3rd Annual "Stories of Yale Internal Medicine"

Transcript

• 00:00Good morning, everyone and Welcome to medical grand rounds.
• 00:03Addicted to zeros away so I'll be doing the announcements.
• 00:07Next week medical grounds is cancelled the following week. We'll have our 30th annual Massimo Calabresi lectureship in Cardiology, given by doctor Sylvia Priore from Povia, Italy.
• 00:19There's no commercial support for this frame rails, there's no conflict of interest.
• 00:24So this is the 3rd consecutive year that we're doing this special grab balance and titled Stories of yell internal Medison, where we invite.
• 00:36All members of our Department. I think students Housestaff Fellows, faculty and this year, nurses and allied health professionals to submit stories. Personal stories to present at medical grand rounds and once again. We had many stories submitted. It was difficult to choose which ones to select so again convened a committee consisting of doctors. Anna recently Sanders Doctor Dana Dana myself who read selected and then edited the stories for presentation with the.
• 01:08Both of the most valuable editing done by Lisa Ann Anna so like a publicly recognize again their major contributions.
• 01:18So for those of you have not been here before the past 2 years. You may ask why we're doing this, or medical grand rounds and I think the reason is quite simple that storytelling.
• 01:34Is fundamental to so much we do as positions?
• 01:38Creating writing and presenting a history president list.
• 01:41To writing grant proposals to writing manuscripts to determining goals of care and patient preferences.
• 01:48With our patients to mentoring columns.
• 01:51And for that reason, I think I become convinced that the narrative form is actually one of the most powerful methods to educate physicians and that brings us here today.
• 02:01So I'd like to start off with our first story. Teller, who is doctor, Emily Pinto Tail, who's one of our graduating residents from our internal medicine. Pediatrics program and current chief resident in the primary care program and her stories entitled somebody sunshine.
• 02:27They picked you.
• 02:29Can you be at the hospital tomorrow morning to pick the baby up?
• 02:32I'm standing in the corner of the ICU hallway, speaking softly into my phone shielded by Cupped Palms.
• 02:40I've been awake for 29 hours.
• 02:44What sorry can I what?
• 02:48The baby is ready.
• 02:50Don't forget to bring a car seat.
• 02:53There are a number of different ways to become apparent.
• 02:57In this case, it starts when a social worker friend tells you there are 525 children in your city in foster care.
• 03:07And only 70 foster homes.
• 03:10She tells you that today. There are 3 babies in the office sitting and pack and play crib's waiting for placement.
• 03:19Today, right now as she's talking to you.
• 03:24What about one of them?
• 03:26You feel a sense of urgency and think we could do that.
• 03:31Fast forward 2, 1/2 years.
• 03:35One open house 2 home visits.
• 03:3956 hours of classes over 16 weeks.
• 03:44Five finger prints on each hand 15 homework assignments.
• 03:4947 pages of forms asking you to describe your parenting philosophy.
• 03:5530 minutes, inventing a parenting philosophy.
• 04:0090 minutes of interviewing.
• 04:033 forms describing the type of child you will take with 85 possible medical emotional or behavioral problems they may or may not have.
• 04:15You receive a certificate in the mail.
• 04:18You have fix it with a magnet to the fridge and you wait to become apparent.
• 04:24The voice on the phone repeats that without a car seat, they won't let me leave with the baby.
• 04:29I hear that without a car seat, I will look as unprepared as I feel.
• 04:33Can I be there at 9:00 AM?
• 04:35Yeah, I guess I say trying to cover my panic by whispering Head turned toward the corner.
• 04:43Uhm yes wasn't exactly the fairy tale story. I hope to tell my child, one day about how we met for the first time.
• 04:50I hang up the phone and stare at it briefly before I return to rounds resuming my position behind the junior residents tumbling through her overnight presentations.
• 05:00Uncharacteristically, I have nothing to add lost in my anxieties about what that phone call might mean.
• 05:06She finishes the last patient and we walked together out of the sliding glass doors at the hospital.
• 05:13I get in my car call my husband and drive to target following signs to the baby section a new experience.
• 05:20The diapers boxton stacked in towers loom over me, do babies really need that many do I need that money.
• 05:29Choosing a lotion takes 10 minutes wasn't there an article recently about not using Johnson and Johnson's on your baby or was it that the pink kind of bad, but the yellow kind is OK and what about sense is unscented safer for infant skin or is uh sent better for covering up diaper smells and what if this lotion is scented simply's baby.
