Tuesday, April 12, 2016
*details changed to protect anonymity (as always)
“Live while you got all your rhythm in your hips still, okay?”
If you looked at Mrs. Sanders' life, you'd count it a success. Five children, all of whom were mostly healthy and all of whom grew up to be gainfully employed with families of their own. More grandbabies than the fingers on two hands could count. And a marriage that had lasted more than 50 years. Yes. If you looked at her life, you'd use those spiritual words spoke often by the Grady elders for lives like hers, “blessed and highly favored.” Descriptors for lives filled with the things that matter the most.
Her health was good. Beyond some degenerative arthritis in her knees and some very mildly elevated blood pressure, Mrs. Sanders had very few medical problems. She could do for herself and was even still driving. Again, the kind of thing we all envision when wishing upon stars for our futures as senior citizens.
Mr. Sanders had passed on a few years before. Not necessarily suddenly, but it wasn't drawn out either. Just enough time to get things in order and to allow people to get to him and love on him. His death was surrounded by family and the aftermath of it all was mostly okay since it fit into the natural order of the rhythm of life. And, yes, losing him broke Mrs. Sanders' heart. But honestly, it didn't seem to break her.
So the point of telling you all of this is to say that this woman seemed to have a pretty peaceful life. It seemed to have followed the narrative that little girls act out with their Barbie dolls, you know? But every time I saw her, there was this sadness about her. Nothing overly somber or extraordinarily awful. Just this undercurrent of melancholia that cloaked the room whenever I was in her presence. And honestly I'd assumed it was all related to missing her husband. After all, they had been married for over fifty years. But truthfully, I'd known her before his passing and even before he'd gotten ill. And even then, I'd felt the same way.
“How are you?” I asked her toward the end of our visit.
“Am I?” Mrs. Sanders pointed at her chest to make sure she understood the question. I nodded. She released this weak chuckle and said, “I'm here.”
“Well, naw. Ain't nothing wrong, if that's what you mean. Guess I ain't sure what you mean, Miss Manning.”
I pressed my lips together and kept my eyes on hers for a beat. In that split second, I reflected on the time last year that I'd screened her for depression with a series of questions. She caught on to what I was doing and interrupted me. “I ain't depressed or nothing like that if that's what you gettin’ at.” And after I completed those questions, it became pretty apparent to me that she wasn't.
But still. Each time I felt it. And even if it didn't mean there was some pathology there, I really wanted to understand it.
“You know what, Mrs. Sanders? Sometimes when I see you, you seem like. . .I don't know. . .kind of sad-like.” Sad-like? I cringed at my own language. I sighed. “I don't know. It's hard for me to put my finger on.”
Mrs. Sanders offered me a warm smile and then reached out to touch my hand. “I ‘preciate your concern. I'm okay, baby.”
This time she squinted her eyes and smiled. The expression seemed to suggest I was naïve. I wasn't sure how to feel about that. Straightening up my spine, I trained my eyes on hers, making certain not to crack a smile in return. Her face became serious and pensive. Finally, she spoke.
“Miss Manning? How many kids you got?”
“And how long you been married?”
“How old your kids is?”
“Ma’am? Oh. Nine and ten. Boys.”
She pursed her lips when I said that last part. “Wheeewwwweeeee. Boys is something. Something indeed. They keep you busy, too.” Mrs. Sanders shook her head and then paused. It looked like she was trying to decide what to say next. Or whether what she wanted to say was worth saying to me. She blinked her eyes slowly, glanced down at her pocket book and then back at me again. Mrs. Sanders leaned her head sideways and asked me this: “What you do for fun?”
She caught me off guard with that. “For fun?” I let out a nervous chuckle.
“Better yet, for you. For your own self.”
“Umm. Well. I … I actually do lots of stuff for myself. I mean. … I do a lot for my family, too. But I do stuff for myself.”
“Good,” Mrs. Sanders replied quickly. “Good.”
I waited. I could tell she had more to say.
“My life been good, you know? But honestly, Miss Manning? I spent my whole life doing for everybody but me. Like, we got married when I was young and started having babies. And I stayed home with them and was near my sisters so we all saw ‘bout each others' kids, too. And my kids grew up to make me real, real proud. They good people. They got to do a lot of good things and I'm glad. But I guess the more time go by the more I realize I ain't never get no chance at nothing.”
“Tell me what you mean by that.”
“I mean. . .I ‘on't know. Guess I jest mean I ain't never been able to choose something that I wanted to do just ‘cause. Just ‘cause it's what I wanted to do or where I wanted to go. Seem like every decision was connected to somebody else needs or wants. And now I find myself wishing I had done some more stuff for me. For me.”
Mrs. Sanders eyes glistened with tears. She swallowed hard and cleared her throat after saying that. Then she looked slightly embarrassed for disclosing those thoughts. Or perhaps ashamed of uttering them aloud. That said, I could tell she was serious. And honestly? There wasn't much I could say to any of that. This woman was nearly eighty and had thought about this long and hard. I certainly didn't want to trivialize it all with some Pollyanna statement, particularly one that came across canned and void of empathy.
“I'm sorry.” That's all I could think to say. And I said that because I was sorry. Not sorry in that way I was when her husband of fifty two years went on to glory. But sorry nonetheless.
