rain rain go away

It's going to be a wet summer in Guatemala. I'm thankful for Gore-Tex and Chacos.

guate or bust

Apparently, in T-4 days, I'll be flying out of Atlanta Hartsfield-Jackson for Guatemala City La Aurora International. I'm filled with a pretty healthy dose of anxiety. 

A lot of firsts for this trip:

- first trip flying solo

- first global research project

- first data analysis project (SAS, epi, oh my)

- first time in Central America

But trying my best to embrace the exciting and positive parts:

- first trip flying solo

- first global research project

- first data analysis project (SAS, epi, oh my)

- first time in Central America

Sometimes, you just have to dive in head first and gasp for air in order to discover that you're still afloat.

continuity of care.

It was December and I was on my pediatric surgery rotation, which made those dark, gray mornings seem even lonelier. Yet I found comfort in my 4:15am commutes to the Children's Hospital. Some mornings, I let the thick silence percolate around me and marveled that I was the only one on the road. Some mornings, I blared bad hip-hop and Miley Cyrus and created an internal soundtrack for the long work day ahead of me. That month, most of the sunlight I saw was filtered through the tall windows that flanked the hallways of the hospital. 

It was a Friday night. After a 15-hour day at the Children's Hospital, I was headed out the door for an overnight shift in the trauma bay at Grady, a public hospital and the only Level 1 trauma center within 100 miles of metro Atlanta. Then the surgery consult phone rang. A trauma was coming in: 10 year old kid in a car wreck. I watched the trauma team of nurses, ER physicians, pediatric surgeons and auxiliary staff efficiently manage the chaotic scene. No family member was with the scared and crying child.

Once his fractured leg was stabilized, I quietly slipped out the door to make it to my Grady shift for the adult traumas. Once I arrived, a resident sent me directly to the interventional radiology suite. It looked like the set of a horror film; there was blood everywhere. A female patient lay unmoving on the table as bag after bag of blood was infused into her, unable to keep up with the massive amount she was losing directly onto the table and the floor. They failed to find the site of the bleeding in order to stent the vessel and staunch the blood loss and she was taken to the OR.

As they wheeled her out, I sat in front of a blank computer screen as adrenaline coursed through my body. I was trying to remember the vasculature tree of the pelvis and lower extremities while simultaneously feeling shell-shocked by the violent and gruesome scene I had just witnessed. One of the residents showed me a clip from that afternoon's local news broadcast. Our patient's car had been hit head-on by a car going full-speed - the wrong way - in her lane.

I saw her again as she was wheeled to her room in the surgical ICU. Her abdomen had been left open, wrapped in plastic, to contain the massive swelling and I was told to repack it. It was all so surreal and intimate, pulling out blood-soaked towels and sponges as well as giant clots from inside this stranger's body. Her husband and parents hovered at the door - watching, crying and shaking - as multiple codes were run. The medical team pulled the family aside to discuss the precarious situation; she was unstable and likely not going to make it through the night. What were the family's wishes?

Her mother dropped to her knees and emitted a long and loud wail from deep within. I looked away so that the other medical student wouldn't see the tears streaming down my face. Through her cries, I pieced the story together. Our patient, this 35 year old female, was the mother of the boy with the broken leg from the Children's Hospital. Half of the family was at Grady with the mother and half was across town with her son. The boy would make it through the night, but his mother did not.

It was the middle of the night, but I called my own mother: to tell her that I loved her. Verbal declarations of love do not happen often in my family but I felt vulnerable, scared and raw. I needed to say it out loud, even if she already knew it.

Over the next week, our team at the Children's Hospital took care of that young boy as his leg healed. I suspect that he was only beginning the real healing process though. I thought about how this would be his first holiday without his mother. I wondered if Christmas would forever be a time of sadness for him.

I felt like an intruder, allowed to witness this family's pain and trauma, from the Children's Hospital to Grady and back to the Children's Hospital. I'm not sure this was the kind of continuity of care I was expecting.

*****

I dug this draft out of the archives, which I had saved from over a year ago.

high standards.

"You are more fun than beer."

-Adam J. Carlisle

Bold statement. I'll take it.

bittersweet.

Yesterday, my friends became doctors.

Today, I jumped out of an airplane from over 14,000 feet.

I s'pose tomorrow will also be a good day.

never stop caring.

And so, who are we? Well, we are very different and very alike.

