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

Tuesday, December 1, 2015

Go hard or go home

“My grandmother swears up and down that somehow I got dropped on my head.” She laughed and shook her head. “Like it had to be some kind of explanation for me being like this.”

Since she'd chuckled first, she gave me the green light to laugh, too. “When did you first know?” I asked.

“I don't remember ever not knowing. And if they'd just stopped ignoring what was right in front of them, my granny and them woulda known, too.”

She pushed down hard on the bed and scooched her bottom back. Then she reached for her cell phone on the tray table, turned on the camera and changed the direction so that she could use it as a mirror. The minute she saw her face, she shook her head and shuddered.

“I look a hot ass mess.”

“You've been sick.”

“Still, chile. I look crazy.”

I leaned back in the chair and watched as she pulled the screen close to her face to study her eyes. The false eyelashes she'd been wearing when she arrived at the hospital were half on and half off. First she tried pressing them back down with her thumb a few times, then groaned. “Uggggh!”

Her biceps bulged out when she lifted her slight arms. That and her voice were probably the only immediate signs that she was born with a Y chromosome. And yes, perhaps her square jaw could be a clue, but mostly she was delicate and feminine. Perhaps more so than many genotypic females I know.

“Your lashes lasted a whole lot longer than the ones I've had before. I just wore some recently and they made me crazy.”

“You got to use the right glue and get ‘em in the right place. Honey, but these here? These thangs can't be saved.” With both hands she gripped the edges of each lash between her thumb and index finger and zipped them off of her eye lids simultaneously. “Oh well! I'm still cute!” She threw her head back and let out a raspy laugh and coughed a bit. I nodded my head in affirmation.

After that, we both just sat there for a beat, saying nothing. My eyes rested on the almost cartoonish eyelashes that lay on the blanket before her. They were so big, bold and unmistakable. A clear declaration saying, “I am here. And screw you if you don't like it.” I decided that I liked that. My eyes came back up and met hers. We both smiled.

“You know … you're doing so much better, Ms. Nika. I think we can probably discharge you this morning if your labs look good.”

“Hmmm. Okay. Let me work on some things then.”

“Do you have a place to go?”

“Me? I mean, not exactly yet. But I always make it happen. I always do what I got to do to survive.”

I paused when she said that, not knowing what to say. Instead I just twisted my mouth and waited to see if she had more to add. Instead of expounding on her living situation, she yawned with both arms outstretched and went back to our original conversation.

“I used to have this little backpack when I was like 4 or 5. It was light blue and it had trucks on it. My granny got it for me to take to pre-school or kindergarten or something like that. And you know? I used to hold it on my forearm like a pocket book. And I had some Vaseline and ChapStick and would pretend like it was makeup.”

“When you were 5?”

“Or younger. I just always was like this. Not just a girl. A lady, you know? From even when I was little. So I spent my whole life just trying my hardest to do me. And be me.”

“Makes sense. That's bold.”

“Bold? Meh. Mostly it's just fucked up. Because you get kicked out of the house and then you find people who act like they accept you. Some, I mean a few, really do. Some just think you're funny and interesting like some kind of movie when it's your life.”

I swallowed hard on that part because I wondered where I fell. Immediately I felt bad for saying such a cookie-cutter statement about being “bold.” Even though I believed she was.

“That's deep.” That's what I said since that's all I could think to say.

“I see, like, regular females walking around sometimes and think, You don't even appreciate it. Like you don't appreciate being a lady. You know what I'm saying? Walking around in sweatpants and T-shirts. Or clothes that don't fit good. I saw this 1 girl who I could tell had a great body and felt mad. She looked all frumpy and crazy. Like, how this chick get to be a girl from the start and treat it like this?”

I'd never even thought of that. Quickly I imagined the sweats and UGG boots I'd worn to run errands the day before. This was a new perspective, even if I wasn't sure what to do with it. Either way, I love it when my patients give me new things to think about.

Ms. Nika went on. “People think they know but they don't. Like, they see me with my girlfriends and we all laughing and ki-ki-ing with our heels on and our lashes. We strutting hard and serving side eyes and slaying it and the people who ain't in our world they just stand by and stare. Like we some kind of aliens. But, see, when this is your world? Like, when you make your mind up to dress like who you know you been in your heart since you was little and be like what you feel inside? You go all the way. At least, I see it like that.”

“I get it.”

“Like, go hard or go the fuck home, you know? And then when folks looking all hard at you and saying dumb shit like, ‘That's really a dude,’ I just sashay even harder. ‘Cause they don't even know that me still looking like a boy but dressed like a girl still look and feel a million times better to me than dressing like a boy and feeling like a girl. Even when I can't get meds, you know, hormones and you can see a little bit of hair on my face, that's better than … it's better than … “

“The alternative?” I interjected.

“Yes. That. Anything is better than that. So it's not that it's so brave or so bold or whatever. It's just what I have to do to live and feel alive. Do that even make sense?”

I felt my eyes welling up. Partly because I felt so tremendously grateful for her transparency. But mostly because it did make sense. Being authentic was like oxygen for her. And the more I thought about what parts of my life I love the most, I realized that being my true self was always a part of it.


“Now, Dr. Mannings. What you up in here crying for?”

She reached for my hand and I let her. Right away I noticed her long acrylic nails and how they contrasted my short, square unpolished manicure. It made my eyes sting more.

I tried to say something but nothing came out. So I just shrugged. Finally, I eked out a few words. “You're beautiful.

And that? That made her cry. Which made me cry for real.


And so we just sat there holding hands, sniffling and not saying much else. Not even fully sure why we both felt so emotional but deciding to just roll with it (like ladies often do.)


You know? I'm not even sure why I felt the need to write about this today. But you know? I'm just so astounded by the many facets of humankind and how much people have to teach one another. I'm so grateful to Ms. Nika for letting me in a little. I will never see a transgender person the same way again.

I won't.

For the rest of that week, I wore a bold red lip. Kind of as an homage to Ms. Nika. And every time someone commented to me about it, I gave a knowing smile. But really in my head I was saying, “Go hard or go the fuck home, you know?”


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.

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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.

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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.

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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.

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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.

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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.

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PLoS Blog
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One of the most popular anonymous blogs written by an emergency room physician.

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