Oxtail Signs

0:00I'm Dr. Kimberly Manny and this is Dr. Ashley McMullen and you're listening to the Human Dr. Podcast where we explore the human side of medicine, along with teaching, living, learning, and all things in between. Using the power of storytelling, conversation, and connectedness. Hey, we're two dope academic internal medicine doctors, but we ain't show doctors. So if you perceive anything to say here as medical advice, know it ain't bad. Also, the things we say, they only reflect our brilliant black woman magic mind and not our employers. You could have been anywhere y'all, but you chose to be here with us and we appreciate you. Let's go. So we are still in Hawaii. Yes, we are. One of my favorite things that happened to me since I've been out here is kind of in the thick of the storm. I was going a little stir crazy and I was like furiously checking the weather to see when there'd be a lull, so I could eat out and maybe try for a run.

1:04And I went out because I was just like, you know what? Effett, I'm just gonna go see what happens. It was great for like the first three miles and then I got caught in a torrential downpour. And you were happy about that? When I was planning it, I thought that was gonna be awful, but as I was in it and there was nothing I could do about it, it was actually great. So liberating. I have not been out running in the rain. I don't know probably since I was a child. And thankfully, I was already kind of on the turn, like heading back to the place I'm staying, but as I was going, there was one other runner out there and we locked eyes with each other. And as he was passing me up, he stuck out his hand for high five and we just like, it was like the most rotastic thing I've done in the world. I love it. I love it. So, you know what? One year, I want to say it was like 2015, something like that. I did the Atlanta public's half marathon.

2:04And it is usually on a, I think it's on a Sunday or Saturday. I don't know. Whatever it was, all the people that were gonna do the race that I knew, they saw the forecast and it was supposed to be raining the whole time. And people were just like, no, I'm good. So everybody just backed out, including my main running partner. So I remember I just decided, okay, bonfire, I'm gonna just go. And I get on the, the martyr, which is our, our public train and get to, you know, the, the starting site. And it is like, I'm standing there and it is just pouring down and it's kind of cold too. You know how you like, get those, you know, those aluminum wraps from other races. So I had an aluminum wrap from another race, man, that I was trying to figure out how was I going, like, how was I going to manage this here at this? I'm cold, it's wet. I'm about my hair. I ain't out here trying to like wet my hair. So I ended up biting with my teeth. This thing,

3:11turning it into like making a strip out of it and making a hair wrap with it and tying my hair down with this name. And I had a baseball hat and I put the baseball cap on over it. And it was cold and I just decided, like, bump it. I'm just gonna go for it. It's, and that's a very hilly tough race. And I just like ran this race in the rain. And I don't know what it was about that little thing that I had. But when I got home and I took that thing off my head, my hair looked like it looked right now. Because when I don't sweat in my hair, but it didn't, my hair didn't get wet because my cap was kind of had a big bill on it. But I don't know. So I felt like, you know, it was not a PR, but, you know, I actually felt like I was winning. That is a PR like to do 13 miles and cold and wet and have your hair intact. By myself, with nobody, nobody with me, nobody to amp me up, nobody to pace me, nothing. It was just me

4:17by myself and what is notoriously a very, very difficult race. Because it's very, very, really. Yeah. I was just like slugging it out by myself. And I have like, I have this picture of myself at the end of that race, like jumping in the air with my hand up. It is, I'm soaked. And I'm just like, yeah, it was legit. I did not look cute after, after my downpour. But thankfully, nobody was there. I bet you was cute. Yeah. Yeah. So what are you today on a scale of one to five? I think probably a 4.9. Damn. That's good. Yeah. I know. And why it sounds out like it's already been just like a really lovely day so far. I think I'm about a, I'm about a 4.3 maybe. Okay. I'm just busy. I have a couple of deadlines that require a creative spurt that has not happened yet

5:22that needs to happen very soon. I have a flight. I'm catching tomorrow for a turn and burn. Talk I'm giving in North Carolina and the Atlanta airport right now and all airports. Girl is straight up the Hunger Games. And this is the kind of thing where the plan has to come together. I have to make the flight. I can't, like, it's not a situation where I could, I need to get there in time, you know, and you know me, I'd be like in the, like, cut it close. So from what I am looking at, I think I'm gonna have to go to the airport at like, like, as soon as we log off, I'm not being there. So go ahead and spend it tomorrow. Oh, Lord. Yeah. So that isn't fun. I'm not thinking about that. But yeah, it's all good. It's a good problem to have. Let's see. I did start reading rest is resistance. Mm-hmm. Yeah. And very, very thought provoking. Yeah. Yeah.

