Choosing a residency program is such a tricky thing for medical students. After working so hard, it only seems right to climb on what most would agree is the highest ladder rung attainable. In every specialty, certain programs at certain hospitals hold that distinction. Those sit high on shiny platinum pedestals far out of the reach of most. These are the ones that you utter aloud and immediately garner raised eyebrows. Not the suspicious kind but the affirming kind that say, "Daaaaaamn. It's like that?"
Yeah.
Honestly, I'm not fully sure how it all happens. And by "it" I mean a residency program becoming so sexy that everyone loses sight of the details of what really should be considered in such an important choice. The name flies so high like a gigantic flag in the sky that what it represents (or even if the place is right for a particular individual) becomes moot. Everyone wants to be down with them and thus, one of the cool kids. It isn't a far cry from middle school, actually.
Yeah. I said it.
In all fairness, I should say that there are sexy, platinum programs in every specialty that are perfect fits for certain folks and also ones filled with people dedicated to creating great learning and training climates. But I guess what I'm thinking about right now is this simple truth:
Just because a residency program, or even medical school, is the most recognizable and shiny on paper doesn't mean it is the very best one for you.
Nope.
I will never forget my residency application process. I'd done fairly well in med school and was a student leader. As an underrepresented minority to boot, sexy programs found me sexy, too. And I hope everyone is getting my use of that word--sexy. I mean it in the "it place" and "thing-of-the-moment" way. Not the Pretty Woman-knee-high-patent-leather-boots way.
Just saying.
Okay, so where was I? Oh. Yes. Me applying to residency. So yeah, I applied to these sexy places and they granted me interviews. I'd walk in and see how I felt and hope for something inside of me to ignite so I'd know. That was my experience with medical school and college. That "eureka!" feeling. But for the majority of my residency trail, it just wasn't happening.
Ugggh.
I was flattered by the number of interviews I received. I caught planes, trains and automobiles to places that any and every person, even the non-medical ones, would recognize when they saw the name. My chest would poke out a bit and my step would pep up some, too. And that? Yeah. That was cool.
The thing, though, was that nothing ever really stood out to me. I mean, the names sure did when I told people, but when I was in my quiet time, nothing else did. And here's the thing: I know I'm scrappy and that no matter where I went, it would ultimately be fine. But some piece of me kept hoping that "being fine" wouldn't have to be the goal. I wanted to be more than fine and I kept hoping that, just maybe, one of these places would blend the sexy with the tailor-made fit I was looking for.
It came to a head half way through yet another two day interview back in 1995. I was shuffling around in my taupe heels and feeling mostly "meh" about this program that I was supposed to be jumping for joy over. I smiled politely during the resident lunch and asked a few questions. But mostly I was lost in my own thoughts.
What was I looking for? I think up until that moment, I had only asked myself that in a general sense. Again, I was just aiming for the highest rung on the ladder; the places that would puff my parents' and my deans' chests out and garner the eyebrow raise of approval when spoken out loud.
Yep.
But in that moment, I realized that this wasn't enough. So I began to really, truly think about it. Finally, I distilled my needs down to seven critical things--the absolute essentials without which it might be a deal breaker. And in full transparency--NO, this wasn't written down in a journal back in 1995. But I did shift my thinking to reflect these things that I'm about to share.
Hand over heart.
My hope is that by sharing them, someone who is preparing to start this process for residency--or even medical school or a fellowship--can use them as a springboard to think of their own specific needs.
Oh, and spoiler alert: It probably isn't the stuff you think it is. Although hopefully after this it will be.
Like to hear it? Here it go.
Seven ESSENTIALS to look for in a residency program, medical school or fellowship program beyond just how SEXY the name and reputation are
Need #1 Genuine interest in me as an individual
No. Not the fake kind where you shake my hand and act all nice for a few moments. I needed to feel like someone there would be genuinely advocating for me, on my team and slugging it out with me to help me succeed. That would require time over time. Interest. Sacrifice.
Yes.
How could I tell? Well, for starters, the places where folks were genuinely invested in my potential there were prepared. It was obvious that at least someone in leadership had not only read but thought about my application and how I'd fit in. Some piece of my interview day was built with this knowledge in mind, too. They made eye contact with me and listened when I spoke instead of clearly calculating their next talk point during mine.
Yes. That.
We all know it when we feel it. And we all know it when it's absent. The key is just to not ignore the truth when someone is, well, blowing you off.
Need #2 A climate that won't force me to assimilate into someone I'm not
Look, y'all. I'm a black girl from inner city Inglewood, California. My high school was pretty much 80% African-American, 15% Mexican, 5% Pacific Islander and 0% anything else---and I attended both a historically black undergraduate college and medical school. Sure, I can speak standard English as well as the best of them and my fund of knowledge isn't or wasn't inferior to my non-black counterparts.
But.
By this point, I'd had 25 years of experience at being comfortable in my own skin. I am a woman who identifies with black culture and doesn't pretend it doesn't exist. I'm down with celebrating all that is you but don't really see the need to downplay my own identity in the process. And I learned quick that not every place is good for that kind of person. I'm not one of those people who, like plain yogurt, takes on the flavor of whatever gets mixed into it. I guess I like it more when our ingredients enhance but don't overpower. But still pop out as their own to create an awesome blend. So that? That was important to me.
