Barriers to caring.

"She doesn't speak English," my resident said.
"Okay," I replied. "Let's call the interpreter and then go see another patient until they are ready for us."
"We can use the phone line or the video chat interpreters."

That's what the med student said. And honestly, it was a very good suggestion considering how busy we were that morning.

But.

See, I had never met this patient. And though I am deeply appreciative of the technology that affords us easy, prompt ways to close language barriers, whenever I can help it, I like everybody talking on that first meeting to have a pulse that I can feel.

Our Grady interpreters are so amazing. They have this way of melting away during a discussion and allowing you and your patient to really, truly connect. And again--sometimes I have no choice but to use the phone or video interpreter. On this day, though? I had a choice, man. I did.

Yep.

And so. With the help of Maria, one of our exceptional Spanish interpreters, I listened to the story of this patient. And not just the story of her present illness. The story of her life outside of the hospital. Of her six children who make her very, very proud. Of the tiny details of her symptoms that only come out when feeling unhurried. I also loved that her fluent-in-English son and daughter didn't have to interpret but instead got to sit there and just do what every single other family with a matriarch in the hospital l gets to do: Love their mama, ask their questions, and worry as only they can.

Yup.

The next day she felt better. And, again, I called that human-being interpreter even though the technology and bilingual family member options were readily available. And since she didn't feel sick anymore, this time I learned even more about my patient.

Here's what I learned:

We both have a spoiled labradoodle.
We both have danced all night at a wedding in Mexico City.
We both wish we'd worked harder in school to learn the native tongue of the other.
Neither of us like cheese. (Yuck.)

She's never been to my hometown so I told her all about southern California. I've never been to or even heard of hers so I listened to her paint a vibrant picture of her hometown in Mexico--a place with breathtaking waterfalls and rivers so blue they make you want to cry. "Agua turquesa!" she said with closed eyes for emphasis. Her kids nodded in agreement. Then her English-speaking son insisted that me and his mom Google image it right then and there. Which we did. And she was right--words didn't do those turquoise waters justice. No, they did not.

And I want you to know that that human-being interpreter shared everything we said word-for-word. And none of it took long but all of it made my patient feel better. Which made me feel better, too.

Here's what I know for sure:

Barriers to care can create barriers to caring. Every single time I call and wait for an interpreter to come, it honors my patient. Now more than ever, I want to do that. And though I (always) feel slightly annoyed with myself for being a Los Angelino who doesn't hablás español and though I'm (always) impatient with the time (no matter how short) I have to wait for the human-being interpreter to come, not one single time have I ever regretted it after the fact.

Nunca.


I'm really thankful for our interpreters at Grady.
***
#mejortrabajodelahistoria #elamoresloque #bestjobever #loveisthewhat #amazinggrady #iwanttogotosanluispotosinow #herhometownisdope #nowaterfallsininglewood

From from.

“Where are your people from? Maybe Mississippi or an island?” 

- India.Arie, “Brown Skin”

Grady elevator, July 4.

Him: “Hey doc.”
Me: “Hey there, sir.”
*silence*
Him: “Hey doc? Where you from?”
Me: “Me? I’m from California.”
Him: “No I meant like, where you FROM FROM.”
Me: “Ummmm. Born in Compton. Raised in Inglewood.” *holds up hand gesture* “West syeeeeeed.”

*laughter*

Him: *squints eyes* “But where your peoples from?”
Me: “Alabama.”
Him: “Alabama? So you just regular black? I was thinking you was something else.”

Me: *shrugs and smiles* “Nope.”
Him: *still pondering my ancestry*

*silence*

Me: “So tell me, friend. Where’re you from?”
Him: “Straight out the A. Vine City.”
Me: “Gotcha. Is that where you’re FROM FROM? Like, your peoples, too?”
Him: “Yep. I’m just a regular ass n*** from Atlanta.”