• 05:50By the time I reached the diaper cream. I've already become loyal to the brand with the fewest options.
• 05:57I vaguely remember learning in class about the importance of newborn hair care for black infants and I jumped to reach a hair cream on the top shelf.
• 06:05I spend the longest time in the clothing section, deciding between outfits reading just like Daddy and Mommy's sunshine.
• 06:14We were taught to refer to ourselves as Foster Mom or foster dad or with our first names, but no ones you say Emily loves me?
• 06:23I imagine a little toddler learning to say mama and I wonder who he will mean.
• 06:28Hoping he will be somebody sunshine.
• 06:31Blinking back tears. I grab instead a onesie with the NASA logo. Amarti convinced my baby will walk on the moon.
• 06:39My husband drives through the night to get home but I'm awake when I hear his keys in the lock. We're going to be parents. Today, he says slipping off his shoes as he crawls into bed.
• 06:49Parents I repeat back the words foreign and sick in my mouth.
• 06:54I fell asleep trying to figure out how to say a prayer.
• 06:58We get to the hospital early at 8:30 park in the employee garage and retrace the steps. I take daily on my way to work.
• 07:06Today I feel like neither a professional employee nor apparent holding an empty car seat.
• 07:12My husband, laughs even empty these are heavy.
• 07:16The baby is a small wisp of a thing smaller than any baby. I've seen from friends who took all their prenatal vitamins. He stares up at us wrapped in a hospital swaddle wearing a donated hospital hat in a bed with a donated hospital quilt.
• 07:32I read the tag made especially for you by Rosalie.
• 07:37I wonder if rosalie thought she was quilting for me D Child, a sick one or one no one loved.
• 07:44I hate that quilt suddenly viscerally and I shove it aside in the crib.
• 07:49I changed him instead into the outfit, I bought the NASA shirt and pants with little raccoons at a tea party.
• 07:56I realized then that the pants are meant for a little girl and momentarily feel ashamed and unprepared.
• 08:03The nurse brings papers to sign adds the coil to hit the bag of his things.
• 08:08I quietly remove it as we walked in the door is slipping it on to the counter.
• 08:13We pulled the door shut and walk out into the August heat.
• 08:18I asked my chief resident for the next day off of work. I am now a mother after all. Can I get one day of maternity leave?
• 08:27But they can't find someone to work for me.
• 08:29So at daybreak, the next morning, I go into work in the dark, leaving my husband asleep arm dangling out from the side of the bed hand on our son's chest in the bassinet next to the bed.
• 08:43It would be the first of many times, I choose duty over duty love over love.
• 08:52In the evening when the ICU comms and the sun begins to set in the summer heat outside the window. I show a photo of my sons, wide eyes to the nurse beside me.
• 09:03Passing her the phone as if it were Holy Communion shared between the two of us.
• 09:08We sit at a computer station, dark and quiet in the back.
• 09:13She looks at the photo for a long time.
• 09:16He's yours, she asks.
• 09:19A complicated question.
• 09:21He's mine I say.
• 09:24The nurse unlocks her phone and hands it to me.
• 09:27A photo of her toddler son running toward her Open Arms.
• 09:32For the first time I imagine myself in our son. Someday him running toward me calling mama.
• 09:40It feels almost natural.
• 09:43Thank you.
• 10:03OK, our next presenter will be darker in here now who is the gme directed the Bursae Equity Inclusion Associates shared or Department through diversity and inclusion her story is entitled in ND made in America.
• 10:33I come from poverty.
• 10:38Is not easy for me to say this to you my colleagues?
• 10:43In becoming a physician I have endured struggles that I have long kept secret due to fear.
• 10:50The fear of being looked down upon.
• 10:54The fear of being made to feel less qualified as a physician.
• 10:59The fear of hearing comments that would rain force how I have felt too many times.
• 11:06Lost.
• 11:07Invisible.
• 11:09Inferior.
• 11:11With no sense of purpose.
• 11:14I spent my childhood in a small hardscrabble town in the Dominican Republic, where poverty was an oppressive mental.
• 11:24Growing up, I owed just two pairs of underwear.
• 11:28They were made by my mother out of old clothing want to where were the other was trying.
• 11:36The thread was so warm that you were common done and I felt like I was wearing a loose curd under my raggedy dress.
• 11:46Sometimes I would walk with one hand on my hip just to keep it from falling.
