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Wednesday, April 25, 2012

Life at Grady: Complexities

The following post is adapted from the blog Reflections of a Grady Doctor, written by Kimberly Manning, MD, FACP. Names and identifying information have been changed to protect individuals' privacy.

I was sitting at the nurses' station typing my notes and minding my own business. It was smack in the middle of the afternoon so there were scattered residents, students and ward teams around the area. Some were rounding. Some were teaching. A few others were just hanging around tying up loose ends from the morning.

And me? I was just in my own world typing my notes into the computer. My own team was on call so I was left to do my work while they stamped out disease in other parts of the hospital. I looked at my ratty checklist and methodically marked off my boxes with each note.  I was completely in that getter-done mode; I was in that zone that others automatically know to not disturb.

"You need to go be with her ass then!"

This was what jolted me out of my note-writing groove. My head whipped up and I saw her standing there. A young woman with a hand on her hip and an elbow resting on the counter. In that hand she had a bedazzled cellphone pressed up against her ear tightly. Almost as tight as the expression on her face.

When I looked at her we locked eyes. It was my way of telling her that she was not speaking in an "inside voice" at all. And that, seeing that this was a hospital and all, she needed to.

She rolled her eyes away from me and dug back into that conversation.

"See now you 'bout to piss me off. That b---h called your phone and I saw it. You think I'm stupid. I ain't stupid."

Her voice was loud. Too loud to be standing where she was standing and saying what she was saying. I looked up at her again. Trying my hardest to communicate with her through my searing eye contact.

Another eye roll.

"I tell you what! Tell that b---h to come within two feet of me so she can see what I got for her. Naw. . y'all both got me f--d up!"

That f-bomb grabbed the attention of everyone within earshot. She ignored the glares and snickers and kept on going. More f-bombs and even the n-word. Repetitive. Loud. Unfiltered.

And embarrassing.

There were easily twenty people who heard her. And of those twenty people, I was the only one there who looked like her.

Here I was sitting there in my white coat and professional attire trying my best. After walking around and seeing patients who smiled so deeply and with such pride to see me, their doctor, standing before them. Touching the hands of Grady elders and pulling my shoulders back a little more because I know that I am representing many of them, too. By doing things that were never even options for them to do.

(Click "more" below to keep reading.)

Yes. This is something I have strapped to my back while working at Grady. This responsibility to provide a different kind of insight into black people. Through my actions and the things that I at least try to do. And on many days? I feel like it's working. I feel like somebody is looking and listening and thinking, "Hmm, this was not my impression of black people, but now perhaps it is." Or instead of that,  just some kind of realization that we are far more alike than we are different.

And then this. This young woman with a frighteningly unnatural hair color stomping her feet and hollering into a cell phone. And as if it couldn't get any worse, when I got up from the nurses' station and walked around the counter I saw that she was gripping the hand of a very confused-looking toddler.

Yes.

I thought about approaching her and saying something. But initially decided against it since the last thing I wanted was to let those twenty people witness two black women arguing in the hallway at Grady. So I walked by and cast my eyes in her direction once more. She kept on with tearing that person on the other end of the phone a new you-know-what--despite me or anyone else hearing.

I walked down the hall and then paused. Before I could talk myself out of it, I did an about-face, forward marched right up to her and then stopped. I softly touched her shoulder and also softened my voice.

"Would you be okay with stepping into the family waiting area? Some of the patients can hear you and your conversation sounds pretty personal."

I braced myself for her to say something back but she didn't. Instead she huffed away and into the corridor toward the family area. Still swearing. Still loud. And still with that baby in tow.

And everyone just sort of stood there watching but instinctively not saying anything because I think they knew not to. Perhaps they knew me well enough to know how I was feeling. Or maybe her behavior was so inappropriate that the moment was far too awkward to even comment upon.

I don't know.

I do know that this is one of the things that makes being black so complicated. There is sometimes this self- hatred that creeps up if you aren't careful. This thing where folks who have been given opportunities and guidance and parenting grow further and further away from those who don't. Chris Rock once built an entire stand-up routine on this notion. Which in some ways was very funny, but in the deepest ways was not. At all.

Especially since the whole world was laughing, too.

Over time I have learned that there a lot of folks that don't like black people. Regrettably, more of those folks than many realize happen to be black, too. Just ask Chris Rock.

So I thought about that moment a lot after it happened. I reflected on that toddler standing next to her as those expletives flew off of her tongue with out the tiniest concern for those pre-school ears or any other ears. Then I wondered whose hand she had held as a toddler and what she had heard.

Probably something identical.

It sucks that history tries so hard to repeat itself. And it sucks exponentially more that without a whole bunch of fight, that it almost always wins.

So we have to fight. But fight for all of us. Not just our own kids in our own houses.

After writing my notes, I headed to the elevators. I pushed the button to go down and sighed. It startled me when I looked over to my right and saw her still sitting in the family waiting area. Off the phone now and wiping her daughter's face with a wet wipe. An ironically mundane scene after what I'd witnessed earlier. I took a deep breath and approached her.

"Hey little sister . . .I didn't mean to get in your business like that. . .I just. . . yeah, it just sounded . . . . personal."

"Tha's okay, " she replied. Her voice was surprisingly pleasant. "I just got a lot going on. Sorry I was loud."

And I stared at her and wished that I could sit right next to her and talk to her for four more hours. About why she was even in that conversation and what it could mean to her daughter to hear and see things that could rob of her innocence. I wanted to hold her hands and tell her that she was beautiful and full of promise. And that we are no different except that I was born to William and Cheryl Draper and she was born to whomever she was born to. But, still,  that we were one and the same and that we needed to fight. Together. That's what I wanted to tell her.

But I didn't. Instead I just smiled and said, "I hope everything works out for you. I really do, little sister." And I really did call her "little sister" because that helped me to see her that way instead of hating her.

Because hating her would be hating me.

Yeah.

You know what? I love being who I am. But sometimes? Sometimes it's kind of hard.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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