*silence*

Me: “So, why are you at Grady today on Firecracker day?”
Him: “To see my grandmama. She been real sick.”
Me: “I’m sorry to hear that. Are y’all close?”
Him: “She my heart.” *eyes glistening so looks down* “I see her every day.”
Me: “I bet she’s so glad to see you everyday.”
Him *nods and keeps looking down*

After that, I asked his name and told him mine. I told him that I thought his grandmama was a very lucky woman to have a special grandson who came to see her every single day. And then I reached my floor and the doors opened. I stepped out but then turned back to face him with my hand on the door.

Me: “Hey grandson? Can you do me and your grandmama a favor?”
Him: *looks up* “Yes, ma’am.”
Me: “Please don’t ever, ever refer to yourself as a ‘regular ass n***’ again, okay? Like, ever. Because you’re not.”
Him: *staring at me while I stand in the doorway as elevator buzzer starts going off*
Me: “Alright then, grandson. Go see ‘bout your heart. She waiting on you.”
Him: “Alright then, doc.”

Me: *smiling*
Him: *smiling back*

Both of us: *fist bump*

I love this place.❤️🏥

***
#slowtojudge #hewasspecial #peopleoftenaskwhereimfromfrom #butonlymyownpeopleask #itscooltho #totallycoolwithme #dialoguestarter #amazinggrady #loveisthewhat #alwaysandinallways

Thick as thieves.

Afternoon with a Grady elder:

Me: "I heard you had a lot of visitors today. I hate I missed them."
Her: "Yeah. It was mostly good."
Me: "Mostly?"
Her: "Mmmm hmmmm."

*silence while watching TV*

Her: "My granddaughter got upset with me."
Me: "Oh yeah? Why?"
Her: "She say I ain't got no business laughing at the TV or at anything else when so much serious stuff happening with my body. She don't like me to be talking about or thinking about anything that ain't concerning my health. She feel like I shouldn't do that."

Me: *just listening*

Her: "Here's what happened: My granddaughter came in here with her friend and her friend just cut her hair all down with some clippers into one of these little afro hairstyles." *pats her head to make sure I understand*
Me: "Wait--what does that have to do with. . ."
Her: "'Cause it look a mess." *laughing hard and smacking the cover in front of her* "Oh Lord. Not cute on her at all. Bless her heart."

*laughter*

Me: "Now that's cold. Did she ask your opinion about her hair?"
Her: "When she came up in my room she did." *laughing even louder*
Me: *shaking my head and trying not to laugh*
Her: "And 'fore you say I got hate in my heart for being black it ain't that neither. Some of these little naturals look real nice. I just don't like it when somebody go and cut they hair off and don't do nothing. Just show up looking like somebody bad ass grandson."

*laughter*

Her: "I want you to pick it or put some pomade in it or somethin'!"
Me: *laughing*
Her: "And then you act like since it's a afro I can't say nothing. That's where you wrong."

*more laughter*

Her: *now serious* "But that ain't what made her mad. It was just that I could laugh period."
Me: "I see."
Her: "And I tried to tell her--'Baby, even when sad and heavy stuff happen 'round you, it don't erase the happy and light stuff.'"

Me: *staring at her*

Her: "Like, if you lose your wife, right? I can tell you I'm sorry and mean it. And then if your little next door neighbor come over and borrow a cup of sugar but want to tell you a joke he heard in school that day, I got it in me to laugh at it."

Me: *still listening*

Her: "I can be sad 'bout your wife and laugh at that joke, too. And it don't make me no less sad 'bout your predicament neither. 'Cawse, see, I think happy and sad--they thick as thieves. So I go on and let 'em live in harmony."

*silence*

Me: "I wish I could record this to play back to myself later."
Her: "Naw. You a good listener. When you listen good, you catch it all."