Yeah.
Need #3 People in leadership with whom I can identify
I'll be completely transparent and admit that it definitely was a common practice amongst my Meharry classmates and me to immediately open a brochure (this was pre-internet, remember?) and count up the black faces in the residency program and on the faculty. Yup. That said, this need isn't only about how many underrepresented minority folks there are in the midst.
Nope.
So check it. You ever meet someone or watch someone in action and think, "That person? Now that's somebody I'd like to be like." Or even, "That person? He/She is my kind of people, man." And it's cool when you say that about someone who could be a potential peer. But man, oh man is it uber-awesome to be able to say that about one of the head honchos.
Okay, so the race thing. Let me go on ahead and further address that before going further. If you are an underrepresented minority (which, in my case you should read to specifically mean black person) whether or not a place hires and retains a significant number of people who look like you should be noted. If there is only one or two total in a really big program? Well. Honestly, that doesn't portend the best prognosis for a person like me.
I'm sorry if that sounds harsh. It's true, though.
Remember in that old movie "Do the Right Thing" by Spike Lee when that character Buggin' Out rolled up in the pizza spot and asked Sal, the owner:
"Ay yo, Sal! How come it ain't no brothas on the wall up in here?"
I mean, I'm not saying you should say it like Buggin' Out did, or even at all. But you should note it if you are an underrepresented minority in 2015 thinking about going there. Am I saying DON'T go? No. But I am saying, make a note of it.
Yeah man.
Okay, so with all THAT said, here's another thing I know for sure: It is not a prerequisite for someone to share my race or gender to be one with whom I can identify. Case in point: During my interview day at the program where I trained, I had an interview with two individuals that blew my mind. Seriously, they did. And guess what? Both of them were--wait for it--white men.
Yup.
They were both enthusiastic teachers and in love with caring for patients in the indigent setting. Even though they were leaders, they were still very much entrenched in clinical care and teaching. They were nice to their secretaries (which I always notice) and they also called nearly every person they encountered by name.
Including me.
I watched them both in a teaching conference interacting with the house staff and students. What's funny is that I'd made up my mind to go to that interview strictly because I'd waited too late to cancel it--and not showing up at all would be rude. Had this happened in the email and text message era? Chile please. I would've cancelled that interview quicker than you can say Rumpelstiltskin.
Which reminds me: True story--I wore a mustard-colored blazer, black full leg trousers, a multicolored silk neck scarf and a bold red lip. Why? Because it's not like this California girl was going to actually train in Cleveland, Ohio. (Did I mention? It was snowing?) Plus this wasn't even the sexy program for Internal Medicine/Pediatrics in that city. Matter of fact, a lot of folks hadn't even really heard of it outside of the midwest and--real talk--I'd only scheduled the interview because I'd already planned to be in town for another program (the sexy one. Ah hem.)
But.
The first of those two interviews was the first time that whole interview cycle that I felt that feeling that I'd been looking for. These were folks I wanted to be like. And they struck me as the type who'd do any and everything to help me not only be like them but exceed them.
And so. I recognized this as a need. People around me that I'd want to emulate and who had the time and interest in me to let me into their worlds. And--yes--a place with a decent representation of women and underrepresented minorities at all levels. Because even as wonderful as those two guys were--and still are since they remain two of my mentors--never seeing your phenotypic reflection in anyone makes it not only lonely but hard for people there to imagine your full potential.
#truth
Need #4 Openness to innovation and new ideas
For as long as I can remember, I've always been a creative type. Someone shows me something one way and I immediately start brainstorming ways to put a different spin on it. When I don't see what I have in mind, I set out on a plan to build it (within reason, of course.) That's always been my way.
Now. Raise your hand if you know what it's like to suggest something and to have it immediately flicked down like a gnat in someone's ear. Raise your other hand if you've been in that place where every suggestion is met with either a "yeah, but. . " or some other trivializing comment that tells you in so many words to "take a damn seat and go with the status quo"--even when it's an idea worth trying.
I sure have. So, you know? I now know that I don't do so well in such situations. By the time I reached the end of residency, I knew that this would be an absolute need for whatever place signed me on as a faculty member. Room to build, man. And not just tables that welcomed me to sit at them as a leader but a climate open to me busting out my own tool kit with a team--and building some new tables.
Yep.
What I know is that some of the sexiest programs and hospitals--due to their sheer sexiness--don't really have to give a shit about you and your new ideas. They can just look at you or through you and then nudge your little idea to the back burner. No, worse than that. To the trivet behind the back burner where it will go bad and stagnant.
Do some big name places welcome innovative ideas from young faculty and trainees? You bet. But not all. And what I now know for sure is that the platinum pedestal isn't shiny enough to make up for a place that doesn't foster development of new ideas and initiatives from people other than the highest folks on the food chain. I was looking for a place where hard work and a growth mindset mean something--and where ideas are at least genuinely considered.
Do you have to go with all my harebrained schemes? Nope. But I sure appreciate someone listening long enough to think about it.
Need #5 A soft place to land and a place of redemption
Being a doctor is hard. Combine that with life and other factors and it can feel suffocating. Not having a place to turn beyond your peer group makes for some tough terrain. What I know for sure from doing this for this long is that we are all human and humans are guaranteed to get something wrong or not live up to what someone thought we would. The bible calls this "falling short" which always sounds better to me than "screwing up" don't you think?