6:26Thinking about what it means to just sit down and rest and how much of culture is built around being industrious and where that even comes from, that idea comes from is painstakingly thought provoking. That's it. Painstaking being the operational word here. Yeah. It is still kind of hard to wrap my mind around just how conditioned I feel towards kind of the grand culture, not that I would include myself as, you know, someone who participates in the grind. But, you know, I still have a lot of difficulty disentangling my sense of value from being productive, you know, the temptation to make lists and want to get through that list and just being able to sit still and exist for the sake of existing. Yeah. I think, I think I'm a hit dog that's

7:30tolerant because I'm about that grind life, you know, I like to grind. And it is affirming to me, but it's probably, you know, it's all these things that we make as jokes, particularly cultural jokes that I see on social media sometimes. And now that I'm reading this book, I'm seeing autos jokes differently. For example, have you ever seen the memes where they say black people on Saturday morning, white people on Saturday morning? And it'll be like some key, like some, the black family is like, up, they like cleaning up, they've got toothbrushes scrubbing the baseboard. Everybody is like, like cleaning up, you know, and the other family, they'd like on a swing set somewhere. And then I also think about when we were kids, if we were laying on a couch watching cartoons, when my dad pulled up, we jumped up and we had a nervous disposition, we just jumped up and we were doing something. You just couldn't look lazy. Right. Got to be doing

8:32something like looking industrious. Yeah, my dad always called it a nervous disposition. Look like you ready to do something. Ready to be helpful. Yes. And where did that come from? You know, in the spirit of trading recommendations and meaning to switch gears to something a little later, I did pick up Theo of Golden yesterday. And I have, I'm just getting started, but I'm really excited. I'm excited for you. Yeah. I'm excited for you. That reading that book is like somebody telling you that they're about to watch Ted Lasso for the first time. You wish, you wish you could be experiencing it for the first time. Good. I like being on the other side of this. Yes. It's going to be, you're going to love it. I'm so excited for you. That's going to be yes. Yeah. Well, good. I'll let you know what I, if I can make it through, rest is resistant. It's okay. Oh, my gosh. Punch me into face, lady.

9:39Well, you know, again, the reason for the season is as always is to get into some stories. And, you know, even though I'm sitting pretty on a 4.9 overlooking the shores of Oahu, it does actually get better from here for me because I'm about to be on the receiving end of a story from the Dr. Manning, such an extraordinary witness, sage, giver of advice, teller of epic stories, clinician educator, traveler, even for these last minute turn and burns. All the things. So thank you for being here. I know it's a busy time. It's okay. But I appreciate, you know, you showing up for us. So all that being said, what's the what's the what is normal? Normal. I feel like we, we say this all the time. I feel like a broken record.

10:44It doesn't matter if we say it before. It don't matter no more. Okay. Yeah. Look, I'm just going like King's Queen's not by nearly word to you. I'm just going just to assume it might have happened before. But you ain't heard this story before. Okay. When somebody says normal, what comes to mind? You know, the hard part about that is when I hear normal, I kind of have this a bit of a negative connotation. So like kind of bland, unoriginal, not unique. But on the flip side, when I think about it, it's like, it's normal. It's great. You know, I love that you said that because that is the context I'm thinking of. And normal is great. There are things that happen day to day in our lives that are so normal that they become like background noise. We don't even realize that they're happening until they don't. And if we are too busy, we could miss a cue or not pay attention to something. But every now and then something happens and it goes away from normal and it is

11:49significant. And that is the first sign that something is very, very wrong. And I had an experience probably like about two years ago that also made me think of another experience. So I'll share about both. But I was at Grady one day and I was on the hospital service and there was this woman who had been admitted to my hospital service. She was probably in her mid 70s. For the most part, she was a fairly functional person. She had a lot of health problems, but you know, she lived independently. She had a lot of family around and was it hospitalized a lot or anything? And she had some mild dementia, but still was quite functional and it was fine mostly. She came to our primary care clinic regularly. People knew her well. She was in care. And she got admitted to the hospital because initially it was thought that she had urocepsis. But you know, when we were preparing to

12:53kind of discharge, she still wasn't quite better. And we were trying to figure out, you know, when do we need to do more or like maybe she just needs to go to subacute rehab and let's just get her out of the hospital when she gets home, she'll get better. So we were kind of preparing to to discharge this lady. One perfect. And you know, a lot of times with some of our patients who have grown older and who have a lot of medical problems, it's not perfect. But you're hoping this going to kind of turn the corner when they get home. Yeah. So she had a son. And our son was, yeah, I don't know. He was like in his late 30s. And he loved his mother a lot. And he was there daily. He didn't live with her, but he would come up there every day. He was the, you know, person who come talk to us. He wanted to know what was going on. His mama, we needed to call him. And he wasn't anybody that was difficult or anything. He just wanted to know what was going on. I'll be the one helping my mom. She gonna stay with me for a little while until she get better. We're like, well, so he told me that he felt like something wasn't right with his mom. He's like,