*silence*

Her: "I don't want nobody turning on they sad on my account. Just be you. If you see me and you feel sad, then be that. But if somewhere in there you got some glad in you, don't go pushing it down on accounta me."
Me: "I love this. Thank you--for real."
Her: "Bet it don't even make sense."

*suddenly I want to cry*

Me: "The thing is. . . it makes so much sense that it makes me want to cry."
Her: "Cry?" *laughing* "Why you want to go and do that?"
Me: "I just feel guilty sometimes. When I feel sad and happy at the same time."
Her: "Don't. Your heart would go crazy if it had to just be one of those all the time."

*silence*

Me: "Do you feel sad about everything sometimes?"
Her: "Sure I do. Sometimes I be in here crying, too."
Me: "You do?"
Her: "Wouldn't you?"

*silence*

Her: "But look here. . . .if you seent that hairdo on that child? Whoooo weeee. You woulda laughed, too. Shit, maybe even cried."

*collective laughter*

Sigh.

My patient was right. I DID listen. And I caught it all. 

Happy and sad are thick as thieves.
And, like her,  I've made up my mind to just let them live.

Yeah.

***
#agoodword #gradyeldersrule #thickasthieves #amazinggrady #loveisthewhat #lettherebelight #andlightenTFupwhileyouatit

The town crier.

"Let her cry. Let the tears fall down like rain." 

- Hootie and the Blowfish

I used to try my best not to cry in front of patients and families. In medical school and residency, I'd excuse myself abruptly and tear out of the room and into a hallway or a bathroom when I felt my eyes stinging. I knew that if I didn't, the volcano would erupt and my secret would be out: I'm a crier.

Yeah.

One day, I didn't make it. I broke down crying while giving some bad news. And you know? The world did not end. I held it together enough to speak in full sentences but, yeah, I cried. Hard, too. And I cried because I was talking about something worth crying about.

Yeah.

Somebody was losing their mama. And that mama was a good mama, too. A sweet, sweet mama. You could see it in the way they rallied around her and rubbed her cheeks and kissed her head. Those grown kids couldn't be objective. Love had them all myopic to how bad this all was.

But not me.

Today that happened to me again. Almost exactly as it did that time many, many years ago. And it happens to me just about every time that I am on the hospital service. I step into the circle of love as one of the only ones who can see. But when they let me in, I start to feel that love, too. I do believe in miracles just like they do. Still, I owe it to everyone to be honest. To tell what I know.

"I don't know what to do," the daughter said.
"I am here to help you be brave," I replied.

And then we both cried. Hard. And I'm crying again writing this.

I'm okay with it, though. When it doesn't hurt is the only time I'll worry. Until then, I'll continue to keep two tissues in my pocket just in case.

Yeah.

***
#thisisgrady #bestjobever #humanityliveshere #letitburn #myteamsawmecrytoo #andiwascoolwithit #amazinggrady #john13v35 #loveisthewhat

Question askers.

I love it when people have people. Like, when they are sick in the hospital and I come in to see them and there is a loved one there at the bedside? That's a good thing, man.

The ones that perk up when you walk in are my favorites. They have the steno pads with questions on them and read your badge then write down your name. These are the folks that ask the questions that the patient is too tired or too sleepy or too scared to ask. They keep you honest and on your toes.

And.

They point out those things that aren't life-threatening but are quality-of-life-threatening like:
"Can y'all do something about how dry his lips are?"

or

"Is there something prescription you can give her for those ashy elbows?"
or, my favorite this week:

"Miss Manning, can you PLEASE have somebody maybe from surgery come and see about fixing his outty?"

O_o

Um. You mean as in, the outty belly button that has been in such a state since Muhammad Ali was telling folks he wasn't fighting in no war?

Chile please.

Seriously though? I don't mind. Because seeing you at the bedside is right up there with seeing balloons, cards and flowers. It's a sign that somebody loves my patient. And somebody loving you is a positive prognostic indicator, man. You got a bunch of questions? That's cool. Bring it on.
That is, unless you start asking me about YOUR ashy elbows. Or YOUR outty belly button from 1965.