Ha.
Either way. I want to know that if I do something and it isn't perfect or if I feel lost or lonely or burnt out or upset or overwhelmed or whatever. . . .that there will be somebody there in that hospital standing ready to support me. This is CRITICAL in residency and medical school. Without it, you can make it, yes. But it's exponentially harder and more unpleasant when you are fending for yourself.
I also know that sometimes things just aren't fair for people who look like me. I mean, it just is what it is. So one thing I always hope for is that there's someone fearless and fair high up on the food chain who isn't scared to go to bat or offer another chance should one be needed. And no. Not some hand out of a second chance. Just the same second chance afforded to everyone else.
#truth
Everybody knows that falling down isn't the issue. It's how we get back up again. Having somebody there to give you a ring of gold and redeem you sure as hell helps.
#realtalk
Need #6 Opportunities for growth and challenge--and mentors to help identify the right ones for you
Are you a researcher? Then a place with ongoing research and a track record of funding is definitely one step. But if there isn't room for you in the lab or a chance for you to get involved in something that fits for you? That's a problem. And just because U.S. News said some medical center is THE place for the thing that you were hoping to investigate, unless you have numbers 1 through 4 on this list, it's likely to be a pretty lumpy experience for you.
Yup.
Are you someone who wants to teach? The place for you needs to have the combination of teaching opportunities and mentors who are ready to show you the ropes. Ones that are involved in national organizations and regional meetings that can connect you to people and push you to the next level. Folks who've gone far enough to drop some chafe for you to pick up behind them. And who aren't so caught up in themselves that they only do things out of self interest--not YOU interest.
I should say that sexy places often have money and resources. And, honestly, opportunities do require resources. It's important to consider this--but not at the sacrifice of everything else.
Especially your sanity. Hello?
Here's a question: Are all the leaders at the place you're considering folks who've been in the position for seven thousand trillion years? Are things dynamic--in a good way? Are you interviewing with people who've been on faculty for 25+ years--but who are still at the Assistant Professor level? And for the underrepresented minorities and women, here's another question: Has there ever been a chief resident, chair, dean or program director that looks like you or that has the same number of X chromosomes as you? If you don't ask yourself that question, you should. Because chances are that you aren't the first talented woman/person-of-color to enter that place as of 2015. And you should wonder what's up with that.
Even if no one has noticed or considered it, you should. So if in 2015 you don't see any diversity in leadership? Or some history of it? Something IS up with that.
Yeah, I said it.
Look. I'm just saying--just maybe--no matter how sexy the place is--a homogenous leadership or leadership history just might be a red flag. Or at least a reddish one, depending upon what you have in mind for yourself. It could say something about the amount of opportunity there--just maybe. Especially if you don't fit the look of the homogeneity in the high ranks, nah mean?
Look, man. For somebody with leadership potential who's hungry to go further? This is a big deal. And for me, a black female with interest in such things, this was the case. Which is why this proved to be one of my 7 essential needs.
You feel me?
Need #7 High Expectations and Motivated Peers
Man. This is perhaps the most important one of all. Let me explain.
Okay, so check it. My parents expected SO much of us growing up. They had a fit when we brought home a 'B' in a class where our potential was an 'A' and they never shot down our dreams to try hard things. Expectation is a mighty motivator for young people. Over time, I began to realize it was something that, when absent, caused me to sag like a heavy load.
Yup.
They also put us in activities and challenged us with things in the presence of other kids who were striving to do well. The competition was healthy. Being an intellectual standout around those who don't challenge you can make anyone lazy or bored. And everyone knows that this never ends well.
Nope.
What else? Oh. Yes. With residency and medical school, people selectyou. I mean, sure, you somewhat have some say in it, too, depending upon how academically superstar-ish you are, but still. The sexiest programs have the most say. And the super-duper-sexy ones have even more say than the top percentile applicants.
Yeah, I said it.
And guess what? I'm also going to say this: Depending on the place, those academic superstars aren't immune from being tossed into a giant stack of nondescript high achievers on a roster. And given not much more than the gold star on their lapel that comes with being a member of the training program at "Sexy-everyone-thinks-it's-awesome Hospital."
Yeah, I said it.
See, just because you got straight A's and were a student leader and got on their radar doesn't guarantee that someone will be there interested in you on a daily basis, pushing you and recognizing your talent enough to expect something uniquely better from you year after year.
Did you catch that? Uniquely better.
That means they have see you. Then recognize your talents and consider you for things that might be a fit. It means checking in with you and seeing if you're following through on things and giving you a kick in the pants when you aren't. Without expectation, it can feel like no one ever knows how hard you're working or worse, they do know but don't care.
And look. Maintaining expectation is exhausting for clinician-educators and administrators. But, in my opinion, any program that isn't willing to work at this for each and every resident or student in their program or school? Well. It simply wasn't the one for me.
Nope.
So. There you have it. My seven essentials.
Oh. So what does this all mean? Well. It means that there are things far, far more important than being on the platinum pedestal "it program" list. It means that the gold star on your lapel as your only prize short changes you regardless of how dizzy with glee it makes everyone to say when asked about you.