13:55something don't seem normal about her. Like, I don't know what it is. I just felt like, I need to look for some more stuff because something is not right. Like, I don't know. I don't, I feel like this wasn't just no bladder infection that got in her blood. This is, I don't know my mama. I was like, well, what else has she been doing at home? He was like, you know, she just, I don't know. You just don't seem right. So let me tell you what he did. I am not joking. That day he went home and he went by the Grady Farmers Market, the curb market and bought some food. And he made his mama some ox tails. He brought them ox tails to Grady Hospital. And he said, mama, I made you some ox tails. And one of the things that he was saying in the hospital said she had not been eaten well. And we, people don't eat well a lot of times when they're in the hospital because they're like the hospital food. But he put them ox tails in front of his mama and she didn't want them ox tails. You would have thought they needed to call a code on the spot.

15:00Not to say, when I say his mama not wanting them ox tails, alarmed him. So like it was actually funny to me at first until I realized he was not, he was not laughing. Like the nurse called me and they're like, her son wants to see Dr. Manning, like the quarterback. And I was like, okay, no, I'm in the hospital. I'll come over there. I come over there. And he's like, something right with my mama, something right with my mama. You're gonna have to check, check her for some more stuff because something right. I'm not taking her out of this hospital like this. And I was like, whoa, what happened? I went home and I made my mama some ox tails. And I brought my mama some ox tails and I put them ox tails right there and I see the plate. And there's my back tails on there. There's got some collagen, some rice, some gravy. My mama, my mama ain't eat no ox tails. And I'm telling you right now, if my mama don't eat no ox tails, something wrong. And I feel like my mouth kind of twitch up a little bit because that shit was funny. I was like, what? Wait a minute. Hold up.

16:04I never heard of the ox tail sign. Like what? What? And then I realized he's not laughing. He is serious. And then I don't know if you've ever made ox tails or seen somebody make ox tails. That's a process. That's a slow cooking process. This is something that people do with love. This is not an everyday, you know, Tuesday night meal. This is something you go cook with like because you really put in thought into it. Right. And then it dawns on me that like this was really like the the ultimate litmus for him. So I was like, you know what? This is not normal. This is not normal. And he knew, he knew that there would be like it would have to be something very, very serious for his mom not to eat no ox tails. And that lady ended up having multiple my llama. Wow. At the time, it was very subtle. But his reaction made me go sit in front

17:09of the computer and carefully looked through her labs. So as I carefully looked through her labs, she was a little bit anemic. But she had always been a little bit anemic, you know, because she had chronic kidney disease. But her anemia was a little worse. Her calcium was a little bit elevated. It was like right at 10. But she had been on a on a thizide diuretic. She was like on a diuretic. So I was like, eh, it could have been the reason for that. Her total protein was a little bit elevated against a slightly lower albumin. And then we just would like, you know, a bump it. Let's let's just check a couple tests. So I sent off the SPAP and the UPAP and it was abnormal. That lady had multiple myeloma and it was not smothering. It wasn't, you know, uh, undetermined significance. It was my multiple myeloma. And the literal prompt was that

18:16something was not normal, something, you know, small. And if he had not advocated for her in that way, if he had not made her ox tails, I'm not sure when we would have made it a diagnosis. And um, though she had a lot of comorbidities, she was at a point where she could be treated. Mm-hmm. So I never forgot that. That long ago, that was like a couple years ago. I just remember how funny it was to me and how, and how he wasn't joking. Mm-hmm. As you know, in 2012, my sister died of a sudden cardiac death. The very, very first sign that something was terribly wrong was that my sister used to pick my kids up after school from aftercare. And the joke we always had was that when she picked them up, she picked them up at a good time. And then when mommy picked them up, I came in on two wheels and my kids was like two of the last kids there. And she told me, she used to tell me I was trifling for that. She's like, you trifling for that. I don't know if you wanted me to last