Then you got to go.

Good times, man.
***

Affection control.

Late afternoon rounds today

Me: "Hey there."
Patient: "Hey."
Me: "I just came back to check on you and--"

*notices another person in the bed*

Patient: "Oh we ain't doing nothing in here. We just cuddling." *pulls back cover* "See? We dressed."
Me: "Wow. Umm, okay. Soooo. . . that's like. . .uhhh. . . . . yeah."
Patient: *smacks lips* "You act like we in here hooking up!"
Me: "Ewww. Seriously?"

*laughter from both.*

Me: "Okay but for real. Y'all spooning in here is an infection risk. Soooo . . . .you have to get up out of this bed." *laughing and shaking my head*
Patient: "Awww man."
Me: "Sorry not sorry."
Patient: *pouts* "But that's my boo."

*laughter*

Me: "Well. Boo? You ain't got to go home but you got to get up out this bed I know that. Before the infectious disease team comes to get me."

*laughter*

Patient: *scowling as Boo gets out of the bed* "Miss Manning, you was probably a blocker back in the day wasn't you?"
Me: "Wait. A what?"

*laughter*

Me: *shaking my head* "Okay but for real. The bed is for the patient only, okay?"
Boo: "I got to leave anyway, babe."
Patient: "SEE, Miss Manning? You a BLOCKER."

*silence*

Me: "I'm sorry, I just threw up in my mouth a little bit."

*laughter*

I love this job.


***
#nospooning #idontmakethisstuffup #yourewelcomeinfectioncontrol

Fear of dogs.

When you came in, this problem was barking like a dog. It looked like one and behaved like one, too. A few tests later, it was confirmed to be just that. A dog.

Albeit not a very nice or well-behaved one.

This is the kind of dog that requires the help of expert dog tamers. And we have very good ones who stepped right in and made recommendations. Special tricks to acquiesce the gnashing teeth of this dog.

They say what to do and we do it. I am only the middleman. And you feel fine, mostly. So I come in to see you, do what the experts suggest, and not very much more. Which can sometimes be how it is with exotic breeds like yours.

“Has everything been explained to you?” I ask.

“It has,” you reply. I confirm by pressing you a bit with questions. Your understanding is accurate. Your exam unchanged. There is nothing to do.

“I was so scared I wouldn’t see you by yourself today,” you say. “Outside the team rounds.”
“I’m here,” I say. "I'm back, okay?"
You smile and your dry lips crack. “I'm glad.” The look on your face makes me feel glad, too.

And so. I sit beside you and lay my hand before yours. You reach for it and close your fingers. And then we just sit and hold hands. I listen to your thoughts. Hear about what makes you afraid. We talk about how you are scared of dogs. Real ones and metaphorical ones, too.

I'm not the dog whisperer and no, I don’t have all the answers. And, yes, I'll admit that I have fears of lions and tigers and bears—and, just like you, those cancer rabid dogs, too. But what I also know is this: Even though I’m not the expert, I am brave enough to hold your hand and face them with you. I am.

Or to at least show up and try.

Yeah.

***

This time.

*image shared with permission

I’ve passed you too many times to count in the last decade and a half. Our eyes always meet and the same thing happens. I wave my hand and say hello. And you offer a gentlemanly nod accompanied by a gesture for me to look at your collection of items for sale. I smile in response and, without fail, you say, “Maybe next time.”

Every. Single. Time.

This morning I woke up thinking of you. Recounting the hundreds of lunches that I’ve had that called for me to pass you and for us to have that same Groundhog Day-like exchange. I decided that today would be the day that I stopped and really, truly looked at what you were selling.

Yep.

I walked up slowly, to let you know I wasn’t in a hurry. And when you held out that flattened palm toward that rectangular cloth holding all of your goods, this time I halted, kneeled down, and gave it all a good, hard look. I asked you prices and questions. You were patient and answered each and every one.

