Black Man in a White Coat (12 page)

In death, Lucy had become part of a set of troubling racial data. Black women are more likely to die from heart disease than white women at all ages; this disparity is more prominent in women under sixty-five. In life too, Lucy had been a walking billboard for health disparities: hypertension and diabetes are far more common in blacks compared to whites, and black women are almost twice as likely as white women to be obese. Together, hypertension, diabetes, and obesity had surely conspired to cause the heart attack that Lucy suffered right before our eyes.

From what I'd seen there and elsewhere, she probably hadn't been getting the care she needed. Some of that was likely the health system's fault—impersonal, inefficient, inferior care. But much of it surely stemmed from Lucy's cultural surroundings—unhealthy diets, less exercise, and a lower likelihood of following medical advice. All too often, patients at Grady delayed treatment until forced to come to the emergency room. By then, it was often too late.

These public health facts and debates were far from my mind at that moment. Instead, I kept thinking about how her chest pain began during an argument with her son. This dispute had ultimately been the trigger, or tipping point, in her rapid descent from life to death. According to the paramedics, he had gotten into some serious trouble.

As I stood next to Dr. Collins while he completed a “death note” summarizing the medical events of that morning, the charge nurse approached us: “The family is in the waiting room,” she said.

Dr. Collins looked over at me and back to the nurse. “Tell them we'll be right there.”

A few minutes later, we stood face-to-face with Lucy's family. They met us in the main waiting area, where dozens of black people crammed their bodies onto rows of hard vinyl seats bolted to the floor. Pam, Lucy's older sister, took the lead. Her complexion was a shade lighter, but the resemblance between her and Lucy—broad nose and thinning hair—was evident. They shared a body type too: Pam's short frame carried 100 pounds more than needed. Behind her stood Lucy's daughter Wanda, a mid-twentyish, trimmer version of her mother and aunt. Missing was the son who had helped set off this chain of events. Wondering where he was seemed easier than thinking about what Dr. Collins had to say.

“How's she doin'?” Pam asked Dr. Collins after he had introduced us.

Her wide stare, sweaty brow, and shallow breaths revealed her panic. Dr. Collins paused as he measured his words: “Let's talk where we can have a little bit of privacy,” he said. “Please follow me to the family conference room.”

Pam and Wanda held hands. They knew this was bad news. I struggled to stay calm as we stepped toward the conference room, knowing that this family would soon be devastated.

Before we could close the door, Pam demanded to know about her sister: “Tell me how she is doing.”

Dr. Collins glanced at his hands briefly. He then looked up to Pam and then to Wanda. Finally, he took a deep breath. I braced myself for their reaction. “I'm sorry to say that things did not go well…” he began.

“What do you mean?” Wanda asked, her eyes pleading. “She's still alive, right?”

“No … I'm afraid not,” Dr. Collins said softly. “We did everything that we could, but she went into cardiac arrest and died about thirty minutes ago.”

“Lord Jesus…” Pam moaned, her knees buckling slightly for an instant.

“This is … bullshit…” Wanda screamed. “What kind of damn hospital is this?”

By this time, I'd seen enough misery and death to know that anger and blame were natural reactions for many people. But Dr. Collins seemed unfazed.

“We're very sorry for your loss,” he gently answered. “I can assure you that your mother received the best care possible.” I silently agreed. Everything they'd done here was exactly how I'd seen it work in the state-of-the-art cardiac care unit at Duke. Sometimes medicine is simply powerless against the wickedness of disease.

“This is Tony's fault,” Wanda said, rapidly shifting the target of her fury. “That dumb ass. Mama told him to stay out of trouble, and he couldn't keep his stupid ass straight.”

We figured she was talking about Lucy's son. “Can you tell us what happened this morning?” Dr. Collins asked. “We heard that there was some kind of dispute?”

Pam's rapid breathing made me fear that she might soon need medical attention herself. Leaning against the wall for support, she managed to compose herself long enough to answer, “Tony … Tony's her son. He been in a lot of trouble. He was on probation. But almost done. He was at a party last night. Somebody got shot. They arrested him this morning. Lucy … Lucy's chest started hurtin' right after they took him away.”

Pam broke down in spasms of tears and moans. Wanda reached over and hugged her. Dr. Collins and I looked at each other, helpless. Though we were standing in an emergency room, and Lucy had died from a medical problem, its context was social. The stress of her son becoming a statistic, another black man locked up, had been too much.

Neither of us could relate. Dr. Collins later told me that he'd grown up in an all-white Connecticut suburb and attended private schools his entire life. The most heartache he'd ever caused his mom was marrying a Protestant girl (he was raised Catholic). Although my origins were grittier, I had always stayed out of trouble.

Dr. Collins answered Wanda's questions about her mother's care. He did his best to explain what had likely happened to her heart. By the time he finished, Pam had regained some of her composure. “Can we see her?” she asked softly.

“Certainly,” he said.

We led them to the room where Lucy had been treated. Since the end of the code, the nurses had largely restored it to its prior appearance. At the center, Lucy's body was covered with a white blanket from the neck down.

We remained outside while they entered. As they approached, a nurse stepped aside. Pam immediately rushed to the head of the bed, while Wanda hesitated and stood back. As she ran her hand across Lucy's face, Pam leaned over the lifeless body. “Oh Lucy … my baby sis…” she cried out, sobbing.

Wanda's anger abruptly washed away: “Mama…” she wailed, as she fell to her knees.

I was intensely uncomfortable in the midst of their sorrow, as though I needed to step away and pretend that it never happened. This was the sort of situation our professors didn't—or perhaps simply couldn't—adequately cover in their textbooks or lectures. I looked over at Dr. Collins to gauge his reaction, but his poker face gave no clue to his emotions. As sister and daughter moaned in grief, we stepped away and headed to the main area in search of our next patient. There were other people waiting to be seen. We'd done all we could for Lucy, and it hadn't been enough. I hoped it would be different with the next patient.