Now. I do need to add this disclaimer:
I know some amazing, amazing human beings at sexy programs--or who trained in those sexy med schools and hospitals--who get all of this. They get that no matter what, every person--students and residents and young faculty included--want to know that someone is seeing them and being intentional about helping with their future. And no, it doesn't have to be everyone. But someone.
Someone.
So that brings it back to me and my experience. College was at Tuskegee University. I am proud of my alma mater, but would be lying if I told you that I've encountered scores and scores of fellow Tuskegee alums at my medical meetings--even all added up after nearly 15 years of going. Nope. As far as being pre-med goes, in the early 1990's when I was there, Tuskegee definitely was not a sexy pre-med choice. It was more of an engineering and pre-vet med place. But did it have #1 - #7? Damn right it did.
Next? Meharry Medical College. Teeny tiny. Historically black. And frustratingly the place that people either mispronounced or looked puzzled over when you told them that you went to medical school in Nashville but didn't attend Vanderbilt. Historic? Absolutely. Sexy? Meh. That said, I left there strong and a leader because of the nurture given to me in the form of #1 through #7.
Yep.
Then came that tricky residency choice. Did I have good interviews? You bet I did. And were a good bit of them sexy? Without question. But the place I chose was the county teaching hospital affiliate of Case Western Reserve University in Cleveland, Ohio--MetroHealth. Those who know Cleveland know that this isn't the "it" program in that city by a long shot. But once I knew what I really and truly needed to succeed and ultimately thrive, that didn't matter. MetroHealth in Cleveland, Ohio was my very first choice on my rank list--and I was delighted to open my envelope on match day and learn that I was among one of theirs, too.
And guess what? Three non-sexy choices later, here I am. Happy. Whole. Confident. And dare I say it? Pretty darn successful so far. I'm proud that these places all get credit.
The take home for any and every person reading this--especially medical students and pre-medical students--is this:
Know what's important. Don't be so caught up in a name or a brand or the reaction you get when mentioning a place that you ignore your own unique needs as an individual applicant. Don't be afraid to rank the place that feels right. You know, the one with the kind, empathic, and innovative program director in the city that you worried wasn't sexy enough or the program that is only sexy-ish. Fight the urge to count that place out. And please-- don't be tricked into thinking that, by definition, just because you performed at a high level academically that you shouldn't look into places that seem like they might have what you need in your #1 - #7--even if they aren't on THE (insert your favorite media source) Top Ten hospitals or programs.
*Eye roll*
Oh, and medical students who just matched? If for some reason you didn't get your first choice and ended up somewhere you didn't expect to get, please--for the love of God--don't show up like a wet noodle or assuming your life has ended. Don't arrive already plotting your transfer or repeatedly telling people about all that is better, shinier, sexier about the other four programs that didn't pick you. Instead, refocus your attitude. This could be the best thing that ever happened to you. Just because people don't wet their pants when you say where you're going doesn't mean it's not a great program. Look for the things in that list. Chances are, if the place has those things, it will work out great.
Take that from a Los Angeles native who spent five years in Cleveland, Ohio. And who has historically chosen places that garnered the other kind of eyebrow raises (amongst majority folks.)
Which brings me to the last point:
This was MY list of seven essential needs. While I do think that most of these are important to any and all people facing this step, maybe some don't. I would urge you to sit down and create your own list. Ponder what you need and push yourself to think of the abstract things that can't be found on program websites or your CV but that can guarantee misery if ignored or not considered.
For me those are:
Genuine interest in me
Permission to be authentic
Some people with whom I can identify (professionally, genotypically and phenotypically)
Openness to new ideas and vision
A soft place to land
Opportunities for growth
Great expectations
And you know what? Last time I checked, none of those were among the factors that get any place ranked number one on any lists.
But you know what? They should be.
That's all I've got. And hey, that's just how I feel.
***
Happy Sunday. (And congratulations on reading that entire ramble.)
Read this beautiful post yesterday by my friend and fellow blogger Elizabeth and felt my toe crunch. I needed that message. I heard some teenagers and tweens that I know saying that word--"retarded"--repeatedly under my earshot just recently. "OMG, that's so retarded!" and "Dude, stop acting like a retard!" One even mimicked what they thought that looked and sounded like just in case no one was clear on it. I knew them. And all of them, for certain, are great, kind young people. They are. But. They're kids. And to them, it's just simple slang, you know? Sigh.
Yeah.
See, what's worse is, I was totally in a position to say something but I shrunk because the mood was light and I talked myself out of it. Those teenagers all respect me and totally would have listened to me, too. Sure, it bothered me the second I heard it but I didn't say anything. And what's funny--or rather not funny--is had they been dropping f-bombs over and over again instead, I am 100% sure that I would have immediately shut that down. Even though the f-bomb is far less hurtful albeit less socially acceptable.
Yeah.
It was as if she wrote that post for me to read. And then my other friend Angella linked to it just to affirm that YES, I needed that message. To use the word properly, a teachable moment was retarded by my lack of vigilance and resolve to stick to my guns.
Yeah.
Hey. Thanks, Elizabeth, and especially Oliver, for reminding me to refuse to shrink and also to use my influence and power for good. It may seem first world to someone reading this. But I think if any of us still ourselves long enough to feel the sting of whatever word or words hurt us the most, it won't be for long. That's what Elizabeth and Oliver's message has done for me.
