Monday, September 19, 2016
You didn't quit smoking. Nope. Not even after that big, long, drawn out discussion we'd had about you setting the perfect quit day. ”Juneteenth!” you announced with a big, loud laugh. You banged your hand on the desk and clapped your hands after. I typed it right into the chart when you did:
QUIT DATE: JUNE 19, 2016
Then you added, “Perfect, ain't it? The day of emancipation, right?” And I nodded my head in acknowledgement, loving the idea of you being freed of the nicotine stronghold on the very day that our people came up from under the dark cloud of slavery.
“That day sounds perfect,” I replied. And I said that because it was true.
But sadly that day came and went. And you didn't quit. Nope.
Your blood pressure was high today, too. You promised that you'd take your blood pressure pills but when I looked into the pharmacy history, you hadn't picked up a refill for two full months.
342. That was your blood sugar reading on the finger stick today. Which meant that you probably weren't taking you insulin either. (Even though you'd promised you would.)
And last was your weight. Your chief concern at the last visit was losing weight and quitting smoking. We'd talked and talked and talked all about it and you sounded so ready. So ready. Together we identified some simple tweaks that could be made to help you shed pounds and, I have to admit, I was just as excited as you.
But that didn't work out either. Instead of dropping a few pounds, you gained nearly 10. 9.73 to be exact. Which didn't fit the gameplan we'd discussed. At all.
So yeah. Essentially none of what was supposed to happen happened. And honestly, I'd be lying if I said that some piece of it wasn't frustrating because it was.
Yeah, it was.
And so. I creaked open the clinic room door to come see you. The undeniable scent of cigarette smoke wafted into my nostrils the very moment I stepped inside; it had found a crevice of every part of that room. I coached myself to not be disappointed in you. To not feel like you'd hoodwinked and bamboozled me into believing that this visit would be some celebratory party where I fist bumped you for your big emancipation from cigarettes and unhealthy foods. Yeah.
“Good morning,” I started. I took the seat across from you and smiled. Trying my best to not sound condescending, I added, “It's good to see you.”
I was kind of tired that morning. Isaiah had forgotten to tell me about a homework assignment he had until the very last minute which forced a late night/early morning kitchen table science combination. Zachary couldn't find his shoe and seemed hell bent on wearing only the pair that had the missing mate. Our dog decided he'd tear up a throw pillow overnight. And I'd run out of creamer that morning so had to drink black coffee which I did but did not enjoy 1 bit.
So yeah. I'd hoped for some good news from you.
“I didn't quit, you know.”
I sighed and leaned my face into my hand. “Yeah. I know.”
“I gained some weight, too. Even though I ain't had much of a appetite. I just ain't been doing so good.” Your mouth twisted when you said that and I could have sworn I saw tears glistening in the corners of your eyes.
“What do you mean by that? By ’ain't doing so good?’”
That's when those tears became undeniable, spilling over your lashes and onto your cheeks. You offered a lopsided shrug in response. And this? This was different for you. Normally you were chipper and full of happy spunk. And even though I was not so thrilled about your failure to clear the hurdles we'd pinky sworn upon, at minimum, I'd expected some funny one-liner about why it didn't happen. But not this. Not tears.
And so. I just waited. I touched your forearm and waited.
“Remember my grandson? The one who was staying with me?”
I thought for a moment and then remembered him from a visit once. He'd driven his grandmother to the clinic one day and seemed rather unhappy about having to sit in on a discussion of antihypertensives and insulin. “I do.”
“Well, he … he … “ You couldn't finish. Instead you just dropped you head into your hands and wept hard. Your ample bosom shook rhythmically along with your fleshy arms.
“Oh my goodness, did he get hurt? Is he, is he alive?” My hands covered my mouth immediately after I said that. I hated to be so direct but I'd worked at Grady Hospital long enough to know that it was a fair question. Your home address was in a rough part of town and that grandson was in your custody after drugs left his mother unfindable and incapable of raising him. The same streets that took his mama, though, preyed upon him, too. And you knew that. You'd lamented about your concerns of him selling drugs on corners and getting mixed up with the wrong crowds. So yeah. That question wasn't unreasonable.
“He got locked up. Caught a murder charge. He gone, Miss Manning. He might as well be dead. He gone for his whole life. And he ain't but nineteen.”
I felt my eyes throbbing with tears. I puckered my lips outward and swallowed hard to try to keep myself from crying, too. It didn't work. “I'm sorry,” I whispered. The tears splashed disappeared under my chin before I could wipe them away.
“Me, too,” you murmured back.
And that was it. We didn't utter another word about you blood pressure or your smoking or your blood sugars or your weight. We just sort of sat there and felt the enormity of how hard this life can be sometimes and pushed all of the rest of it to the back burner. And yes. Your blood pressure and weight and blood sugar are important. But your emotional well-being is, too. You'd lost your baby boy after losing the baby girl who made him. Your aging soul didn't deserve this pain. The streets were winning 2-0, which meant you were 0 for 2.
Later that day I thought of you. Thought of your grandson and the significance of his age--19--and that date you'd so cheerfully chosen for your quit date, June 19 or, as you said it, ”Juneteenth.” That number was supposed to be a happy one, representing freedom and a brand new day. Instead, it turned out to be symbolic of pain.
I hated that.
Here's what you taught me, though. That sometimes even when there is some pressing shit to discuss, something else more pressing should take precedent. And that sometimes the reasons that people don't follow through on things is because they physically and emotionally cannot. That slowing down and paying attention to souls matters more than slapping wrists for missing marks.
This lesson is one I need in all aspects of my life. So thank you, my friend. And know that this morning I am quietly weeping into my coffee and holding your hand. Feeling sad that nineteen hurts for you and wishing there was something I could do to fix it all. Like offer you some kind of Juneteenth to rescue you, your baby boy and his mama from the shackles of your reality.
“Let's talk about all of that other stuff next time, okay?”
“I'd appreciate that,” you replied.
I realize now that I appreciated it, 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.
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