“I like the copper bracelet but don’t have enough cash on me for it,” I said. “Maybe I could make a donation instead?”

You asked if I needed socks. Or perhaps some African oil? What about some shea butter? You didn’t want a handout. It was clear.

“What about you play me some music? And I pay for that?” I asked. You seemed to like this suggestion best of all.

And so you played. A sweet little ditty that I’d never heard before. But sweet all the same.

After that, I decided that I didn’t want us to be strangers anymore. I learned your name. You learned mine. I discovered that, like me, you love people more than you fear them and believe that we are all more alike than we are different. I found out that—no, you aren’t a Rastafarian from the West Indies. You are a bona fide ATLien—a Grady baby born and raised right in the heart of the 4th Ward. You’re a musician, an entrepreneur, a jewelry maker, a singer and, especially, a man who loves the pulse of a thriving city. You used to live in New York City for many years but found your way back home to Atlanta. You thought Dinkins could’ve done more as “the first brother mayor of NYC” and that Rudy Giuliani was decent but that he had no business running for President of these whole United States. Oh, and you like that Mayor Keisha Lance Bottoms is one of Atlanta’s own just like you.

Yep.

I bid you adieu and went to have some lunch after that. On the walk back, you gave me that same gallant nod and gestured to your spread. “Maybe next time, Dr. Kimberly,” you said this time.

“Yes, Mr. Harun,” I replied. “Maybe next time indeed.”

I love this place.

***
#amazinggrady #ilovepeople #objectsarecloserthantheyappear #loveisthewhat #iseeyou

Grandson.

“Where are your people from? Maybe Mississippi or an island?” 

- India.Arie, “Brown Skin”

______________________________

Grady elevator, July 4.

Him: “Hey doc.”
Me: “Hey there, sir.”

*silence*

Him: “Hey doc? Where you from?”
Me: “Me? I’m from California.”
Him: “No I meant like, where you FROM FROM.”
Me: “Ummmm. Born in Compton. Raised in Inglewood.” *holds up hand gesture* “West syeeeeeed.”

*laughter*

Him: *squints eyes* “But where your peoples from?”
Me: “Alabama.”
Him: “Alabama? So you just regular black? I was thinking you was something else.”

Me: *shrugs and smiles* “Nope.”
Him: *still pondering my ancestry*

Me: “So tell me, friend. Where’re you from?”
Him: “Straight out the A. Vine City.”
Me: “Gotcha. Is that where you’re FROM FROM? Like, your peoples, too?”
Him: “Yep. I’m just a regular ass n*** from Atlanta.”

*silence*

Me: “So, why are you at Grady today on Firecracker day?”
Him: “To see my grandmama. She been real sick.”
Me: “I’m sorry to hear that. Are y’all close?”
Him: “She my heart.” *eyes glistening so looks down* “I see her every day.”
Me: “I bet she’s so glad to see you everyday.”
Him *nods and keeps looking down*

After that, I asked his name and told him mine. I told him that I thought his grandmama was a very lucky woman to have a special grandson who came to see her every single day. And then I reached my floor and the doors opened. I stepped out but then turned back to face him with my hand on the door.

Me: “Hey grandson? Can you do me and your grandmama a favor?”
Him: *looks up* “Yes, ma’am.”
Me: “Please don’t ever, ever refer to yourself as a ‘regular ass n***’ again, okay? Like, ever. Because you’re not.”
Him: *staring at me while I stand in the doorway as elevator buzzer starts going off*
Me: “Alright then, grandson. Go see ‘bout your heart. She waiting on you.”
Him: “Alright then, doc.”
Me: *smiling*
Him: *smiling back*

Both of us: *fist bump*

I love this place.❤️🏥

***
#slowtojudge #hewasspecial #peopleoftenaskwhereimfromfrom #butonlymyownpeopleask #itscooltho #totallycoolwithme #dialoguestarter #amazinggrady #loveisthewhat #alwaysandinallways

Baby Daddy.

