that they aren't, no matter how hard I try to avoid not seeing all of these logistical changes that way, the inertia of every day living blurs out the reality. I wish I could say I was so deeply and consistently empathic that I haven't fallen short in this way. But I can't.

Our inboxes were flooded with emails about this. Well, maybe not flooded per se, but definitely we got our share of notifications. The contract between Grady Hospital and Blue Cross/Blue Shield of Georgia had been terminated. Those with that as their insurance carrier would need to seek care elsewhere. And I guess if the majority of your patients have no insurance you hear that and think, "Man, well that sucks." But I'm not sure if it mobilizes you to march on Washington or social media or whatever it is folks march on these days.

But seeing you last week felt like a stinging slap across the face. You, who'd entered this world at this very place. You wore that badge with pride--"Grady baby"--and had stayed loyal to the brick and mortar building that initially welcomed you. "I'm always gonna be a Grady baby," you said. That is what you said every time we saw you.

Not only did Grady give you life, you'd trusted us to save your life, too. Now officially middle aged and, yes, insured, you had a choice. But you continued to choose Grady. In fact, you even paid a higher premium to afford you the chance to do just that. You sure did.

I remember that day when I, along with the amazing resident doctor caring for you, gave you quite the tongue lashing about cigarette smoking. You countered it a bit but then gave in to the tough love recognizing the love more than the tough. "Y'all care about me," you said. And you were right.

We spoke of highly personal things that required trust and patience. The barriers to caring for you had long since come down so the things we dissected didn't make anyone blush or shift in their chairs. It was all love and all a part of the tapestry that had been woven over years and years of being a Grady baby. Medication changes, tests, and referrals. You did as we asked of you, asked great questions, and formed what I know for sure is the very best kind of therapeutic alliance--one built on genuine caring and mutual respect.

The muddy sclera of your eyes glistened when you told us last week. "This will be my last time here for a while. I have to go somewhere else." And at first I was puzzled but wasn't for long; your resident primary doctor clicked on the screen and up popped your insurance information: Blue Cross/Blue Shield of Georgia.

"Is there anything that can be done?" I asked, my naiveté  almost embarrassing. Both Dr. Spicer and you looked somber and acknowledged this inconvenient truth: Immediately? No.

Immediately, no.

And your health still requires "immediately." Close follow up and such. And it's never been a burden for you or for us to work you in because beyond the business parts there is the relationship part. The laughter, the fun-poking, the explaining, and the exploring. The parts that people don't show on the six o'clock news when speaking of Grady.

Maybe there are fine details that I don't get and surely there are high-level things regarding the dissolution of that contract that some person reading this can argue with a fervor that I cannot. I admit that I should know far more about the political ramifications but I don't. In fact, I'll even accept that I could have a better understanding of many other things related to health care and health equity that are still a bit fuzzy and slippery whenever I try to grab them in three full dimensions. That's the honest truth. But this? This encounter with you and your tearful eyes was as real as it gets.

Not slippery. Not fuzzy. Nope.

And so. We spent part of the time talking about your "immediately" things and the rest holding hands and saying good bye. At least, good bye for now.

When you told me where you'd be going, I wanted to be positive. "They'll take good care of you," I said.

"But not like Grady," you replied. "'cause there's no place like home." And all I could do was squeeze your hand in acknowledgement. . . all the while wishing that if only I could click my heels three times to fix this.

I can't, though. . . .at least, not immediately.

"Living here in this brand new world might be a fantasy

but it taught me to love so it's real to me

And I've learned that we must look inside our hearts to find

a world full of love

like yours, like mine

like home."

~ from The Wiz

***
Happy Sunday.

Now playing on my mental iPod and making me cry this morning. . . one of my most favorite performances of ALL TIME that never, ever, ever fails to give me chills or cause me to break down crying. I am so grateful to find it on youTube this morning. Thank you, Miss Diana Ross for words that are a part of my daily soundtrack while walking into Grady.