We are women, we are men, we are immigrants, we are Georgians.

We are black, we are white, we are Indian, we are Asian and American, but not Asian-American, we are part Chinese, we love our people, but we sometimes feel most foreign amongst our own people.

We are minorities, but not always the majority of the time, we are well-traveled, we are hoping to become more well-traveled, we are somewhat bilingual, completely tri-lingual, and hopelessly unilingual.

We are believers, but not judgers, we are not easily offended, but we take offense to people being mean, we are older siblings, we are younger siblings, we are only children, we are twins, we are products of traditional families, and we are products of nontraditional families full of great traditions, we are close to our families and yes, we care what they think.

We are mature, we are immature, we are talented, we make sacrifices, we are driven, we try hard, we are modest but we give ourselves credit when it is due, we love anything that is outdoors, but we love to relax on the couch indoors, we love physical activity, we are determined to do more of it.

We have ties in Europe, Vietnam, China, Jamaica, India, Trinidad, Korea, oh yeah and Brooklyn, we think patients are people and we hope to always think that way.

We are full of culture in its every definition, however we choose to define our own culture, we won’t let our culture define us.

We care about what we’re doing and we hope that we never stop caring. Ever.

-- Never Stop Caring: A Charter- a compilation of things said during the inaugural meetings of Small Group Alpha circa July 2007.

Small Group Alpha - EUSOM Class of 2011 from Kimberly Manning on Vimeo.

To Alanna, Tony, Adam, Hreem, Doug, Jin and Dr. Manning:

Four years ago, we were eight strangers.

Four years later, we are a family.

Gracias para todo.

Cảm ơn cho tất cả.

Thank you for everything.

always,

Ant xx

[Charter and video courtesy of Dr. Kim Manning]

Bright before me the signs implore me

To help the needy and show them the way

Human kindness is overflowing

And I think it's going to rain today

**

Nina Simone

But the sun always returns.

(Unless you live in the Pacific Northwest or the UK).

vieques, puerto rico, march 2011

Plan B

In case this being-a-doctor business doesn't work out, there's always the circus.

dating 101

I recently road-tripped home to the Lone Star State for some Phamily time. Good times, good food all around. And you know it's never a trip home without some quality Mama Pham talks.

So, do boys like you and you don't like them back?

Or do boys never like you?

I just want to make sure you aren't defective.

Thanks for the vote of confidence, Mom.

black tutus + red hair

As a part of my family planning elective, I spend two afternoons a week at the Grady Teen Clinic. Every patient is assigned to a counselor and is taken care of by a multi-disciplinary team: doctors, mid-level providers, psychologists and social workers. It's a great resource for adolescents - both male and female - who want to take ownership of their reproductive health and it's a safe place for them to come to when they have problems. I've heard stories of sexual trauma, emotional trauma, neglect, and domestic violence. Grady may be a resource-poor hospital but it's a wealth of complicated personal histories.

But at the end of the day, they're also just teenagers. They talk about boys. And about each other. And they're constantly texting on their cell phones.

One afternoon, Tanesha* came into the exam room with her cousin, who was sporting bright red streaks in her hair. They were both 16. As I talked to Tanesha, asking about her sexual history and what she knew about birth control, I noticed she and her cousin were wearing matching black skirts.

"Hey girls, what's up with the tutus?"

"It's for our friend Jay.* She died last week."

"That's horrible. I'm so sorry. What happened?"

I maintained my composure, but internally, I felt alarms going off and a tight knot already forming in my stomach.

"Her baby daddy shot her in the head. They got into some stupid fight and he started calling her names, pulled out a gun and shot her. She was three months pregnant too. I mean, she shouldn't have been talking mess but he could've just hit her or something. She didn't deserve to be shot and killed like that. You may have met her. She's been coming to this clinic too."

Tanesha relayed this information matter-of-factly and promptly whipped out her cell phone to show me pictures of Jay, who apparently had a penchant for bright red hair and tutus. Her friends were paying homage to her in their own way. When I later poked my head into the waiting area, I noticed a few others in black tutus.

During that clinic visit, we talked about the importance of personal safety and appropriate behavior in relationships. But I'm not sure if my words fell on deaf ears or not. They were listening to me but also appeared accepting of their young friend's fate.

How could my words possibly return innocence lost?

*names and personal information have been changed to protect privacy of patients