From My Wandering Internet Reads
Just something a little bit different today that I found while reading techie stuff. The hurting of a person as described by one care giver.
There is nowhere Black people can go to not be inside a carceral gaze or at risk of experiencing police brutality. …And we, in healthcare, have to [start] building that sanctuary for folks as their human right.— Rhea Boyd1
A Perspective; “Without Sanctuary,” S. Michelle Ogunwole, M.D, New England Journal of Medicine
On an otherwise routine day in 2014, I walked into my hospital as a new internal medicine resident to find a patient I would never forget.
Ms. A. was the first patient with sickle cell anemia I’d treated. She was 28 like me, tall like me, Black like me. But there was one notable difference between us: she was admitted for a vaso-occlusive crisis and needed care, and I was the doctor assigned to care for her.
In the mornings when I prerounded, our conversations often drifted from pain management to ordinary things, like the misery of being trapped under the hair dryer at a Black salon, or our shared love of the chopped and screwed hip hop that originated in our home state of Texas. It struck me then that in another world, Ms. A. and I could have been friends.
But in this world, I was a doctor tasked with helping her navigate her health crisis. And in that pursuit, I fell short. Even in her hospital room, where Ms. A. came to find healing and relief, she could not escape White supremacy, police violence, or White indifference. Like many Black people in the United States, she had no sanctuary.2
The day I began that journey started normally. I walked into Ms. A.’s room to check on her and was surprised to find her sleepier than usual. After she dozed through my more vigorous attempts to rouse her, I checked her chart for recent opioid administration: none. I found her nurse and conveyed my concerns. As we considered possible explanations for Ms. A.’s sleepiness, the nurse offered a startling theory: perhaps Ms. A. had taken pain medication not prescribed by our team. Before I could fully weigh the implications of the suggestion, the nurse recommended calling security to check the room.
I hesitated. The recommendation felt hasty. But I was a new resident and lacked the confidence to trust my instincts and disagree. Instead, I followed the nurse’s recommendation.
In medicine, many decisions are necessarily time-sensitive. But that moment taught me that “tricky” health care situations often unfold even more quickly for Black patients, as clinicians move expeditiously to “have a bad feeling,” to escalate, to request backup — which often arrives in uniform.
The commotion of the security guards searching the room awakened Ms. A. I sat on her bed and relayed our concerns. Still drowsy, she replied, “I have a bottle of pain meds from home. They are all mixed together in one bottle…easier to carry.” I nodded, recalling the Ziploc bag with Tylenol, Advil, and Zyrtec in my own purse.
A few minutes later, the security guards announced their findings: a “suspicious unmarked bottle.” They needed to process its contents and would not return it to her.
Ms. A. sat up and demanded an explanation. Her anger was palpable. “Y’all don’t understand what I have to go through every day,” she yelled. “This pain is every day, people not believing me is every day!” She vehemently denied taking additional medication and threatened to call the police and report the confiscation as theft.
Thirty minutes later, uniformed officers arrived. Ms. A. paced the room as she explained the situation, her voice and emotion rising. I stepped out of the room momentarily to answer an urgent page. When I returned, I found the officers pinning Ms. A. to the floor with her hands behind her back. She flailed and shouted, as she tried to escape. I panicked when I recalled her platelet count from the morning labs. They were low enough for her to bleed spontaneously, and I feared serious injury. As I contemplated how to intervene, Ms. A. looked up and begged me for help.
In response, I begged her to stop fighting. I told the officers about her medical condition and asked if their actions were necessary, but I did not insist they stop hurting her. I did not protect my patient. I did not fight for her or the sanctity of that space.
Ms. A. eventually gave up. The officers let go, and the nurse escorted her back to bed.
In bed, she wept.
As I watched her cry, I realized how profoundly I’d failed her through my inaction.
Years later, the heaviness of that realization and the sound of her unanswered pleas still haunt me.
In quiet moments, I often reflect on how our society decides who deserves punishment and who deserves redemption. I think about grace, and how Black people get so little. I think about trust, and how Black people get so little. I think about benefit of the doubt, and how Black people get so little. And I think about the varied manifestations of Ms. A.’s pain — how no one, me included, offered her a sanctuary.