Happiness is. . . .

. . . .driving into work every day to a job that you look forward to doing.

. . . . watching friends moving through the phases of life together.

. . . . a really cute picture of your good friend's dog when he was a puppy.

. . . missing your advisee and then getting a text that says she misses you, too.

. . . . tasting the samples in the Sam's Club with Isaiah.

. . . .plain Greek yogurt with flavored balsamic vinegar splashed on top.

. . . . old friends.

. . . . new friends that feel like old friends.

. . . . hanging out with Zachary at basketball practice.

. . . . meeting a school bus driver at the vending machine at Grady and hugging her and thanking her on behalf of all of the bus drivers I haven't hugged or thanked for handling my precious cargo with such care.

. . . . getting a text from my nephew with a screen shot of his early acceptance into Emory University--his first choice of colleges.

. . . . sons who look very much alike but who are so very different.

. . . . nurses that you can have fun with.

. . . . the smell of stinky boys.

. . . .watching your medical students evolve before your eyes.

. . . . a bold lip for no reason whatsoever.

. . . .  amazing mentors who always seem happy to see you no matter how big of a deal they become.

. . . . a mom who is genuinely helpful to you in every possible way.

. . . . former advisees-turned residents who still make an effort to see you whenever they pass through town.

. . . . a fancy hamburger in a restaurant prepared perfectly.

. . . . wearing my power color, red.

. . . .spending some quality time with an old friend and discovering that time or miles can't stop real Ruths from always being in lockstep.

. . . .  these little red rubber duckies that make me think of my sorority sisters.

. . . . having a sleepover in your 40s.

. . . . still believing.

. . . .  laughing out loud with your girlfriends.

. . . . seeing two of your favorite residents on the front row when you're about to give a lecture--and knowing you have them as moral support.

. . . .  funny text messages from your residents that include you even when you aren't in the hospital taking call with them.

. . . .  getting the news that your small group advisee that you've known since his first day of medical school in 2007 has matched into a Cardiology fellowship. . . . at Emory. (And being one of the first people he thought to call.)

. . . . brothers who get along enough to build Lego sets together.

. . . .  lunch with your advisee and his lovely future wife.

. . . . your nephew telling you that he wants to be a doctor someday. . . . and you imagining the moment that he does.

. . . .  Grady Hospital.

. . .  friends that you admire personally and professionally.

. . . . students who you admire personally and professionally.

. . .  the anticipation of watching your advisees' lives unfold.

. . . .  time with three of your favorite Grady doctors.

. . . . splurging on the holiday drinks from Starbucks.

. . . . . taking a fun "ussie" after church.

. . . . when doctors from Emory and Morehouse come together for patient care and teaching. . . and simply as "Grady doctors."

. . . . .interviewing 2 medical students who look like you for residency positions in one morning . . . . and then realizing that every single award or accolade you've ever received in your career may have all been in divine preparation for the moment when those students would sit in your office and see living proof that they are enough.

. . . . watching your boy serve the guests living at a shelter. . . . and laughing at their funny jokes.

. . . sitting up late at night. . . .and taking an inventory of the happy parts of life regardless of how many not-so-happy things you hear.

Appreciating the happiness around you is. . . . .  

a choice. 

Yeah.

***

Happy Sunday. Won't you choose to see the happiness in the world? (It pairs beautifully with kindness.)

*I modified this last part out of sensitivity to those who struggle to feel happiness every single day. Clinical depression, dysthymia, grief, and more can rear their ugly heads something ferocious. . .especially during the holiday season. I should acknowledge, particularly as a physician, that for a lot of people it just isn't in their control. I think my point is to counter so much of the ugly in the world through trying to appreciate the little slice that is my life and to rage against all of the negative images I'm seeing as of late. I pray for us all to find the peace of mind that stills our troubled waters and helps us to live our best lives. 
xo, KM