19:18kid waiting. So I tried to call my sister because my schedule changed and I could, I didn't need her to pick them up that day. And I was ahead of time. It was like four or something. And I knew she would be heading over there soon. And pick up is you have to pick up by six. She normally would come before five or around five. And she was going straight to voicemail, which is not really that big of a deal because she's an educator and sometimes her phone is off at work. But at the time when I knew she was done with work, I texted her. And you know how iPhones look blue if it's, if their phone is on and it's another color if the phone is off. Her text messages were reading green, which meant her phone was dead and she wasn't getting the text messages. And my sister, much like me, she liked her devices. So she, she wasn't ever away from her phone. She always had her phone. I wasn't using social media back then. So I called my younger sister and I said, hey, look and see

20:18what's the last thing DNA posted on Facebook or comment it. And she hadn't been on there all day. But the first sign that something wasn't normal was the stuff with her phone. And I didn't really even feel scared then. I didn't feel this was kind of like the guy saying, I feel like something right with my mama, but not quite yet alarmed. That's where I was. I was like, some feel weird, but I'm not quite alarmed yet. It was about 520 and I still couldn't reach my sister. And by 5, she has always gotten the kids. So I call Harry and Harry was near the school and I said, hey, run by the school and see if DNA has already gotten the kids from aftercare. And when he got to aftercare, it was like 535 and he walked in there and he texted me and he says, hey, I got the boys. He's not even alarmed yet. The very second he told me he had those kids was when I knew my sister was gone. I knew it. I said, over her dead body, wish she lived my kids at that school,

21:24past 530, over her dead body. And that is the first thought that came in my head. I was like, God. And it wasn't, it was a very, very like sharp discerning moment. I knew it. And when I reflect on that man and his mom, I was like, he knew it was a big diagnosis. He knew it was something little. And when he put those ox tails in front of that lady and she didn't eat them, it was like my kids being at that school, at 535. I was like, I ain't no inhale. She didn't get arrested. She didn't get held up at work. She is physically unable to make sure that this didn't happen because I don't, I couldn't think of any circumstances where that would have happened unless she could physically not do it. And I always remember that. I have never really felt that way since. I've never felt such strong

22:28disarmance. But I have learned to respect it in my patients because some people feel it about themselves. Some people feel it about their loved one. Some people feel it about something else. I don't know. But you know, whether you believe in a higher power or, you know, not or whatever, I do believe that there are moments of disarmance where you absolutely, positively know. And you might not know all the details, but you know something. And it's almost always some little tiny thing that has deviated from what is normal. And for that lady, it was Oxtails. He said, and he kept calling them my Oxtails. I made my Oxtails for my mama and my mama. If I bring my Oxtails to my mama, she don't need something right. And I'm not taking her home until y'all figure it out.

23:31And you know what? He was right. I should have presented a paper on it, a poster. Oxtails as a marker of no one has need to work up some old stuff at your patient. God, I have to sit with this one. Because it's such a powerful connection, you know, even kind of the humor in that story still kind of leaves me a little shook. Because there's so many, we have so many stories like this where a loved one or the patient themselves is trying to communicate that something is off. But because it doesn't fit our like fixed paradigms and then outside of that, there's so much external pressure to get patients out of the hospital or get them out of the clinic so we can move on to the next or incentivize not to listen. You know, I think the beauty of you recognizing the seriousness of this man's conviction and going back to look

24:39at the labs and ordering the diagnostic tests. And then, you know, the appreciation of, you know, call it discernment, intuition, you know, a god moment. But the seriousness of people's knowing and that it comes from a place often outside of our cognitive ways of understanding or cerebral rays of interpreting things, you know, sometimes you have to switch that off and listen. But so much in the world distracts us away from that knowing. Yeah. You know, no matter how many times I hear you talk about DNA, it still leaves me with chills. The way that that experience unfolded. You know, so here the DNA part of that story isn't the part that chokes me up. My chokes me up is the thing is I, I know all the components of what that man did.

25:40I like, I have gone with my mother-in-law into the Grady Curb Market to shop in the meat section to get some ox tails. I have seen someone, I don't make ox tails, by the way. But I have watched somebody make ox tails and there was just so much love in it. And this guy, he was working a manual job that had, where he had a uniform and he would come up there and he would be in his uniform and he had kids and everything and he'd be asking about his mama, you know, and family meetings, whatever he was, he was all in. But in the middle of all of that, he loved his mom so much that he was like, I know once and for all how to figure out if I'm tripping. And that is to make my mama what I know what I know my mother will want and that is my ox tails.

