Blog | Monday, April 8, 2019

The little girl who didn't cry wolf


Your chest was hurting. This was your chief complaint. “Like pressure,” you'd said. Then you shook your head and closed your eyes. Your hand pushed into the center of your chest for emphasis.

I asked what you were doing when it came on. You shrugged and insisted that it was nothing out of the usual. Then you scratched your shoulder vigorously. The suddenness of the gesture startled me.

“You okay?” I asked.

“Yeah,” you said. “I just be itching sometimes.”

I nodded. And then went back to the discussion.

Pressure like chest pain at rest that made you miserable enough to come to the emergency department. A little bit of shortness of breath. But not much. No numbness or tingling in your arms. You weren't exerting yourself in any way.

Nope.

And yeah. You USED to use crack. But not anymore. You were adamant.

“I fell to my knees,” you said. “I was so tired, Miss Manning. I fell to my needs and asked God please. Please take this stronghold away from me.”

I kept listening. Almost feeling like I didn't deserve to be on the other end of this testimony given my mood. My team was surrounding me during this conversation. They followed my lead, saying nothing.

You went on: “Then? Just like that. He took it away from me. I swear. It's been three whole months. THREE WHOLE MONTHS.” You repeated that last part.

“Wow,” I said. My ‘wow’ didn't sound wow-ish. It sounded mechanical and fake. My hand was rubbing the side of my neck. I was listening to you and watching you. Your eyes were dancing and your hands were animated. The laxity of your jaw as you spoke reminded me of the many heavy crack users I'd seen over the years and the patient years ago who pointed to Bobby Brown on the television and said, “That way he move his jaw like that? That's when you use a whole, whole bunch of crack.” So yeah. This was what I was thinking about. The whole time that you were talking about what God had taken away from you.

Sigh.

I didn't fully believe you. Not that I didn't think you believed what you were saying. But I was tired. Very tired this day. And I just needed something to just bark exactly like a dog and say, “Hello. My name is Fido.”

Sigh.

The third year medical student, however, was new to this. He'd heard your story and presented you to me as the last patient at the end of a busy day. And every drop of your Kool-Aid, he'd lapped it all up, gleefully reporting your newfound abstinence. “I believe her,” he said about you. His young face was emphatic and his greenish eyes glistening with advocacy and defiance. He repeated himself. “I believe her.”

I wanted to. But my bias against you was so strong. And I was tired. Like so, so tired. Not take-a-nap tired. But emotionally tired of watching how this sickening crack epidemic decimated my people and how it was all beginning to feel like a hopeless version of that movie Groundhog Day.

Uggh.

I remembered what I'd learned about ways to fight bias. Being aware of triggers like exhaustion and such. And so I held your hand and did the things we do for chest pain. I nodded my head and mumbled words of affirmation about God's intervention like “Won't He do it.”

Then I said sorry in my head right after that. To God for fronting and using his name in vain.

“We didn't check a urine drug screen,” the student said outside of your room. “I mean, we can. But I will be so disappointed if it's positive.”

I was tired. So I just dragged a breath of air and said, “Me, too. But check it.” Which he did.

Yeah.

Today when I came to see you, you looked so happy to see me. Your face was still full of light. The gladness in your eyes to see this black woman doctor was palpable. I could see it before I even turned the light on. “My doctor! Heeeeey Miss Manning!”

You reached for my hand. I grabbed it. “Hey sis,” I said softly. Then I sat down. My face was serious. And my eyes almost immediately welled up with tears.

“What?” you queried. Your eyes looked worried. About ME. “What?

I swallowed and gained my composure. “I owe you an apology.” Your eyes widened. “I … I just got back your urine drug screen. The student didn't want to get it. But I insisted.” You kept listening. “It was negative.”

The expression on your face was inexplicable. Then what you did next surprised me. You held open your arms and asked for a hug. I obliged you.

“You be wanting to believe, don't you? But you can't always believe.”

I nodded and sighed. “I do want to believe. I do.”

“It's okay. That's the thing about a stronghold. It make reality and fantasy look like one and the same. Bet you heard a whole bunch of folks cry wolf before.”

I tapped my foot and bit my lip so I wouldn't cry. “I am very proud of you. And so happy for you.”

“And I believe you,” you said. Then you squeezed my hand.

When I left your room, I went to a stairwell to cry. Mad with myself because every day I am preaching to my teams to believe that today could be the day. Here “today” was staring me in the face and my bias and exhaustion wouldn't let me believe it. Or at least try to believe it.

Sigh.

No. I don't have all this shit figured out. No, I do not. But you were right. I be wanting to believe. Damn, I do.

Yeah.

P.S. I told my medical student I was sorry, 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.