Here's a challenge:
Let's all commit to not using "retarded" or "retard" as a slang word. And even more, to speak up and let those who do use it know that it's not cool (just like Oliver does and Zachary did here.) That word is hurtful to many people even if it isn't meant that way. We can right this wrong. I know I'm recommitting myself today to doing better. Who else is in?
Read the post below and make your mark if you want to be down with the movement:
X______________________________________
Hey Elizabeth? Next time I vow to say, "F-that."
*************************************
Because "love" should be a verb and "retard" should never be a noun.
The room was filled with people. Seats all forward and facing the hanging screen that displayed the image from the LCD player. A youngish man stood at the front of the room, white coat starched to perfection, a tie that most certainly had the name of some fancy designer on the back, and shoes that appeared to be spit shined. Even though he lacked the grey hair of the endowed professors, he had the look that holds the attention of medical colleagues. Professionalism personified.
But beyond that, he knew what he was talking about, too. His slides were well done and cited all of the resources for the topic of discussion. For the majority of the presentation he wasn't even looking at the screen at all; he knew his stuff that well. And he was cool. No shaking hands or nervous throat clearing. Just one youngish doctor-dude standing at the front of the room with closely clipped nails gripped around a laser pointer. And this doctor-dude? He knew his stuff.
I, being a person who is enamored by excellent public speakers, felt myself wavering between actually listening to what he was teaching and how he was doing it. The clean slides with the clear diagrams. The cadence of his voice and the way he interacted with the audience. And then there was his chosen topic--an area that happened to be his expertise as well as one that is high yield for all of us. Not only was I learning something, I was enjoying it at the same time.
But then something happened. He turned a slide and things weren't configured as he'd expected. Of course, he was still cool as a fan. After trying to talk through the disjointed words and images any way, finally he stopped and knitted his brow in frustration. Then he said this:
"Sorry about that, guys. I prepared this on a Mac and these PCs can be so retarded when it comes to going between PowerPoint for Mac and Windows."
A few people chuckled in acknowledgment. The talk had been so good up until that point that no one seemed bothered.
"I'll move past that slide," he said with a shrug of his shoulders, "Sorry -- I should have checked compatibility before. I'm such a retard sometimes."
A ripple of gentle chuckles went through the room. And that was that.
The rest of his slides were fine, I guess, because I don't remember much else. Everything after that for me was just white noise.
In 2009, I helped lead a writing workshop with a group of colleagues at the Society of General Internal Medicine (SGIM) national meeting. The session was called "Writing and the Art of Medicine: From Personal Reflection to Publication" and included a breakout session where we actually spent time writing narratives. It was really well attended and I remember being pleasantly surprised by the number of people sitting at the round table with me during our breakout.
The task was simple. "I will give you a sheet of paper. You will write -- longhand -- for ten minutes about a pivotal moment or critical incident you've experienced that has taught you, moved you, or simply made you think. We will then share a few of the ones you've written." Straightforward enough, yes?
I recall that there were many beautifully written pieces. Important topics that we all, as physicians and medical students, could feel resonating in our souls. But there is only one narrative that I remember in full detail. Only one. The story was simple, really. It was written by a young woman who was a resident at the time and she'd spent her ten minutes describing two very clear images.
The first was her interactions with her nephew, to whom she appeared to be very, very close. As it turns out, he was born with an additional copy of chromosome #21 which most people recognize when they see. That's because trisomy 21 is the chromosomal abnormality responsible for Down Syndrome. Yes. Her nephew had some developmental delays and some mild to moderate mental retardation. But that's not what she described. Instead she painted a picture for us of him running recklessly on the front lawn chasing bubbles. Of him tackling her and covering her with his sloppy kisses. And of how much he loved classical music. So much so that whenever he heard it, he'd stop, close his eyes, and wave his fingers like a maestro.
Then she went to another scenario. Her in the hospital working on a ward team. The lab system had gone down for the day and her resident declared the system "retarded." Her co-intern had left his stethoscope on another floor and dubbed himself "a retard" for doing so. And the list went on. According to her, it had become the slang word of the month for that team. Anything imperfect or dysfunctional was referred to as "retarded." And the funny medical student with his perfect comic timing? He was "such a retard." But in the nicest, most endearing way, of course.
So she read her words in her quiet voice and I swear to you that you could have heard a pin drop. And at the end she simply told us that she never got around to saying how much that word stung each time she heard it from their mouths. How awful it made her feel to know that her nephew's life would be just a little bit harder because of that word. I never, ever forgot that.
I will admit that before that fateful moment in 2009, I'd never really "heard" that word. Surely I'd heard it at some point, but it had never created a nails-on-chalkboard effect for me or a visceral response in me either. But her words? They opened my eyes to something that I'd never thought about. An aspect of "the other side" that our patients and their families and their friends experience that even the ones that are supposed to be allies have completely overlooked.
Sigh.
So that man with his perfect PowerPoint presentation and his spectacularly white coat should have been an ally. But he hadn't heard that word either. And from the response he got from everyone in the room, it was business as usual. Which tells me that the majority sitting under his voice hadn't really learned to "hear" the word "retard" like that young resident writer had taught our breakout group to hear it that day.