I could see how things had ended up this way. I mean, like her, I'm a mom and a wife, too. And in my mind I've always noted that those mothers and wives set on the highest pedestals are the most selfless. What's also weird is that it's hard to even realize that something is being denied of you, you know? Because everything you hear and see tells you that your definition of joy gets revised the day you become a mother and/or a spouse. And that this is what you were made to do and that this idea alone should be enough.
So yeah. I got it. I got what she was saying. I did. “It's not too late, Mrs. Sanders,” I finally said. “Your health is good. There are definitely things you could still do.”
“I know,” Mrs. Sanders replied. “I know. And I don't want to seem like some ol’ charity case that stay sad. I'm not. I do some stuff. But, see, what I can't have back is doing it as a younger woman. With curves and in high heels and with young woman sass. Young enough for people hold the door for you because they think they got a chance to court you, not jest ‘cause they got enough home training to respect their elders.” She gently laughed at her wittiness. I did, too.
“I get it,” I finally said.
“Do stuff, Miss Manning. See ‘bout them men of yours. But do stuff for you, too. Live while you got all your rhythm in your hips still, okay? I tells my daughters that. I do. Wish somebody had’a told me the same.”
“Yes, ma’am,” I whispered. Then I stuck it on a post-it note in my head for later.
Last week, I went to Paris, France. Despite my 45 years on earth, I'd never been. A college sorority sister took a job there this summer and inboxed me on Facebook a few months back urging me to come for the Semi de Paris--that is, the Paris Half Marathon. She explained that it sells out pretty quickly and encouraged me to “just sign up” and figure out the logistics later.
And so I did. Register, that is.
But honestly? I never truly considered going. I mean, not really. Sure, I'd registered for the race, but still. Could I really see myself going all the way to Europe for a race? One that wasn't connected to my kids or work? That answer was a solid no. It wasn't because I don't have support. Harry loved the idea of me running strong through cobblestoned streets and past historic landmarks. Especially in Paris, a city to which I'd never been. And I did, too.
I think I purchased that race number because I liked the idea of it more than anything else. Buying that registration would be affirmation that I really did consider going. Which, in a lot of ways, was nearly as significant to me.
A few weeks after I'd submitted my payment for the race, I was casually talking to my colleague-friend Ira S. With my feet kicked up on a chair in his office, I mentioned this opportunity to do this race in Paris and my friend living in France. He immediately began speaking as if there was no question about whether or not I planned to go. But Ira is different than me. He speaks other languages, has lived in other countries and is, in my mind, more worldly than me. Of course doing this would be a no brainer to him. But to me, it was simply a pie-in-the-sky notion. So I told him the truth. That there was no way I'd go thorough the hassle of getting all the way to Paris just for me to go and run some race. That is, one just for me and the experience.
Ira immediately began listing the litany of reasons that I should go. That life was for living and that if I tried as hard as I could and it didn't work out, that was one thing. But automatically counting myself out would be something I'd regret later. And you know? I inherently knew he was right.
Of course, I can't say that I never do anything. I've had some amazing experiences as an adult woman that called for an understanding and supportive spouse and some hands on deck from others. But nearly all of those things have been either local or stateside. Which means they could occur over a three day (or two and a half day) weekend. Nothing calling for a passport or acquaintance with another language. And I can't say that it was because of lack of opportunities. I think it was more lack of consideration, you know?
And so. I went. And from the moment those wheels went up and that plane rose into the heavens, I knew. I knew that it would be a pivotal experience and one that would enrich my life. And you know? It was amazing. Just. … yeah.
Another of our college sorority sisters routed a business trip from Barcelona through Paris to join us. And, in the end, we became three girls about town together. Feeling the pulse of the city, testing out our rudimentary French in cafes and on trains, window shopping and laughing so hard that we could hardly breathe. I'm so glad that I went.
So very glad.
For nearly the entire time, I thought of my family. But I also thought of me.
And you know what? I thought of Mrs. Sanders, too. I went a little harder, laughed a little louder, imagining myself as an octogenarian reflecting on this time. I sure did.
Look. I don't know all the answers. But what I do know is that my trip to Paris taught me that I really should push a bit outside of my pragmatic mom-work-wife life box some more. To put my own life experiences on the table for discussion. Especially the outlandish ones that require jumping through a bunch of hoops like this one did.
I hate that Mrs. Sanders has regrets. Because regrets suck. Even the little twinge-y ones that niggle at you when you know you should otherwise be happy with the hand you've been dealt. My guess is that Mrs. Sanders' narrative is one to which many women can relate. I feel honored that she trusted me with those feelings. I'm also grateful to Ira for helping me to picture myself as worthy of that experience in Paris.
When I see Mrs. Sanders again, I'll tell her of how she inspired me. And hopefully she can take solace in knowing that she helped another woman do at least one thing that she otherwise wouldn't have, and perhaps shielded her from some potential regret.
“Live while you got all your rhythm in your hips still, okay?”
—Mrs. Sanders, Grady elder.
Words to live by. And to live it up by, too.
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.
Contact ACP Internist
Send comments to ACP Internist staff at email@example.com.
- Patient-centered care, part 1
- Are GMO foods safe?
- Public health and citizens, truly united
- Improving patient experience-within reason
- Moving beyond the 0.05 P value
- Our slow motion pandemic
- Incentives and capabilities
- Protecting human subjects in medical research
- Fatness, affluence, adaptation, and hope
- One doctor's approach to the quantified self
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
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, 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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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)
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,
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
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.
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.
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.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.