Blog | Thursday, July 27, 2017

Sixteen years


We wear the mask that grins and lies,
It hides our cheeks and shades our eyes,—
This debt we pay to human guile;
With torn and bleeding hearts we smile,
And mouth with myriad subtleties.

Why should the world be over-wise,
In counting all our tears and sighs?
Nay, let them only see us, while
… We wear the mask.

We smile, but, O great Christ, our cries
To thee from tortured souls arise.
We sing, but oh the clay is vile
Beneath our feet, and long the mile;
But let the world dream otherwise,
… We wear the mask!
—Paul Laurence Dunbar

We are drawn to Grady for its complexity. The people riding along in the struggle bus just hoping and praying to be seen. Seen by someone who cares for real and not just because caring seems like the cool thing to do this year. We want to be that person. We want to be the one who swoops in and helps.

Because this is what we do at Grady, right?

July 1 marked my 16th year as a Grady doctor. And in 16 years I've seen a lot. I've grown a lot, too. There are stories that I've heard that would break your heart into a million tiny pieces. Laughter garnered from my patients that would split your side in two and make you vow to cover your ears at all funny things for the rest of your days.

But.

Here is what I have especially learned: Those drawn into the doors of this place know not fully what she will offer to them. She changes you. Makes you believe in humanity again and recognize the similarities we share instead of the polarizing differences. Without asking for it, she gives you that. Freely. And those who are most eager for her lessons get the most frequent and most heaping helpings of them.

They do.

I saw something beautiful today. A patient felt broken. Sad and like their world had not really, truly been worth living. And no, not suicidal but more in this downward spiral. Life looked bleak. And, when I listened, it reminded me of the man who once told me that he felt like bugs were crawling all over his body. Once I leaned in and looked closer to him? He was right. There were bugs crawling all over his body. So sometimes? A bleak outlook on life is exactly what it is.

Bleak.

But here is the thing about Grady. From some of the hardest, coldest concrete lives, there is still life. And from it, if you stay long enough, you see a leaf shoots out of it. And then a tiny bud. It blooms into a rose. Fragrant, beautiful. And something about seeing that restores hope in the person who watered it, not believing for sure that it would ever become the flower it was designed to be.

Yeah.

So that? That is what I saw today. A patient was going through it. And that patient was honest about it. Said, “It is what it is--messed up.” Family who mostly isn't fully supportive. And the person who was supportive not living long enough to stay in your corner, pat your back and send you back into the ring when you get your mouth piece knocked out.

That is where we thought we came in. Us.The Grady doctors. With our listening ears and our hearts on our sleeves and our hearts that have just a little extra space inside for the least of these. Because, you know, that's what we do. Thinking all along that it's them who need us.

Except when you do this you learn. Especially after sixteen years. You learn that, really, people are all a little bit broken somewhere. Us included. And that kindness is kindness and empathy is empathy and that all of it is therapeutic whether you have several letters after your name and student loans on your credit report or not. Every one of us could use that balm for our weary souls in the form of another human being looking in your direction and offering affirmation. Especially when it's genuine.

I saw that happen today. At Grady, I did.

The patient was seen by a medical student on my team. And under that student's care that patient felt connected and safe. So, to this student, that patient shared a truth that had never been shared. A scary truth that doesn't perfectly fit into the box of “how to be” in the Bible Belt. And that student sat on a chair and held that patient's hand.

She sure did.

She listened and nodded and created a safer space than the patient had ever known. A student did this. Yes, a medical student. And it made this tremendous difference that will, I'm sure, lead to better outcome for this patient. I believe that it will.

So I come back in with the team to see the patient. And I do the things an attending physician is supposed to do, you know? I ask a few questions. I repeat a few parts of the story. I hold the patient's hand and let them know I am an extension of the care they've already received. And if the care hasn't been good? I am the place where that ends. Except, in this instance, it had been good. It had.

Yeah.

So I go over everything and it is good. This person who'd felt broken was feeling better. Motivated to fight hard as hell to get to the other side of complicated. And a lot of it had to do with this medical student who'd quietly slipped into that room with a tiny pad of paper and a very big heart. Peeled off the mask that the patient had worn for over half of a century. And it was as a amazing as it sounds.

It was.

But then something happened. That patient turned toward that student. Looked into her eyes and spoke words stronger than any healing salve in your grandmama's medicine cabinet. Trained those big brown eyes on hers and spoke of gratitude. But that isn't all that happened.

No, it is not.

See, this student also knew of the pain of wearing masks. That patient let it be known that this student and her transparency had provided the wings this patient would need to fly. And it was stated concretely, too. In front of that whole team. Me, the resident, the others on the team. And that patient said that because it was exactly what was deep down inside of their heart.

Sure was.

“Thank you for giving me the courage to speak the truth. I don't have to pretend I'm a mistake or the wrong person. I'm so proud of you,” the patient said to that student. “You are so brave. And I admire you so much for that. Seeing you be so strong makes me feel stronger, too.”

That is what that patient said. That.

Let me tell you—this? This was a magical moment. And another perfect reminder that we think we sign up to do the healing. Here we come in with our little bag of medicine tricks, believing that we have the panacea to whatever ails you. Or at least the brains to talk about it all.

But.

Like I said before we, too, are broken. We come to Grady for one thing. But we stay or keep coming back for something altogether different. Healing. Our healing. Opportunities to remove our own masks and walk upright. Souls being soothed by humankind and reminded of the very best of who we can be.

Grady gives that a thousand fold. Maybe even more ‘fold than that.

I know I'm totally rambling. I know.

Anyways.

Today was the very best of Grady Hospital personified. Underscoring yet again that the most important things we can give to our patients are never learned in medical school. We don't come needing to learn that critical piece—humanism. Instead, it is simply our job to fight to keep it intact. I think that what our patients most need from us are exactly the same things we need from other human beings, too. And when we both agree to remove those masks and share freely? It is a beautiful thing, man. It so very is.

That is what I saw today at Grady. And what I've witnessed for the last sixteen years.

And I'm thankful for that. Super, duper thankful.

Yeah.

Thank you, Grady for giving me sixteen fantastic years and for saving a piece of my life every day, too. And thank you to that brave medical student for being you. You know who you are.

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.