I held her thin, shivering hands in my own as the anesthesia team counted down, three… two… one. Mrs. H closed her eyes and squeezed my hands as the epidural was inserted. She looked so tiny in that huge OR, donning a gown 3 sizes too big, her feet dangling from the side of the bed. “You’re doing so good…so, so good.” I whispered. She opened her eyes and smiled – hopeful and ever-trusting.
Earlier that morning, I had introduced myself to a scrub tech as a “brand new, first-day-on-the-job medical student.” “Ha!” he said. “This case on your first day? I’m sorry it’s so hopeless.” I must have instinctively furrowed my eyebrows because he followed with, “It’s just that she’s so old and so sick. I wouldn’t waste my time on her. And her kind of people – they like to complain.” he laughed. “Although her accent is so funny you probably won’t understand what she’s complaining about anyway.” Mrs. H is a 74-year-old black woman from Barbados. On her chart, she looks like a sickly woman with a “poor diet” and “non-compliant on her hypertension meds”. In reality, she was a proud matriarch of her family, a huge fan of The Price is Right and someone who truly wished the best for everyone – even our “orange President man” – she once told me on an afternoon walk. She was also fighting stage four uterine carcinosarcoma with metastases to her bowel and liver. At the time of her surgery, I didn’t realize the impact of what that scrub tech had said to me. When we opened her up and started to dissect the regions around her cancer, I questioned if this would be worth it. At hour seven, I found myself wondering if this was really hopeless. Would she just “die anyway?” Would the recovery process cause a lot of strain on the nurses and dieticians and physical therapists who would be responsible for her care? Would she just go back to her old habits of poor eating and medication noncompliance? The rest of that week, Mrs. H taught me more about medicine than I have learned in all of my preclinical courses. I learned that I can’t always trust what is written on a chart. A “poor diet” may really mean “loss of appetite due to cancer,” and “non-compliance” may actually be due to adverse reactions. I learned that hopeful people could bounce back quickly. At just three days post-op, Mrs. H was walking up and down the halls. One day later, she was discharged. The same afternoon she was discharged, I went to see another patient, 29-year-old Ms. F, a black woman who suffered from AIDS, ESRD, sickle cell anemia, and actinomyces. She was a medicine consult, and I had been asked to take a full OBGYN history (my first ever on a real patient!), to see if we could remove her IUD. Her chart said she was “very irritable” and a “poor historian”. Part of me felt like my residents were sending me in to fail. When I walked in the room she was screaming “Another doctor? What do you want? I swear I’m going to rip this IV off and walk out of the hospital.” I was startled but told her I was just a student who wanted to take her history. She grumbled as I fumbled through the G’s and P’s in my notebook, asking her about pelvic pain and previous STIs. As I gained her trust, she started to calm down and tell me why she hated being in this hospital – she had a D&E here a decade ago and still felt guilty for losing her child. When I went to get gloves to examine her, her roommate, another black woman with sickle cell anemia, Ms. K, yelled out at me, “Ain’t nobody in this hospital treat us the way you do. I heard you talking to her, asking her questions. No one else asks us questions. They just come in and tell us we complain too much… You care.” I laughed and told her while I did care, I asked all these questions because I really didn’t know what was important, so I had to ask everything. “They don’t see us. You are white and I am black and all of you see us as monkeys. I’m not a monkey, I’m not a drug addict, I’m just someone looking for help. I didn’t choose to be this way. I didn’t choose to be black. I didn’t choose to be a sickler. This is just what my parents and God have given to me. People here like to blame me for being in pain. I’ve been slowly dying for 40 years now and no one wants to help me.” I couldn’t help but break down when Ms. K told me her story. I remembered zoning out during a lecture on pain control in patients with sickle cell disease during preclinical year, and now I felt like I was failing her. We took down the curtain dividing the two rooms and I listened as they told me about the injustices they faced as black patients every day, and the doctors who turned them away from care as their arms and legs were covered in ulcers. These women knew they there were not being treated humanely but had few alternatives for care. Ms. F and Ms. K approach physicians with suspicion and a deeply seated mistrust, which stem from mistreatment. This type of mistrust can lead patients to be noncompliant, further increasing the gap in health disparities we face. As I treat my patients this year and into the future, I will be holding on to everything these very first few patients have taught me. Having the best intentions isn’t enough. A doctor is much more than a dedicated clinician, she is also as a devoted humanitarian. Appreciating diversity comes with an appreciation of differences and an eagerness to learn from others. This is what I hope I’ll bring to the table as I begin to have an impact on patients.
0 Comments
|