• 11:54In addition to being our Taylor my mother served as our doctor.
• 11:59As a child, I almost died of measles by that experience pales when compare to the parasites.
• 12:08Once a year, she would give us liquid Medison to perch our guts of parasites this liquid. Madison made those critters wiggled inside us and within hours, they were come out squirming from all orifices, including our noses.
• 12:29They were in every color rubbery and about 8 inches long.
• 12:34My mother would condemn them to death by leaving them to dried in the sun murmuring? How do you like it now ha?
• 12:44Well, we can put on in horror and relieve.
• 12:50I was the oldest of 4 children, ages 10 eight 6:00 and 2:00.
• 12:56We're skinny with little bulging bellies from the warms fisting inside us and countless nice going to bed hungry.
• 13:05One morning, my mother sent me to the bodega with a 10 peso bill to buy some bread.
• 13:12The cashier made a mistake.
• 13:14And gave me change for 20.
• 13:17I can run into my mother, with my little hand in a tight fist, Mommy Mira Mira.
• 13:23My mother dropped her knees.
• 13:26Pull me closed rest their head against my belly and began to SOB.
• 13:32Then why but her eyes with the back of your hands. I want yours. I owned yours, Gracias meal.
• 13:39I remember wanting to erase all this sadness from my mother's face.
• 13:44And I told her.
• 13:46Mommy when I Grow Up I'm going to be a doctor.
• 13:50My mother, remarked, seemingly with a kiss on my forehead.
• 13:56I never so poverty as a barrier to my dream of becoming a physician.
• 14:01I remember the one story building of the Town Hospital is where is where area smell of rubbing alcohol and imagining my name is dreaming of the intercom total. Hey now since this data in a cellar numeral cuadro.
• 14:17Many times I walked around the house below fascinated by this scream, so women, giving birth.
• 14:23How to play doctor with my siblings markup incisions and give pretend injections?
• 14:29Even though my mother couldn't even imagine what it would take for anyone to become a doctor let alone her own daughter. She never ordered a single word of discouragement.
• 14:42When I was 11 years old, my father left for the US.
• 14:47When we received the first check, he sent back. My mother took me to the bodega to apologize and pay back the money. I had brought home.
• 14:582 years later, my mother joined my father as soon after the whole family reunited in a 4th floor apartment in Washington Heights Manhattan.
• 15:10There we experience at different side of poverty. I now had more than 2 pairs of underwear and we were not going to bed hungry. But the apartment was infested with huge rats and roaches and we did not have appropriate clothing. The weather, the winter months.
• 15:28My mother got a factory job sewing clothes for dolls.
• 15:32Soul jury and rent it out.
• 15:36One room, sometimes two of our 3 bedroom apartment.
• 15:42We were barely making ends meet the primer rent kept going up and her minimal wage salary.
• 15:50This qualified us from public assistance.
• 15:53To stay afloat, she quit her job and I spent her time filling out applications to state agencies and attending the requisite meetings.
• 16:03Public assistant did not keep pace with the rent, and eviction letters kept coming.
• 16:09At that point she added yet another agency to her list. The Legal Aid Society.
• 16:17Even in the darkest hour, she never considered put her children to work like our neighbors did.
• 16:23She would say your job is studying so that you don't go through what I'm going through.
• 16:31I took my job very seriously and discovered within myself. Some of my mother's resourcefulness Brazilians and determination.
• 16:41I want this student who frequently visited the teacher after class.
• 16:45Attended tutoring sessions formed a study groups and who requested next grade textbooks to self teach.
• 16:54I graduated in the top 10% of my class and with each degree. My mother could not have been more proud.
• 17:04But for my mother and I residency made it all real.
• 17:09I felt like a millionaire with my monthly paycheck. My health insurance on my title of doctor.
• 17:17My very proud mother, not at all shy about sharing her shoulders accomplishments once asked me may I have your business card.
• 17:29I asked before she said. I need to show it to my doctors. They don't believe I have a daughter, who's a physician but who do they think they are.
• 17:38I said, yeah, Mommy, who did I think they are.
• 17:42And we just burst out laughing.
• 17:46I all my dream, becoming a reality.
• 17:49To this land of opportunity, we call the United States of America.
• 17:54And as so many immigrants or children grandchildren. Great grandchildren of immigrants in this room. I am forever, grateful thank you.
