1/
When intern me got her as my senior resident? I was elated. She was smart and decisive. Funny and confident. She went hard for patients and advocated. And she stood up to people in ways that others didn’t.
Intern me wanted to BE her.
And intern me tried to be her, too.
Yup.
When intern me got her as my senior resident? I was elated. She was smart and decisive. Funny and confident. She went hard for patients and advocated. And she stood up to people in ways that others didn’t.
Intern me wanted to BE her.
And intern me tried to be her, too.
Yup.
2/
She seemed to like me. Or at least appreciate my hustle.
“You’re my kinda intern,” she’d said through a mouthful of Stromboli at 2am one day. I'd just run up from doing a gram stain--myself. She gave me a greasy fist bump.
I was over the moon.
She seemed to like me. Or at least appreciate my hustle.
“You’re my kinda intern,” she’d said through a mouthful of Stromboli at 2am one day. I'd just run up from doing a gram stain--myself. She gave me a greasy fist bump.
I was over the moon.
3/
The month had been long. Our team had been busy. And all of us were tired. But she seemed to gain steam when others ran out of it. Her big stack of cards with patient data was tucked in her waist band at the small of her back—her signature move.
She pulled 1 out and sighed.
The month had been long. Our team had been busy. And all of us were tired. But she seemed to gain steam when others ran out of it. Her big stack of cards with patient data was tucked in her waist band at the small of her back—her signature move.
She pulled 1 out and sighed.
4/
“Full disclosure—your next admission is total B.S.”
That’s what she said. And because I admired her so much and wanted to BE her, I took that to be the gospel. She went on to describe a patient who’d run out of his meds “forever ago.”
She shook her head for emphasis.
“Full disclosure—your next admission is total B.S.”
That’s what she said. And because I admired her so much and wanted to BE her, I took that to be the gospel. She went on to describe a patient who’d run out of his meds “forever ago.”
She shook her head for emphasis.
5/
Yes, his BP and sugar were high—but no target organs damaged or DKA.
“Dude needs a good pharmacy. Not an admission.” She dragged in a breath and flipped the index card to me. “Go see him while I try to get our attending to DC him from the ER.”
She laughed.
I did, too.
Yes, his BP and sugar were high—but no target organs damaged or DKA.
“Dude needs a good pharmacy. Not an admission.” She dragged in a breath and flipped the index card to me. “Go see him while I try to get our attending to DC him from the ER.”
She laughed.
I did, too.
6/
In 2019, this all sounds so cringey, I know. But I can attest—this was a resident who cared. She lamented about things that weighed down the system. Her passion would well up into legendary turf wars and confrontations. She cared. A lot.
This day was no exception.
Nope.
In 2019, this all sounds so cringey, I know. But I can attest—this was a resident who cared. She lamented about things that weighed down the system. Her passion would well up into legendary turf wars and confrontations. She cared. A lot.
This day was no exception.
Nope.
7/
“This is such B.S.,” she kept saying. She paced the room between sips of room temperature coffee. Then her pager went off again. “Uggh! Head down—I’ll page you in a bit.”
I did as I was told.
Headed down to the Emergency Department.
To see the patient described as "B.S."
“This is such B.S.,” she kept saying. She paced the room between sips of room temperature coffee. Then her pager went off again. “Uggh! Head down—I’ll page you in a bit.”
I did as I was told.
Headed down to the Emergency Department.
To see the patient described as "B.S."
8/
The patient was a really nice man. He’d been underemployed and underinsured. School had been abbreviated so his limited literacy was complicated by some health literacy issues, too.
Him: “Do I have acid in my blood? I did before.”
Me: “No, not this time.”
Him: "Praise God."
The patient was a really nice man. He’d been underemployed and underinsured. School had been abbreviated so his limited literacy was complicated by some health literacy issues, too.
Him: “Do I have acid in my blood? I did before.”
Me: “No, not this time.”
Him: "Praise God."
9/
Me: “Your pressure is high.”
Him: “I been out of my medicine.”
Me: “Does your chest hurt? Or your head?”
Him: “No, ma’am.”
I looked in his eyegrounds--sharp disks.
Peeped his EKG—LVH with strain but unchanged.
Exam with an S4 audible even by a PGY1.
Otherwise? Not much.
Me: “Your pressure is high.”
Him: “I been out of my medicine.”
Me: “Does your chest hurt? Or your head?”
Him: “No, ma’am.”
I looked in his eyegrounds--sharp disks.
Peeped his EKG—LVH with strain but unchanged.
Exam with an S4 audible even by a PGY1.
Otherwise? Not much.
10/
Him: “My daughter was gon’ come pick me up ‘fore they decided to keep me.”
Me: “You wanted to stay?”
Him: “Stay? Hell naw. I wanted to GO.”
*silence*
Me: “If we were able to help you get your medicine, would you want to go today?”
Him: “Most definitely.”
Him: “My daughter was gon’ come pick me up ‘fore they decided to keep me.”
Me: “You wanted to stay?”
Him: “Stay? Hell naw. I wanted to GO.”
*silence*
Me: “If we were able to help you get your medicine, would you want to go today?”
Him: “Most definitely.”
11/
I called a SW and spoke to a PharmD, too. They were a huge help. In less than 15 minutes, we had it all worked out.
Yup.
I agreed with my resident idol. This man didn’t need an admission. I mean, yes, his BP and blood sugar were high. But mostly? He needed help with meds.