26:46And the fact that there is even a thing called your ox tails, that makes me so happy. And it also just counters so many ideas of exactly what this black man would look like if you saw him walking down the street. This was a loving, doting, caring young man who was seeing about his mama. And maybe even the boy mom and me is just like deeply moved by every aspect of that. But he saved his mother's life that day. He slowed us down, he threw a flag on the play in a form of a ox tail. His ox tail. That recipe is like I'm like, man, it must be serious because everybody thought it was funny until it wasn't. Yeah. Because you know what a nurse called me. She was like, girl. She was like, girl, this man,

27:49this lady's son, they made him some ox tail, made her some ox tails. And she won't eat them. And he up in here throwing a fit. And I'm like, that lady is sick. She don't want no ox tails. And she's like, he kept saying she will want my ox tails unless something is wrong. And it wasn't until I came over and put my eyes on him that I knew how much work and thought and care he had put into that. And how worried he was. And it was like a weekday. Who makes ox tails on a Thursday, right? Just to bring him in. Just to show y'all that like, I'm not tripping up. Gosh, man. When did you reflect on that in the context of your experience with your sister? Probably like a year later. It was a long time. It was a long time because I was, you know,

28:52it was one of these days that I was just thinking about her. And I was thinking about how how very early I knew that she was gone. I knew that. I knew she was gone. And the way that I was able to kind of navigate talking to my family, I was talking like I knew she was gone. But I knew something or or or or extremely, extremely ill in a place where she couldn't move, like unconscious. So it's but but it was it was when the minute Harry called and said the kids, I have a voice. And that was, you know, 5.35 pm on November the 15th, 2012. That's when I knew my sister was gone. And nobody I had not nobody had been at a house. Nothing. But that's when I knew you know, that's one of the dope things about medicine and life. I miss Audis lettuce lessons up in it. And the people they love people the most, we got to listen to them. Yes.

29:54Like parents, you know, telling doctors about their children, you know, children telling doctors about their parents. And people telling you about themselves, you know, it is hard to be a little objective about yourself. But but you know, that's just a lesson that because I was extremely sure that day. And it just made me think about him and how sure he was. Yeah. Yeah. Even if you a catastrophizer, you know, you know, when it's that feeling I had that day, well, it wasn't like my regular catastrophe, Kimberly Manning thoughts. And they are plantable. This was different. This was like, yeah, yeah. I'm learning to distinguish that myself. I've had a handful of these moments. But I guess, I guess the longer I've been alive, the more clear it is what feels like something in the realm of my own thoughts or anxieties versus something deeper

30:59and wiser. And it might not be bad. It might be something good. Yeah. But in a hospital setting, a lot of times the patient and the loved one, that's not who is given the authority. So it's this is a good story for people to hear if they are in a position of authority. Whether that is in a hospital setting, whether you're an educator, whether you're a manager of people or anything, where if somebody's trying to tell you something that they know for sure rooted on something that has changed from normal, take a minute and just slow down and see what they talking about. You might find something that you didn't know was there. And I would have missed that diagnosis because it was subtle. And it wouldn't have been the kind of miss that you would have said I was an incompetent doctor for. It was just put all together. I had to be like, I don't know. Garprey would have made the diagnosis. For sure. On a first day. Exactly. Garprey would have made

32:00the diagnosis, but if you listen to this, Garprey, shout out to you, man. Shout out to Dr. Dolby. Well, you would have made the diagnosis. Yes. But for the rest of us in your mortals, that's right. I mean, I needed a cocktail, a cocktail intervention. Woo, girl. Well, in 10 minutes, I have to meet with, you know, I get to meet with one of my medical students. You have a most magnificent rest of your day in Hawaii. I certainly will. And I hope you have a great meeting with your student. I know that student is incredibly lucky. So enjoy that time. Best of luck with your travels tomorrow. You know, if you do decide to head to the airport 12 hours early, it probably will work out fine. Correct. And you know what? I look forward to traveling again in May. To the Society of General Internal Medicine. Yes, y'all. National meeting where we would be live and direct. You can't say it enough.

33:05Come check out your girls. Yes. You know, we're like one of those legit podcasts where we've had multiple lives. You know that? Yes. We're really all better than I threw. Yeah, come through. All right. Says, well, make it a most magnificent day in 10-2. And you as well. And even if you can't. Don't you dare. You're going messing up nobody else's please. That's right. That's right. That's right. Shout out to tap. And that out to us. Yes. Love you, sis. Love you too. That wraps up this week's episode of the Human Doctor Podcast. Special thanks to our favorite brother, gastroenterologist, Dr. Chuma O'beena Mae for the Beats. Shout out to the Dr. Ashley McMullen for editing and production. Mad love to our podcast family at the nocturnes and the clinical problem solvers. Our med twitter fam and especially shout out to all of you, our listeners.

34:09Until next week, remember we see you and you are enough. HALA!