• 18:31OK, our next presenter will be Max Jordan. Many fiacco your medical student. Current Sebion 1000 service and this type of historias. Thank you for your pin.
• 18:56I felt a burning urge to ask but I held it till my last day on the service.
• 19:03So one of the residents on my Pediatrics rotation always were a pen on his key chain around his neck, no matter how he was dressed business casual or in scrubs.
• 19:14It red black lives matter.
• 19:18He was white.
• 19:20This was towards the end of my clinical year and he was the first resident. I met who wore explicit symbols in support of racial justice.
• 19:30I was thrilled.
• 19:32On our last day together, I finally brought it up.
• 19:36Has anyone asked about or made any comments about your black lives matter pin?
• 19:42Only a few he tells me.
• 19:45The first round when they realize what the pen meant a second just ask if it considered the potentially negative impact of wearing such symbols.
• 19:56He feels strongly about wearing his pen.
• 19:59And he holds the conviction that in that it's a way for his black patients and their families to feel that he cares about them, and is aware of whatever injustices they might face in and outside of the hospital.
• 20:13A way to Connor, the potential assumption that they may not get the best care.
• 20:19Something to ease that tension and contribute to building a strong therapeutic relationship.
• 20:27He left the myriad of studies that show that black patients do not receive the same type of care across different settings ages and different conditions.
• 20:37What if I as a black man war such a pen?
• 20:42It would just be about the patients, but also about me.
• 20:46Would it ruffle too many feathers?
• 20:50He wondered the same.
• 20:52In fact, we both wonder if someone in seeing me wearing such a pin would ask me to speak on behalf of my people.
• 21:03Or on behalf of black lives matter.
• 21:07Or even more directly ask me don't all lives matter.
• 21:12Something that he has an experience.
• 21:14That said, I'm grateful that someone on this team is bearing the cross. I mean, the pen of sending racial signals and against.
• 21:27And justice.
• 21:29Interruptions and they need to get through the day's tasks.
• 21:33Before sign up eclipse our discussion.
• 21:37Wow, you get it is a thought that I'm left with.
• 21:41I'm thinking of why it's great for this resident who is a white male to wear a black lives matter pin beyond its impact on one and one patient interactions.
• 21:53In a quiet but powerful way because his senior, he sets an example for the rest of the team.
• 21:59And at the same time, he shows me that he's an ally.
• 22:04Of course, it goes beyond me.
• 22:07Most black people that I've met in the hospital are custodial or non clinical staff, including but not limited to patient transport an environmental services.
• 22:18They don't directly interact with the clinical teams, but they see us in passing.
• 22:23Some team members will acknowledge them others, not so much.
• 22:28Whether or not, we do.
• 22:30Their knowledge us.
• 22:34The clinical team members I mean?
• 22:36They had to.
• 22:38We're often in their way.
• 22:42We filled the trash cans, they have to empty we summon them to transport patients through the next procedures.
• 22:50What they see when they look at us can dictate how the acknowledges?
• 22:54Some greet us with a smile.
• 22:57Another simply yell excuse Maine.
• 22:59While wearing their away.
• 23:02I would venture to say that my residents black lives matter pen might signal something to any passerby custodial staff.
• 23:11A sort of acknowledgment of the plight they face outside of the hospital.
• 23:16Braving the racial plunder that takes ship in innumerable ways.
• 23:21Or even within the hospital feeling invisible these RV colleagues higher up the hierarchy.
• 23:28I've heard others suggest wearing political symbols in support of one group might offend another group or even garner indignation I get it.
• 23:40That's maybe why I haven't mustered the courage to put such a pin on my white go.
• 23:46To avoid the potential confrontation with the disavowing colleague or patient.
• 23:52Of course I can't kill the dark you off my skin like one might take a pin off in certain circumstances.
• 23:59And my presents itself, my conjure the same confrontations.
• 24:05So I know this residents primary audience when he put the pin on his key chain years ago was his patience.
• 24:13But as a team member I too, felt a positive signal.
• 24:18It goes a very long way.
• 24:21So thank you for your pin.
• 24:48Next door will be.
• 24:53Graduating resident from our traditional program seems to be GI fellow at Brigham and Women's Hospital in our story is vertical to horizontal.
• 25:08I suddenly began having stabbing left sided pain.
• 25:12It felt like someone reached into my chest and was twisting my left lung.
• 25:19I couldn't take deep breaths.
• 25:21I felt like I couldn't get enough air.