(photo courtesy of Elizabeth Aquino)
My friend Elizabeth recently posted a photograph of her son, Oliver, speaking at "No Name-Calling Week" in 2010 at his school. I have posted that image above because seeing his young face holding that sign immediately brought me to tears. Just look at him. So brave. . .with that microphone in his face educating what was probably the entire student body. His sister, Sophie, has some special needs and also a severe form of epilepsy. But just like that sweet boy who was chasing bubbles, conducting music with this two index fingers, and freely giving out juicy kisses, there is more to Sophie than her disabilities. So, so much more.
See? Oliver knows that for sure. He lives it and breathes it. So he held that sign and shared his testimony because, for him and Sophie and his brother and his mother and every person who knows and loves Sophie, those words hit like a fist. I am thankful for him and for that picture because now, it hits like a fist for me, too.
Maybe from now on, it will for you, too.
I would make this a jumping point to reference that woman Ann Coulter who sent that tweet during the last presidential debate. You know -- the one that commended Governor Romney for going easy on "the retard." Or being polite or whatever the hell she said. Yeah. I would start unpacking about all of that, but some part of me wants to believe that perhaps she had not yet "heard" this word either.
That or I just don't have the energy to waste on that.
After that lecture, I pulled that colleague aside. I told him about the little boy with the bubbles and paid that story forward on behalf of his aunt. Even though I didn't know Elizabeth and her family back then, I suppose I paid it forward for them, too. In my least judging voice, I shared how that story had opened my eyes. I told him how much I had enjoyed his talk but that his use of the word "retarded" and then "retard" was hurtful and probably not the very best choice.
And you know what? That highly professional physician speaker put his hand on his chest and apologized. He didn't even realize that he'd said that word. And especially felt mortified that he'd said it not once but twice. And I said, "I totally understand because I hadn't really heard that word like that either but now that I do, it hurts to hear." He got it and thanked me. And I thanked him right back for being so understanding.
Today, I say thank you to that young woman whose first name -- Thalia -- I still remember. I have no idea where she is, but she changed me that day. I also say thank you to Oliver and Elizabeth, too. I am grateful to them for helping me to see that if we are going to commit ourselves to making love a verb, then retard should never be a noun.
Or a joke.
From here forward, I hope you'll hear that word differently, too.
That's all I've got for today.
***
Happy Tuesday. (Originally posted on 10/30/2012)
Well. Google is an amazing thing, y'all. I found a piece of Thalia's writing from an essay contest she won as a medical student in 2003. Read it here.It also turns out that Google can also help you find out where someone is now. This remarkable young woman is now a clinician educator on the Internal Medicine faculty at one of the Harvard hospitals. No surprise to hear that! I hope she's still telling that story. . .
I was sitting down doing some work in a quiet area at Grady today and this little girl, who was with her grandma, walked right up to me and touched my stethoscope. "Are you a doctor?" she asked me.
"I sure am," I replied.
"For real? Is it fun?"
"Fun?" I smiled and thought about it. "You know what? It is. It's a whole lot of fun."
"I can be a doctor, too."
"If I can you can. What's your name, sweetie?"
"My name is Pretty."
"Pretty?"
"Yep. And my middle name is Lady."
"Pretty Lady? Really? Is that your real name?"
She giggled and said, "Naww. But that's what everybody call me!" We both laughed and so did her grandma.
"Okay, little mama. Make sure you tell everybody to call you smart, too, okay?"
You know what Pretty Lady said to that?
"They ALREADY DO."
Boom.
***
Happy Tuesday. Again. And no, I don't make this stuff up.
I saw a patient who'd had a stroke. His ability to choose his words was ruthlessly robbed from him--and really that's about it. He could understand perfectly but everything he said came out garbled and super hard to understand. Which sucked.
Talking to him was really, really tough. He'd try and try but no one could make out what he was trying to communicate. That is, all but one word. One of his words came out clear as a clanging gong every single time I spoke to him.
What word, you ask? I'll tell you:
The F-bomb.
Yeah, baby.
Here's what I learned from our encounters: Even if you aren't much of a expletive-user, a lot can be expressed through a perfectly placed f-bomb.
Wet bed?
Annoyed by me turning on the overhead light?
Frustrated with being unable to find what you want to say?
Not happy with what's under the cafeteria tray?
Looking for your reading glasses under the covers?
Somebody IS the father on the Maury Povich show?
Need your family to know how you're doing?
Want somebody to know what you think of them?
Turns out that the f-bomb fits the bill. Like 99.2% of the time, man.
Ha.
I told him that his f-bomb was the best I'd ever heard, even better than my daddy's--which is saying a whole, whole lot. I also told him that he'd turned it into a universal word for any and all occasions. A noun, a verb, an adjective and even an adverb, man. Kind of like "smurf." And you know what? He got that dumb joke and just laughed and laughed at that. He tried to tell me I was funny, I think, but all that came out was the universal f-word instead.
Ha.
Then he pointed at me and tried to say something. I couldn't really understand so he tried again. When I still looked puzzled he finally just laughed out loud, shook his head, and threw up his hands.
"Fuck it!" he laughed. I laughed, too.
And all of this made me happy because his nurse told me that it was the first time she'd seen him laugh for his entire hospitalization. The first and only time.