Him: "You got kids, Miss Manning?"
Me: "Yep. Two sons."
Him: "They grown? Like my age?"
Me: "Nah. Thirteen and eleven."
Him: *eyes widen* "Damn. Doctors be waiting to have they kids."
Me: "Ha. Some do. Some don't."

*silence*

Me: "You excited about being a dad?"
Him: "Very. But it scare me, too."
Me: "What part?"
Him: "Getting it right."

*silence*

Him: "Miss Manning? You think if you didn't have no good daddy, you can be one to your kid?"
Me: "I think there's a lot of good daddies who are the first good daddies in their family."
Him: "Kind of like the first to go to college, huh?"

*silence*

Him: "I just hope I got what it take to be a good daddy."
Me: "You do. You got love. And love is the what, man."
Him: "Take more than love."
Me: "It's a start though. That and showing up."
Him: "I can show up and love her. I can do that."
Me: "Good stuff, man."

*silence*

Him: "That's what your daddy did, huh?"
Me: "What?"
Him: "Showed up. And loved you. I can tell."
Me: *silence*


He changed the subject after that and just watched the TV. And I just sat there on the chair next to him. At first, I wanted to cry. But then I decided to go ahead and give thanks for the amazing father this young man will become.

Because he will. I claimed it.

Yeah.

***
#whynothim #hegotnext #loveisthewhat #amazinggrady #iprayformypatients #gooddadsrule #hewasrightaboutmine

Divine intervention.

A fist has hit your face. A strong hand has gripped your arm hard. Spit has flown from lips as they spewed forth words cursing you. And you took it day after day, year after year. Now your body is sick and growing older. The energy it took to be a crouching tiger from this hidden dragon is needed for other things. Except this is all you know. Or all that you've known for most of your adult life.

"God called me to this place. I am trusting Him." That is what you said to me when I asked about all of this. You explained it with such simplicity. Like, this was your lot in life. Your destiny of lumps that you would just have to take.

Like you had been taking for all this time.

When I explained that I worried about this and said I didn't believe love should hurt like this, your eyes filled with tears. When I told you that I knew it was complicated but we wanted to protect you, they fell. Onto your cheeks and in splashes on your blue hospital-issue gown.

We sat in silence for a bit. Then you squeezed my hand tight and said, "I'll be okay. I've made it this far. I will be okay. God's got me." You smiled. And when you did I saw your cheek quivering. But you nodded hard and sure. So brave and full of fight. You meant those words.

You did.

"No." That's all I said. Then I closed my hand tight over yours, shook my head and clamped down hard. "No."

And you understood what I meant. That this idea of you fighting this old fight and this new fight at the same time was not going to happen. Even if it was super complex and lumpy and scary. We can't unhear it. I can't unknow it.

I can't.

I gave you a hug before walking out of your room. And you hugged me right back. You sure did.
I didn't say anything more after that. But I hope that hug conveyed what was on my heart.

I recognize that you are scared and respect that you believe that God has called you to this place. But I need you to remember something, okay? Just maybe He called me to this place, too.

I will do my best to fight with you. I will.


Yeah.

***
Happy Monday.

Rules of Intern Year.

10 Rules of Intern Year

1. Show up.

2. Do your best.

3. Listen to the nurses. 

4. Don’t lie.

5. Put the patient first. 

6. Do fun stuff when you’re off.

7. Cry when you need to. 

8. Laugh out loud when you need to.

9. Eat lunch and take the stairs. 

10. Care like it’s yo’ mama.

July 1. One day down, 364 to go. You’ve got this, interns. And we’ve got you. Let’s get it! 👊🏽🏥 #gohardest #bespecial #carelikeitsyomama #youarereadierthanyouthink