• 25:25Every time I inhaled there was an electric shock between rib 6:00 and 7:00 and 7:00 and 8:00.
• 25:33I clutched my left side drag myself out of the call room and walked to the workroom.
• 25:40Within those few 100 feet the pain was unbearable.
• 25:44I could no longer safely care for patients.
• 25:47I signed out and walked home.
• 25:51I had never walked so slowly.
• 25:55With so many pit stops.
• 25:58It felt like I had no air to breathe.
• 26:02After each block I needed to lean against a building.
• 26:06To get enough air in Enerji to make it home.
• 26:09I stopped at the bus stop on York Geronimo's on crown and Pacifica on college.
• 26:17The next day, I was still short of breath.
• 26:20I went to the emergency room.
• 26:23As I sat there, it felt like my heart was beating out of my chest.
• 26:27The nurse said did you just walk hear your heart rate is more than 1:30?
• 26:34My Ed provider asked me well, what do you think you have?
• 26:41As a resident this seemingly benign statement made me feel helpless.
• 26:46I knew something was seriously wrong with my body.
• 26:49I just didn't know what it could be.
• 26:52They sent me for a see T chest.
• 26:55There was a collection of fluid on the left side.
• 26:58I was terrified.
• 27:01I was admitted to the floor, but not just any floor a medical resident floor.
• 27:07A floor where I would know all of the doctors taking care of me.
• 27:12It was overwhelming to have attendings?
• 27:15Residents who are my friends and nurses who I worked with so closely.
• 27:20Not only know the intimate details of my medical history.
• 27:24But also bear witness to the scariest moment of my life.
• 27:29I was no longer the resident obsessively annotating my sign out. I was now the patient with too much knowledge.
• 27:37The differential diagnosis was overwhelming.
• 27:40And bad.
• 27:422 chest tubes and a pain pump later, I found myself in the CT surgical step down.
• 27:48In the far left corner room, a room. I had often walked into as a resident taking care of my own patients.
• 27:56Surrounded by neighbors with Al Vads and those awaiting heart transplants. I was seen as an able bodied young person.
• 28:04Perfectly capable of completing my activities of daily living.
• 28:09The reality was with three tubes coming out of my body. I couldn't walk to the bathroom, let alone get out of bed.
• 28:17I was keenly aware that my body wasn't the body that I knew.
• 28:22And needing to ask for help felt shameful.
• 28:25I knew I looked healthy in comparison.
• 28:29I was now that patient who was unable to shower, because of wires and tubes.
• 28:34I was that patient with the humiliating smell of a sweat drenched gown.
• 28:39I felt disgusting.
• 28:42I was that patient you had to encourage to eat because I was perpetually type a partic from hypovolemia and fear.
• 28:50I was that patient who would eat only one thing lemon ices.
• 28:55I was not patient who will miss this all also got her period.
• 29:01I was embarrassed to ask for help from nurses with whom I had worked so closely, but they were kind and perceptive.
• 29:08They told me which drinks were highest in calories and suggested what flavors I might like.
• 29:13The naked mighty mango protein drink. I can't even look at it anymore without getting nauseous.
• 29:21They gave me pep talks. They even ordered new curtains, so that all of the windows could be completely covered when I use the bedside commode.
• 29:30I felt helpless gross and physically and emotionally naked.
• 29:36The nurses place, the chest tubes and pain pump on my Walker and Tide my down so I could walk from the hospital room to the bathroom without feeling exposed.
• 29:46I would walk from that corner room in the CT surgical step down along the long corridor to the bathroom.
• 29:53It felt like miles at first.
• 29:56I would open the bathroom door and place. My Walker to my left.
• 30:00Being careful not to talk on my chest tubes or my pain pump.
• 30:04I would sit down and feel defeated.
• 30:07That short distance tired me out completely.
• 30:12The first time I didn't feel like a patient. I owe to a volunteer violinist who played holiday music.
• 30:18The beautiful sounds made me feel human again.
• 30:22Something I hadn't felt since becoming a patient.
• 30:26I cried as the sounds filled my room.
• 30:29For a brief moment I wasn't alone.
• 30:32I was a person sharing an experience with other people.
• 30:37It was the little moments that mattered my friends who brought me food that reminded me of my childhood even if I ate only one bite?
• 30:45My partner who brought me underwear and remind me when to change my tampon in a place where time was nonexistent.
• 30:54As I walk through the words now 6 months later, I am keenly aware that I am vertical again.