Okay. So I can't sleep. Well, actually, I literally can't because I need to put something in the dryer that is in the washing machine right now that must be dry by morning. Either way, I'm up.
Yeah.
Okay, so check it. I want to pick your brains about this conversation my mom and I had while at the beach last week. To put it in context, I was reflecting to my mom about different experiences that I've had working with residents and medical students. "Emory is a place with smart people," I told my mom. "It's rare to work with someone who isn't really great. But some are just super great."
Mom shared that her experiences, though different as a former elementary educator, allowed her to relate to that. I went into the whole spiel that I give students on my team about being exceptional and ways to get closer to that and she listened intently. "Are they all exceptional after that?" she asked.
"I see a lot more. But sometimes, no. They do really, really well. But kind of stall at 'very good.' Which is still fine, you know?"
"So what's missing?" Mom said.
That's when the interesting part came up. We sat there staring at the waves rolling in and both thought for a few moments. I spoke first.
"I think to some degree you just have to be likable. Not so much ass-kissey. But there has to be the right mix of being cool with yourself and your surroundings that makes people enjoy being in your presence. Which sucks because some folks just aren't fully likable. Does that even make sense?" That's what I said to my mom and quickly she concurred.
"The real question is, 'How can a person become more likable if they aren't already?'" Mom said.
And yeah. The first thought in my head was, like, Steven Covey and Dale Carnegie and their books on this type of thing. I also thought about what I've always told myself is the magic to getting folks to like you is not giving a shit if people like you or not. Which, now that I think of it, is ridiculous. Of course you give a shit.
Don't you?
But I guess what I am up thinking about is just how the "giving a shit" manifests itself, you know? Like, the rule is that you aren't supposed to try hard to make anyone like you. That, I mostly agree with. But this whole concept of just sort of walking around with a virtual finger up at the world because you're "doing you" kind of backfires on a lot of people.
At least that's what I think.
Lord knows I've had my share of folks who don't like me. And, yeah, at certain points in my life it's really upset me. But I can honestly say that mostly I've found favor with people. So Mom and I talked and talked about this and tried to figure out what sorts of things work and what doesn't. We agreed that step one is always being cool with yourself but there still seems to be something more. Eventually we brought the question to my brother--a guy who really is one of the most likable dudes I've ever known--and he had a swift response.
"You have to be interested in people. Genuinely. And they have to know that."
Simple, right? But yeah, it is actually. It all makes sense. You have to be cool enough with yourself and not take yourself so seriously that you can't open yourself up to celebrating others. Or allowing yourself to be intrigued or--dare I say it--improved by other people.
Yeah. That. I think.
So I think I'm going to add that into my little talk on "how to be an exceptional medical student or resident on the wards." I mean it. Because the thing is . . . sometimes a person can work very, very hard but just because of some missing piece in the likability arena, that holds them back from the full embodiment of being perceived as such. The missing "like button."
Good Lord. Does this even make sense? Probably not.
So I guess I'm just thinking. And trying to find ways to push myself and those working with me to their personal best. This is super important with my students who have big life milestones that rely upon it, you know? I mean, if they work as hard as they possibly can but can't quite figure out how to win friends and influence people there will likely be more doors silently closing. Which stinks because they don't really slam. They just sort of gently shut without explanation.
Right. That. What I mean is. . . this isn't likable versus unlikable. It's more like likable versus nondescript maybe. Or like . . .some little thing niggling that makes folks feel like they can take or leave you. Or readily leave you, you know? Which is fine when you don't work with people or need people in your line of work to be successful. But for a lot of jobs, people deeply matter.
Most jobs even.
Anyways. What do you think? I mean, about likability? What makes you like someone? Can a person work at that? Should they? I'm just wondering.
I'm going to leave you with this--an excerpt from a note I received from a medical student who happens to be one that already liked very much before receiving this note. And yes, the note was flattering as hell. But mostly, the level of thought and reflection that went into it speaks volumes of this person's attention to other humankind.
You create this really cool balance between uniting and delineating. Yes, you occasionally allude to various differences in your life experiences that you attribute, in part, to the hue of your skin. You make it crystal clear that we are not all the same and that maybe only babies are “colorblind.” Maybe only babies should be colorblind. Pretending that we don’t notice the obvious differences staring us back in the face may be an injustice. And boring. And ignorant. You don’t paint an illusion that the grass is greener on your side. Rather, you share a reality that constructs this magnetic bridge thing that has all these people lined up wanting to cross. And yes, being black and being female are important components of the whole Dr. Manning. But I had been mistaken in thinking I wanted to pick your brain about just race. It was all of it. The whole. Also maybe I just wanted to say “I dig it.” Perhaps from your perspective, it is just you being you. But from my perspective, it stands out as uniquely badass.
You know what? I think I would have liked this just as much--maybe even more--if it weren't written to me. And yeah, I'm pretty sure that this is just how this person who wrote this is wired. But damn. Talk about a thoughtful string of words. Man. So I'm wondering. . . do you think something like this--this level of human interest--is learnable by all of us? And should we all be striving to watch, listen and learn from others and then quietly (or sometimes openly) deconstruct your observations to grow from them? Do you agree with what my brother said about this? Or does it all really just come down to having great hair, nice teeth and decent skin?
Ha.
