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.