• 31:00But continue to see my patients through the lens of when I was horizontal.
• 31:05I have been there desperately afraid wanting answers sooner than they are available.
• 31:11And anxious to going back to being myself.
• 31:15We see people on the worst day of their life, even when it may just be another day in hours.
• 31:47Karen next presenter will be doctoral China Ekiti Opi Assistant Professor and General Internal Medison Infectious disease kind of her story is ideal.
• 32:09Do you know how to say orev wah in Swedish?
• 32:13His eyes light up like Crescent moons cataracts, gleaming and shimmering with childish joy.
• 32:20His lips pulled back in a smile teeth browned and loosened from their foundation.
• 32:26His mind having turned thought after thought for 95 years can't possibly keep up now, so he asks me this same question during every clinic visit. I smile and pretend I'm answering for the first time every time.
• 32:43No how do you say it in Swedish?
• 32:47Over the years his visits to the clinic have become less about the monotony of receiving his medical diagnosis.
• 32:54We don't spend as much time reviewing his chart.
• 32:57We feel a certain lack of direction in managing a patient who has outlived the average life expectancy.
• 33:04In the race of life, he now runs alone.
• 33:08His days are filled with the deafening silence of an extended existence.
• 33:12A contrast with the past that was filled with jubilant noise.
• 33:16The sound of a babies cry.
• 33:19The sound of his wife's voice.
• 33:21Or the sound of water, clearing his course when he swam.
• 33:25Crowds would gather so watching optimism as he competed in swim competitions in college.
• 33:31Cheers booing his fish like frame.
• 33:34But the muscular arms, I imagined he once board, said power through the length of an Olympic sized pool now hang by his side languid and devoid of their previous purpose.
• 33:47As I listened to him, I notice that his memories begin from afar as if on the horizon.
• 33:54They stop halfway to shore where he now stands in the present moment.
• 33:59He recalls days on the battlefield during World War 2 arms tight around his rifle orders from his superior officer echoing in his head his gaze hardened and focused on a common enemy.
• 34:14He recounts his cherubic Swedish mother sucking sleeves of knack abroad in his pocket and image to his heritage as she ushers him to grammar school. This scent of the crispy bread still fresh in his mind.
• 34:29But he struggles to recall remnants of a conversation we had just 10 minutes ago.
• 34:34His distant memories are as clear as the waters he once we did.
• 34:39Yet they keep him trapped in a space that no longer exists.
• 34:43As we converse, he has difficulty accepting his loneliness.
• 34:48His wife has been gone for more than 10 years, he carries the weathered photo of her in a folded Brown wallet.
• 34:55The edges of the photo missing as if eaten by moths, while the subject remains timeless and whole.
• 35:02His eyes glisten and his voice cracks as he tells me how much he still misses her laugh and her memory.
• 35:11I find myself thinking about men his age, I knew growing up in Nigeria.
• 35:16In my culture, the IBO culture, these men were called elders.
• 35:22On celebratory occasions, they would be enshrined an elaborate cultural attire.
• 35:27Native jewels and beads decorating their wrists, and next standing stoic strong and tall with our native talking drums, reverberating in the background.
• 35:39I recall how these men whose ages were never concretely known but presumed to near 100 were always revered an surrounded.
• 35:48And never alone.
• 35:51I wondered how conceptually different my patients life is from those elders.
• 35:56I wonder what impacts those adornments could have on the man with a ring before me.
• 36:02I have an instinct to reach out and touch his hand.
• 36:05The hand that still grips the weather at photo, but now rattles fearfully with affine tremor.
• 36:12I lack the words to ameliorate the painful silence that surrounds him sensors him in its grasp and consumes him.
• 36:20But I'm aware of the reprieve offered by these clinic visits where he can stand on a stage share his jokes and his memories and feel the intimacy of an audience.
• 36:31Even an audience of one.
• 36:34So I listened patiently I don't hurry him, along as his mind stutters to retrieve catalogs of experiences from his past.
• 36:44I try not to glance at the time on my computer screen afraid that 30 minutes has bled into the hour.
• 36:51I don't have a pen in hand, feverishly writing notes to keep up with a torrent of his stories lacking clinical relevance, but begging to be heard.
• 37:02I repeat myself more often than not louder each time willing my words and expressions to have meaning as much as his half for me.
• 37:12And each time we recreate the foundation of a friendship that fails, the plant roots in the sleekness of his mind.