Okay. There's my washing machine finishing up. Weigh in okay? Or go ahead and silently judge me for sounding crazy. Either way, the fact that you even bother to read this or any personal blog makes me like you already. Ha.
Anyone who is on social media quickly learned that today was "National Siblings Day" according to somebody. And look, I'm not even hating on it since I'm all for any chance to celebrate my brother and my sisters while I'm alive to do it. Heck, turns out I even posted about this alleged Sibling Day in the past since I had a label already for it. Chile, who knew?
Ha.
I guess technically yesterday was the official national sibling day since it's now past midnight. But you get the picture. Hmmm. That's actually a perfect segue for what's on my mind--the photograph above.
Mmmmm hmmm.
Okay, so check it. This photo was taken roughly 24 to 36 hours after Deanna passed away. We were sitting in Will's kitchen and, I'm not sure why, a camera was aimed at us and we decided that we weren't ready to be photographed without Deanna. So we weren't.
Nope.
That photo has become like the Mona Lisa to me. I mean it. I can study it for hours if given the chance. The more I look at it, the more I see. Sometimes I just study one face. Sometimes just our eyes. But most times, I look at each one of us and marvel at how accurately this photograph captures how we were coping during that time.
Yeah.
JoLai's eyes were wistful, wise, knowing. Her expression serious, but decidedly not morose. Her hand around me is protective. And I'd bet you my life that her other hand was firmly placed somewhere on Will. She is the baby sister, yes. But I learned during the time that she is perhaps the most protective of us all.
Will describes himself as "still in shock" when this photo was taken. He fought to be brave at first but then, through the love and support of so many people who came to his side, he'd learned by this point that it wasn't necessary. Maybe his eyes are the ones I study the most. Some days I see them as sad, forlorn. Other days I see them glimmering with an intentional fight to wrestle sorrow to the ground, proudly holding up his sister's photograph and proclaiming: "Love lives on. We win. Sorrow loses."
Yes. That.
I used to be bothered by the fact that I was smiling. Like, who does that? I'd always ask myself. Who freakin' smiles like that less than two days after losing her sister? Yeah. I used to feel self conscious about this picture for that reason. But I'm not anymore. Those who read here or who know me know that losing my sister was a life-changing spiritual walk for me. As crazy as it sounds, my soul had just opened up during that time. I'd prayed fervently during that time for peace that surpasses understanding. That is exactly how I was feeling in that moment. Weirdly peaceful. My mantra--"More glad than sad"-- blanketed me. Seeing how many people loved my sister and the outpouring of support for our family gave me solace. Plus, I knew that my Daddy was the one who usually handled logistics during times of loss in our family. When I prayed, I asked God to help me be able to do the things that he'd normally do. I'd need peace for that to happen. Which is precisely what I see when I look at myself on this photograph.
Yep.
Today I noticed some new things. I noticed the reflection of one of our closest family friends, Bert, taking the photo. How apropos that he's wearing a Tuskegee University shirt--the alma mater that all four Draper children have in common. Bert was one of Deanna's favorite people in the entire world. It makes me even happier that it was him. He's my brother's best friend. Now I will have a whole new set of thoughts when examining this photo next time with that in mind. We were looking at Bert. Will was looking at Bert.
Yeah.
Remember Bert? He's the one that took a shot of Jack Daniels in the pulpit while speaking about Deanna at her memorial service. To which my brother responded to with a standing ovation. Ha. To this day Harry says Bert's "shot heard all over the world" was quite possibly his favorite thing he's ever seen in his life and perhaps will still be at the very top of his top ten most awesome moments ever when he's an old man.
Ha.
The scarf covering us was one of the last ones Deanna had crocheted for me. Zachary's football team that year--his very first football team--was the Ducks and their colors were green and yellow just like the Oregon team. She'd made me that scarf to wear to Zack's games because he'd asked her to. Of course, Auntie did as her nephew asked. She never missed one of his games. Okay, maybe one weekday one. But if you ask Zachary? Never. I like that this is his memory, too.
I'm not sure how the scarf got all the way over from JoLai to Will. I don't recall there being a big production before that photo was taken either. It all just sort of happened. We came together. Someone grabbed her photo. And Bert captured a moment in time.
Yup.
I guess I especially love that the photo of Deanna that we are holding was a photo from a very happy day--my wedding day. She'd been so supportive and helpful. And she always had a special connection with Harry, too. Deanna had this way of making everyone feel at home and alright with being themselves. Her smile in this photo is genuinely happy. She liked this photograph of herself, too. I know that because she told me so. So I guess I like that, too.
Yeah.
So how did I spend my National Siblings Day? Well, I spent it in the most perfect way. First, my brother and I binge-watched on some television in the morning. Then we sat on the beach sipping margaritas, listening to music, and laughing out loud well into the evening. We looked on as our own children built memories near the ocean with their own siblings and silently celebrated through knowing glances that they, too, would know what we know: Life is better with siblings. It just is.
Yeah.
This song from the favorite band of all time of both Will and JoLai says it best so I'll leave it here:
Celebrate we will Because life is short but sweet for certain We're climbing two by two To be sure these days continue Things we cannot change.
Yes. That.
***
Happy day after Siblings Day.
"And the peace of God, which transcends all understanding,
will guard your hearts and your minds in Christ Jesus." - Phil. 4:7
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?
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