Since that incident, I’ve also thought about how I could have acted differently in that moment and in similar moments that followed. These reflections have coincided with a societal reckoning about the pervasiveness and harm of racism. Recognizing an opening for this critical conversation through the lens of the medical system, I began participating in a podcast series exploring antiracism in medicine.1 Our first episode focused on the nexus of racism, police brutality, and health. We explored police brutality as a public health crisis and began a difficult conversation about how health care providers participate in systems that reinforce the normative racist police ethic. As we discussed the absence of sanctuaries for
Black people, my mind was flooded with memories of Ms. A. As we ended the episode, I asked aloud, “How will I create sanctuaries for my patients?”
Soon thereafter, sent to assist with a patient’s preoperative blood-pressure optimization, I found Ms. Z., a 68-year-old Black woman, lying quietly in bed. When I introduced myself and asked her to tell me about her life outside the hospital, she lit up. She told me about her newest grandbaby, the recipes she perfected, and her love of dancing. The conversation eventually turned to more intimate territory: she was terrified of dying in surgery. “If I die, who will take care of my sick husband?” she cried. “Who will keep everything together? Who will protect them?” My heart broke for those questions, especially the last, which I knew revealed a fear especially common among Black mothers.
Though I did not have the perfect answer for Ms. Z., I had an idea for a small source of comfort. I asked if I could play one of my favorite poems for her: “Won’t You Celebrate with Me,” by Lucille Clifton.3 She agreed, and we listened together three times in silence. The last line, “Won’t you celebrate with me, that every day, something has tried to kill me…and has failed,” lingered powerfully in the room. We ended the moment with an earnest prayer that though this surgery was among those things that would try to kill her, it would fail.
As I left the room, I was overcome with emotion. I knew that what I had done was small, that it did not change the heaviness of the world Ms. Z. walked through every day. But it did create a space where she could temporarily lay her burdens down. And that felt monumental.
Imagine, I thought, if we all worked to create sanctuaries for our patients — in small patient-centered ways like poetry-filled rooms, but also in large systemic ways, like interrogating policies related to the interface between health care and the criminal justice system.4
Imagine if practicing medicine required an oath to actively dismantle systems of oppression and build sanctuaries in their place.5
Imagine if our Black patients came into our hospitals broken, tired, and weary, and instead of finding judgment and opposition, they found rest.
Human beings being what they are — identifying with others most like themselves — the surest way to protect Black people from police and other worries is the thing that is more important in itself than most of those other worries put together — get everyone on the same economic level. —–
Here is the fast and easy way how to that in America’s labor union desert — if anyone ever talks up the issue — anyone here want to talk up the issue? —–
https://onlabor.org/why-not-hold-union-representation-elections-on-a-regular-schedule/ —–
After I explained the American labor market to my late, more articulate brother John, he came back with: “Martin Luther King got his people on the up escalator just in time for it to start going down for everybody.” —–
Anybody?
Danger to Ethnic Citizens
please note that when central banks from around the world Tighten down the money supply there is still some fluctuation in money stock so that when money supply dips everybody hopes to buy more t-bonds but sell stocks, thinking that the smaller money supply will cause the economy to slow; but when money supply fluctuates upward everyone wants to dump their bonds and buy stocks. there is a tendency for people to put half their money into stocks half into bonds then fluctuate back and forth between the two depending on money supply conditions, very few people at this point want very much cash, but half stocks, half-bonds,
conversely when budget deficits increase the money supply to the point of a liquidity trap the gold, the T Bonds, and the stocks all have a positive correlation; they go up and down in unison. investors then can then only oscillate between cash and other things rather than oscillating between stocks and bonds. this means that most investors will have about half their money in cash half in stocks whereas before they had half their money in stocks half in bonds. in fact the liquidity trap shifts investment From gold and bonds Into Cash. There’s a greater demand for cash whenever money supply is Toulouse a paradoxical outcome of flooding the market with an oversupply of cash.
Strangely this perverse reflex adds volotility and instability to the entire economy.
within the heat of battle, chaos, and unpredictable random price movements folks everywhere lose their faith in capitalism, and the work ethic as they turn to demagogues and cult leaders who offer the promise to kill off ethnic people and restore order. think for example, the Weimar Republic, for example of Nazi Germany, for example inflationistos, communists, occupy Wall Street, occupy Capitol Hill, and MoB rule.
We got trouble in River City, trouble with a capital T.