• 37:22Growing up in Nigeria I was constantly surrounded by the immediacy of death by the potential of a life lift, too short and unfulfilled.
• 37:32Days were spent balancing the pursuit of purpose and the avoidance of an early death that one often turns a prayer as a potent mediator.
• 37:42Those whose lives stretched far into the distance like a thread pulled free from its pool were celebrated and honored in my culture.
• 37:52And as a result of their age. They were sometimes viewed as reservoirs of wisdom and guidance for those seeking such direction.
• 38:01Therefore, I had always seen it as an honor to live to near 100.
• 38:06Never once contemplating the parallel implication until I Met My 95 year old patient.
• 38:13In my culture, reaching this age was viewed as an honor.
• 38:18For my patient it was a curse.
• 38:23Azar clinic visits come soon end he tucks his wife's photo into the lip of his Brown wallet and picks up his cloth bag.
• 38:31While my thoughts on the purpose of life life scattered on the floor.
• 38:35He continues to share stories as though they've broken free from the dam of his subconscious.
• 38:41He asks me again, where I'm from and I answer him again as if for the first time.
• 38:47And like his scripted play where he knows his part by heart.
• 38:51He tells me again how he once had a friend from Nigeria.
• 38:56But this friends who like all the others has since passed away.
• 39:01And our visit is once more, punctuated by the theme of loneliness.
• 39:07As he reaches for the door handle no doubt feeling the guilty pressure of my anxiety to see the next patient.
• 39:14He turns around and in a loud voice, he asks.
• 39:19Do you know how to say Orewa in Swedish?
• 39:23By this time, I do.
• 39:27But I've learned to play my part.
• 39:30No, I say
• 39:32How do you say it in Swedish?
• 39:59Final presenter is Kareena Danvers, who's directed the New England aids education program and the title for stories 2 drops of blood.
• 40:21I remember when I was diagnosed October 10th 1989.
• 40:26I remember my doctors voice on the other end of the phone.
• 40:30Your results took awhile to get back. We had to send your blood to New Jersey for confirmation.
• 40:37You're HIV positive.
• 40:39We should talk.
• 40:41I remember thinking was, I just told that I'm going to die.
• 40:46In am I going to die, that horrible death like those men on TV.
• 40:52After the phone call ended.
• 40:54Like a very calm.
• 40:56Like a trapped animal planning its next move.
• 41:01Then I heard laughter coming from the office next door.
• 41:04And that's when I recognize.
• 41:06I was experiencing scruci aiding pain.
• 41:11I remember when the only thing I wanted to do was to kill myself.
• 41:15But at the same time.
• 41:17To live
• 41:19I remember going back to my doctors office, a few days later on a cool and dry and Crisp New England autumn.
• 41:27Day for another blood draw.
• 41:30This one to check the status of my immune system.
• 41:34I remember being informed on my doctor was going to draw my blood this time.
• 41:40I only learned later.
• 41:42That the staff at the lab was unwilling to do so.
• 41:47I remember my doctor gathering the equipment for the blood draw and casually mentioning that it had been almost 40 years since he had drawn blood.
• 42:03Exactly.
• 42:07I remember when he identified the vein.
• 42:10Tie the turnock it push the needle into the vein.
• 42:14Then he removed the needle from my arm and told me to press down on the vessel with cause.
• 42:20And then I remember that when he disposed of the needle a drop of blood fell onto the pristine floor.
• 42:29The drop of blood was mine and I drop of blood was HIV positive.
• 42:35I remember when the nurse manager who had been asked to come and clean the spill came rushing in.
• 42:42And a quiet environment of a minute earlier became a hazmat unit.
• 42:48I remember someone in lugging in a gallon of bleach and pouring most of it on the floor. The room, becoming instantly filled with harsh funes.
• 43:01I remember sitting on the exam table and watching my tiny little drop of blood.
• 43:07Dissolve into this lovely here of pink.
• 43:12I remember the floor drying.
• 43:15My neutralize drop of blood no longer perceived threat to human life.
• 43:21I remember walking out onto that Chris Autumn Day, wondering who would love me now.
• 43:28Would I be called unclean?
• 43:30Like a leper in the Gospel of Luke.
• 43:34I remember being told always use condoms do not get pregnant do not buy a house gain weight.
• 43:45This advice was imprinted in my soul and it has never left me.
