American College of Physicians: Internal Medicine — Doctors for Adults ®

Thursday, November 12, 2015

The miracle workers

“Oh, if you were like me
You didn't have a lot of gold
Possessions or money
You didn't own wealth untold

But I'm glad
You didn't look on the things that I had
But you looked on the things you were able to give me.”
—CeCe Winans, “In Return”

I saw this woman once in clinic. It was December and she'd caught 2 buses to reach us just to get her blood pressure checked and to get her medication refills. And at the end of that visit we were talking about the holidays and such and she let me know that Christmas used to be her favorite but now wasn't. And I won't belabor this with some elaborate tale but instead will go ahead and cut right to the predictable chase and let you know that it had to do with her financial situation. She had an 11-year-old daughter and a 9-year-old son who wouldn't get a single gift because she couldn't afford it.


But they had food and a warm home, you know? And she seemed cool with all of that. Like, she wasn't all super melancholy or mad dramatic about it. It just was what it was. And even that—the fact that this was her normal and clearly she'd figured out how to navigate it—isn't the point. I really tell you this to tell you about something else that happened after this encounter.


And let me just preface this by saying that what happened after that encounter wasn't exotic or unusual at all. Instead it was something that happens on a daily basis in hospitals like Grady all over the country.


I called our social worker. And all I did was tell her about this woman and her situation. Then, like our social workers do, she came over to the patient and sat down and spent time finding out her situation. Next thing I knew, some community resources were identified that happened to service the area right where my patient lived. And they were willing and also able to help this woman give her kids just a little bit of magic on Christmas morning.


It was short notice. We were like 3 days shy of Christmas, so that social worker went to wherever she got those resources, retrieved some gift cards and personally went out and bought things for those children herself. Then she delivered it to my patient's home along with some stuff for her to present it to her kids as gifts.

She sure did.

A man I cared for on the hospital service had been ill and was estranged from his family due to a multi-year drug stronghold. He'd been unstably housed and mostly on his own or in the streets. But this illness was serious and sidelined him in that way that no one ever wants to be sidelined. “Where are your people?” I asked. And I asked that because in a place like Georgia everyone has “people.” Or even “peoples” as some folks say. Anyway. This man said he did have people but that he didn't know where they were or how to reach them. The names were patched all together in a ragged little tapestry that fractured into pieces the minute any of us tried to pull it all together.


Then I told the social worker. And that social worker stepped in and got to work. And if you work at a place like Grady or have had any contact with a great and dedicated social worker, you know that there is no need to even say “spoiler alert” before anything else. She found that man's people. And his peoples, too. And those folks were worried and glad and thankful to be able to come to the side of their family member during that time.


Finding somebody's people or peoples may not seem like a big deal to you but it is. And when things like drug addiction and untreated mental health issues and time stand as looming barriers, many times it's a downright miracle when those pieces get put together. And even more of a miracle when something right and good happens as a result.

But this—these sorts of ordinary miracles—happen every single day at Grady. And in this moment I am reflecting on our social workers, the miracle workers who open the doors and windows that have been painted shut for so many for so long. I cannot do what I do without them. The obstacles are too great; my caring alone is not enough.

Earlier this month, one of my favorite Grady social workers of all time died. She fell ill swiftly and was gone in the twinkling of an eye. And when I heard the news it truly broke a piece of my heart. Truly, it did. Because she was my friend. Or rather, we were very friendly. And I realized that I loved her. And no, not in the eros sense but something different. More like some hybrid between the brother-sisterly philos love and the nebulous agape-type love that one experiences spiritually. Somewhere in my deep appreciation for the selfless contributions of every single social worker I've known through the years, my heart felt a particular sadness at this loss because of that love.

Yes. That.

She, Mrs. Veronica Smallwood, was a wonderful human being. Let me not trivialize that piece. But no, she was not the social worker involved in those 2 aforementioned encounters. That said, in countless other ways she was.

Does that even make sense? I know. I'm probably rambling.

Either way, I'm feeling this weird mixture of sorrow and deep, deep gratitude. It's hard to explain, but I'm trying.

And so. To honor her life, today I honor her peoples—the social workers like her. The selfless legion of women and men who stand ready to help people find soft places to land. The ones who navigate the red tape of socioeconomic speed breakers and mysterious Medicare rules and nefarious nursing home situations. The fearless servant leaders who run into the burning houses armed with nothing more than clipboards and willing hearts and who, on my watch, are often the ones who pull the screaming baby or decrepit elder from the asphyxiating plumes of black smoke before anyone else. Just in the nick of time. Yet so interestingly they quietly hand them over to someone else just in time for them to get the glory.

That last sentence just brought tears to my eyes. Because it is so, so true.


Mrs. Veronica Smallwood and her peoples have helped me help others more times than I can count. Surely I could fill an entire blog up with daily tales of these very moments like the two above. I could fill one book alone with just stories of things Mrs. Smallwood specifically did to assist my care of patients for the last fifteen years. I surely could. And I am deeply grateful for it all. I am.

You know? I told Veronica how much I appreciated her every single time I called her or saw her. Not because I foresaw this, but just because it was how I felt and she always gave me space to be honest. I take some solace in that. I do. But I guess today, I felt the need to go and tell it on the mountain. Not just how thankful I am for Mrs. Smallwood, but instead putting a bullhorn to my lips to shout to the world who the real miracle workers are in a place like Grady. In a place dedicated to serving the undeserved? It's them. The ones stealthily making dollars out of fifteen cents day after day after day and leaping from often dilapidated buildings in a single bound--the social workers.

The bible says, “The greatest among you will be your servant.” (Matt 23:11.)

Yes. That.

That. That. That.



Happy Wednesday. And thank you for being the greatest among us at Grady, Mrs. Smallwood. You will be missed. And today you are remembered.

*And shout out to Mrs. Valerie Beaseley and Mrs. Dorothy Zimmer, respectively, the 2 miracle workers who made things happen in the two 100% true stories above.

Now playing on my mental iPod, for you and all of your peoples, Mrs. Smallwood. “In Return” as sung by the matchless CeCe Winans. Perfect lyrics for the ones who bless our patients every day at Grady and ask for nothing in return.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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