I called a SW and spoke to a PharmD, too. They were a huge help. In less than 15 minutes, we had it all worked out.
Yup.
I agreed with my resident idol. This man didn’t need an admission. I mean, yes, his BP and blood sugar were high. But mostly? He needed help with meds.
12/
My body washed over with relief when I saw one of my fave ED attendings walking toward me.
Him: “Kim!”
Me: “John!”
I’d just finished a rotation in the ED 2 months before and we’d worked closely. He had all of us call him by his first name. Even the med students.
Yup.
My body washed over with relief when I saw one of my fave ED attendings walking toward me.
Him: “Kim!”
Me: “John!”
I’d just finished a rotation in the ED 2 months before and we’d worked closely. He had all of us call him by his first name. Even the med students.
Yup.
13/
John: “Oh good! You’ll be taking my patient? Great!”
I loved the vote of confidence. I knew John would listen to me.
Me: “John? Would you be against letting him go home if I could ensure a safe discharge plan?”
After that, I explained what I’d done and John listened.
John: “Oh good! You’ll be taking my patient? Great!”
I loved the vote of confidence. I knew John would listen to me.
Me: “John? Would you be against letting him go home if I could ensure a safe discharge plan?”
After that, I explained what I’d done and John listened.
14/
Me: “He has good support, too. What do you think?”
John: “I wouldn’t be against that.”
He asked a few more questions. Then John nodded & agreed.
John: “Hey, Kim? Thanks for your legwork. I’m super glad it was you. I’ll document the new plan.”
I beamed from ear to ear.
Me: “He has good support, too. What do you think?”
John: “I wouldn’t be against that.”
He asked a few more questions. Then John nodded & agreed.
John: “Hey, Kim? Thanks for your legwork. I’m super glad it was you. I’ll document the new plan.”
I beamed from ear to ear.
15/
Not because John complimented. But because I had blocked an admission. The “B.S.” one, no less. And I’d get the praise of my senior resident for being A WALL.
Yay.
When I paged her, she called me right back.
Her: “Sup?”
Me: “Guess what?! The B.S. bro is OUT THE DO'!”
Not because John complimented. But because I had blocked an admission. The “B.S.” one, no less. And I’d get the praise of my senior resident for being A WALL.
Yay.
When I paged her, she called me right back.
Her: “Sup?”
Me: “Guess what?! The B.S. bro is OUT THE DO'!”
16/
Her: “Strong work, mighty intern!”
Me: “You ain’t got to go home but you can’t come to our team!”
*laughter*
Her: "You are my kinda intern!"
We wrapped up the call and I hung up still smiling. But it faded the minute I heard someone calling my name.
John.
Her: “Strong work, mighty intern!”
Me: “You ain’t got to go home but you can’t come to our team!”
*laughter*
Her: "You are my kinda intern!"
We wrapped up the call and I hung up still smiling. But it faded the minute I heard someone calling my name.
John.
17/
I swung around and faced him. His previously warm expression was now replaced with a furrowed brow and a look of disapproval.
Shoot.
I played dumb. “Hey there, John!”
His face remained flat. And disappointed. My heart rolled down my scrub pant and dropped into my clog.
I swung around and faced him. His previously warm expression was now replaced with a furrowed brow and a look of disapproval.
Shoot.
I played dumb. “Hey there, John!”
His face remained flat. And disappointed. My heart rolled down my scrub pant and dropped into my clog.
18/
John: “Kim, I overheard your phonecall. I need you to know that my resident was really worried about that patient. I was, too.”
Me: *silence*
John: “Your words were hurtful. And disrespectful. Of the patient. Of your colleagues. Of you.”
I felt my heart pounding.
John: “Kim, I overheard your phonecall. I need you to know that my resident was really worried about that patient. I was, too.”
Me: *silence*
John: “Your words were hurtful. And disrespectful. Of the patient. Of your colleagues. Of you.”
I felt my heart pounding.
19/
John: “Man. You’re just so much better than that. Your resident is, too.”
Me: *whisper* “I’m sorry.”
John: “Listen—we’re all tired. But we’re all a team, Kim."
*pause and sigh*
John. "I always tell myself that influence is a mighty thing. We have to handle it with care.”
John: “Man. You’re just so much better than that. Your resident is, too.”
Me: *whisper* “I’m sorry.”
John: “Listen—we’re all tired. But we’re all a team, Kim."
*pause and sigh*
John. "I always tell myself that influence is a mighty thing. We have to handle it with care.”
20/
After that, he went back to being warm, amicable John. He told me that it was my influence that made him consider a discharge. And the resident's influence that made me think it was okay to refer to their decision as B.S. and the pt as a "B.S. Bro."
I think he was right.
After that, he went back to being warm, amicable John. He told me that it was my influence that made him consider a discharge. And the resident's influence that made me think it was okay to refer to their decision as B.S. and the pt as a "B.S. Bro."
I think he was right.
21/
That was my first time really thinking about the hidden curriculum. This was a defining moment for me as a leader.
Maybe my resident was burnt out. And hell, maybe I was, too. But ever since? I think about my influence.
A lot.
“Streets is watching.” – Jay Z
👊🏾#staywoke
That was my first time really thinking about the hidden curriculum. This was a defining moment for me as a leader.
Maybe my resident was burnt out. And hell, maybe I was, too. But ever since? I think about my influence.
A lot.
“Streets is watching.” – Jay Z
👊🏾#staywoke