• 43:51I'm unable to stop using condoms, despite the new data showing lack of transmission without hearing to medications undetectable viral load.
• 44:01I didn't get pregnant.
• 44:03I did buy a house.
• 44:06And I did gain weight.
• 44:11I remember going to Walgreens to pick up my AZT.
• 44:15Late at night to avoid anyone who might recognize me.
• 44:20Not anymore. Now I walk into Bernie's pharmacy on how are Ave and everyone knows my name?
• 44:27I remember how AZT made me feel nauseous fatigue, lifeless.
• 44:34So I'll stop taking AZT.
• 44:36I remember thinking, I have just giving myself a death sentence by stopping the only medication available to control my HIV.
• 44:47This scenario would be repeated many times with other unto Retrovirals.
• 44:53I remember how every T cell count was a dramatic event.
• 44:58Pure joy when the number went up.
• 45:01Total devastation when the number went down.
• 45:05Still, this.
• 45:07I remember every doctors visit was an event.
• 45:11Still is.
• 45:14I remember getting angry about having to take 30 pills everyday never break never break never break.
• 45:22Still, never break.
• 45:24But I'm not angry anymore.
• 45:27I remember becoming aware what HIV itself and it's treatments did to my body.
• 45:34I used to be pretty and sexy.
• 45:36Now I see a Buffalo hump, Skinny Lins.
• 45:41And a huge belly in the mirror everyday.
• 45:45I remember coming out of the HIV closet and speaking at school clinics and hospitals.
• 45:51Kids and adults were stunned that aids look like me and married working healthy looking heterosexual none. Ivy drugs drug using woman.
• 46:05I remember at some point I came quite pinpoint.
• 46:08Making peace with aids.
• 46:11I remember finishing my Masters degree and being name is direct or the aids education and training center here at yeah.
• 46:18I remembering Larry.
• 46:20My wonderful husband of 26 years.
• 46:24And I remember I remember signing up for my 401K.
• 46:31Imagine that.
• 46:34A woman diagnosed with a terminal illness in her 20s, now investing in a retirement plan that's how far we have come with HIV treatments.
• 46:45I remember feeling safe in the cocoon of Nathan Smith Clinic.
• 46:50The Donaldson floor and the work at the eights program.
• 46:55I remembered turning 50.
• 46:57I'm thinking now, what?
• 47:01I had not made plans for beyond 50.
• 47:07Then.
• 47:09I had a heart attack.
• 47:11LED 80% blocked.
• 47:14And I was reminded again of death and dying.
• 47:17Really?
• 47:18I had just gotten used to live in.
• 47:22Then.
• 47:24A second drop of blood.
• 47:2627 years after the first appeared.
• 47:30It happened during my first angioplasty in 2016, a drop of blood appear once again on a pristine floor at a medical facility. This time in the radiology lab a yell New Haven Hospital.
• 47:43Once again that drop of blood was mine and that drop of blood was HIV positive.
• 47:51I remember raising my arms for the procedure and my Ivy, becoming the sludge from my vein. I was instantly transported back to that. Crisp autumn day in 1989, wondering what would happen next.
• 48:05Another hazmat responds and more emotional pain.
• 48:09Excuse me, I said to the X Ray technician and a very quiet child like voice.
• 48:15My views lose and blood is coming out of it and there's blood on the floor and OK, he said. Please step aside and I can clean it and I will have someone come and fix your Ivy sorry about that man.
• 48:30Mam.
• 48:35Who are you calling ma'am?
• 48:39Do I look at all to you.
• 48:41As I said in my head and then I laugh out loud or cried or laugh and cried.
• 48:49S is 27 year seen flash and then vanished from my consciousness.
• 48:55I remember the blood being cleaned from the floor, not by a hazmat team with a gallon of bleach, but by a single X Ray technician with some hospital great wet wipes.
• 49:08I remember a nurse came in and fix my Ivy.
• 49:11And within a few minutes, we were back at the task at hand.
• 49:17On May 28th.
• 49:2020 days ago.
• 49:22I had my 3rd heart attack.
• 49:25On the bumpy ambulance ride to yellow New Haven Hospital. The EMT is about to put an Ivy on my left arm.
• 49:34I said to him, I mean to be positive, maybe we should wait.
• 49:40He didn't say anything.
• 49:42When he finished putting the Ivy in the pit area of the elbow, he said, and I quote.
• 49:50Not a drop of blood.
• 49:53Got spilled.
• 49:54Life is good.