Have we been warned? By Mohamed el Erian? Jeffery Gundlach? Cathie Wood? Larry Sommers?
There are better ways to insure full employment. Just ask me! Let me name the ways.
Justin:
Non sequitur, why is this here? 🙁
Difficult situation all around. In my reading of what was written, the Doctor is confessing to not doing something that would have required some courage to do but also something she knows she should have done in retrospect. But then she seems to shift the blame for her failure onto racism in society in general. And that part of it is weak.
It is like she is saying- if only society was not racist then I would never have had to choose to protect my patient or not.
There are times I know I should have had more courage and stepped up but did not. I consider those personal failures and don’t try to blame society for presenting me with that situation. But there are also other moments I am proud of. And it can make a difference.
Jerry:
Kind of agree with you since the doctor is responsible for her care and should have first asked her and warned her of why she was asking and the result. The patient might get angry at such but then she was warned. It is like someone crashing your house with no reason or illegitimate reasons>
There would have been a pitched fight if they did such with me. I hate going into the hospital and spent weeks there until they got permission to perform something with me. Drawing blood on a daily basis destroyed my left arm while on steroids and they did not give a damn. Even when you point out how they are harming you, they do not care.
I guess one could say the doctor had sympathy but she was not going to sacrifice herself to protect someone who could not do so.
I have said something at times and had to live it down with perverse return comments. My wife does not like when I question things.
Good point Jerry.
Thanks for sharing this. I forwarded the link to our Associate Dean for Curricular Affairs and our Vice Dean of Diversity, Equity and Inclusion. They need to push this out to our trainees.
Joel:
Thanks for your interest. This is a part of healthcare. When I was hospitalized for 3-1/2 weeks, the blood draws were the worst. The manner in how they drew my blood destroyed my left arm. It did not help that I was on steroids. Sometimes they would show up to draw blood in the afternoon and I would tell them no. My daughter the NP visited and got angry because they would not install a “pic.”
It is not my first rodeo with this stuff. I find many of them do not listen to patients on stuff like this or what shots I have had (on my yellow card). I rejected a shot of heparin because of my platelets. Finally the doctor came in and explained what they were doing and why it would not impact me. I only knew it as a blood thinner as I planned it at Baxter. They do not seem to explain why they are doing something or look at the medical record.
Yes, the business model is billing, not patient care. Each of us has to question what is being done to us, or we just become part of the throughput. The people who are tasked with executing the doctor’s orders neither fully understand their charge nor question the directions.
The post at the top of this thread concerns the interface between health care and the criminal justice system, which is different sort of problem.
Joel:
Yes indeed, which is why I chose this article to display. If you are referring to Denis, a black family with money will still be treated in a lesser manner. The same goes for a white family except at a lesser degree will they look down upon you. I have ben that route too and spent a small fortunate fighting back with a superior attorney who is the Dean of a well know School of Law because he believed. We still lost and we are rebuilding another’s life. Most cases are plea bargained. If you fight back by going to trial, the penalty gets worse. We were just a notch on somebody’s pistol grip regardless of the truth. The same holds true for a black family and to a greater degree.
Thank you for your comments.
It sounds like another victim of our war on drugs which was about opening and expanding a front in the race war. White drug users had medical problems. Black drug users were criminals. A patient taking pain killers and not telling her doctor, as in this account, can lead to serious problems, but this article shows exactly how the war on drugs discourages patients from answering honestly. Instead of getting proper medical treatment taking the existing use of pain killers into account, this patient faced further pain, criminal charges and who knows what else.
I can’t blame someone with sickle cell anemia for taking pain killers, and getting them on the street rather than through the medical system. Doctors typically avoid providing adequate pain relief to blacks, partly because they include skin color when assessing “opiate seeking behavior, partly because they don’t think blacks feel pain the way whites do.. I’ve read too many accounts.S ickle cell anemia can be horribly painful, and those who suffer from it have my sympathy and should have access to whatever it takes. (I’m white, and I’ve had my own problems with pain relief from corneal abrasions. Hint: 1 darvocet is roughly 1/2 an advil; 6 oz of Remy Martin is roughly 1 percocet. i would have preferred not to know that.)
P.S. It’s not just blacks, but anyone outside the approved upper middle class who has to put up with this kind of garbage from the medical system.