*   *   *

The four-week emergency medicine rotation took me through day and evening shifts in a variety of settings—an academic hospital, a small community hospital, and a children's hospital. But I spent the majority of my time where I'd met Lucy and her family—at Grady Memorial Hospital, Atlanta's public hospital and primary trauma center.

Grady reflects the best and worst of American medicine. Founded in the early 1890s shortly after the death of its namesake Henry W. Grady, a prominent Atlanta journalist and businessman, Grady had a core mission to provide emergency care for the entire city. And it has done that over the years, sometimes to national acclaim. During the 1996 Summer Olympics, more than a hundred people injured in the Centennial Olympic Park bombing were treated at Grady. Less than a year before my arrival, a securities day trader in the city's upscale Buckhead district went on a shooting spree and killed nine people in two buildings. Seven of the twelve surviving victims were taken to Grady. Not long after I passed through Grady, supermodel Niki Taylor sustained near-fatal injuries in a car accident, spending nearly two months there on her way to recovery. If you were shot, stabbed, or otherwise critically injured in or near Atlanta, Grady was the place where you wanted emergency treatment.

From its outset, Grady's other core mission has been to provide care for the poor. And here too it has received national attention, but not always the flattering kind. During the period of my medical and graduate training between 1996 and 2007, Grady was caught in the vortex of political and economic forces that caused hundreds of public hospitals in the United States to close: rising numbers of uninsured and Medicaid patients, stagnant or decreasing state and federal budgets, and increased competition from private hospitals for paying customers who subsidize charity care. Each year, Grady lost millions of dollars. By 2007, it owed more than $70 million to Emory and Morehouse, whose medical schools supply the hospital's doctors. Grady was on the brink of financial collapse. And while good doctors like Dr. Collins meant that individual patients, such as Lucy, received top-notch care at Grady, problems were evident. Major publications featured stories about the hospital's impending demise, the kind that had befallen D.C. General Hospital in 2001 and Los Angeles's Martin Luther King Jr./Drew Medical Center in 2007.

But at Grady, the patients kept coming. Throughout the early 2000s, the emergency room averaged about three hundred visits per day. More than half of those patients had no insurance; an additional third were on Medicaid. Almost all the patients were black. Despite its shortcomings, Grady remained the best hope for people in dire financial straits.

Even more important to its survival, Grady remained the destination of choice for those with life-threatening wounds, and the Atlanta area had no shortage of such cases. During this same time period, between 3,000 and 3,500 trauma victims were admitted to Grady each year. About two-thirds of them suffered from blunt trauma—usually a car accident—while the remaining third came in with gunshot or stabbing injuries.

I saw one such victim, Sean, midway through my rotation. I'd been assigned second shift in the trauma wing. At first, things were so slow that Dr. Mason, the faculty supervisor, and Dr. Stephens, the third-year emergency medicine resident, spent several minutes talking about the current NBA season. Gradually, the conversation shifted to medicine. They asked me about my career goals. I told them that I was leaning toward cardiology but was planning to stay in school a bit longer to study health policy or public health. Seeing how difficult Kerrie's medical internship had been—thirty-six-hour shifts were common—gave me pause about jumping headfirst into that life. I wanted to have a satisfying career without torturing myself.

“Sounds like you're in the right place,” Dr. Mason said. “Get a degree in public health. Emergency medicine is a good fit with that. Especially for people like us and our community.”

“People like us”—I'd last heard that expression four years earlier, when I stood in a similar position, back then applying to medical school. On both occasions, the focus rested more on my identity as a fellow black person than as a future medical colleague.

Dr. Stephens agreed with his boss. “I thought about doing radiology or dermatology, you know, the specialties that pay a lot without you having to work too hard. But those were kinda boring. And they're removed from the day-to-day life of black folks. I wanted to get my hands dirty while being in a position to try and make a difference for my community.”

At Grady, unlike at Duke, I regularly worked with black doctors. I estimated that about 20 percent of the doctors were black; whereas at Duke, the number was less than 10 percent. Part of the discrepancy was the emergency room setting, which likely drew black doctors for the reasons Dr. Mason and Dr. Stephens stated. Morehouse, a predominately black medical school, also sent its doctors to Grady. Moreover, Atlanta's reputation as a mecca for well-to-do blacks also added to the hospital's appeal to black doctors. Dr. Mason, from Queens, New York, and Dr. Stephens, from Chicago, trumpeted the philosophy often used to justify affirmative action in medical school: black doctors were more likely to practice in areas that served black patients.

Our conversation about race and medicine was abruptly halted as a nurse approached us: “Got a GSW on the way,” she said.

Despite enjoying crime and medical shows, I didn't recognize the abbreviation at first—GSW was short for gunshot wound—because I hadn't seen any cases at Duke.

“How old?” Dr. Stephens asked.

“Eighteen,” the nurse replied. “He took at least one to the abdomen.”

Dr. Mason shook his head. We rushed to the trauma bay, where nurses and a respiratory therapist checked various equipment and supplies in preparation for the patient's arrival. About five minutes later, the paramedics wheeled Sean into our area. He was awake, but barely, his eyes flickering open and shut. He'd likely gone into the early stages of shock.

Dr. Stephens, two paramedics, and a male nurse carefully but quickly moved him from the gurney onto the trauma bed as Dr. Mason supervised their actions. We were soon joined by a trauma surgeon. With three doctors on hand and at least that many nurses, I stood toward the rear as they rapidly assessed Sean from head to toe. Dr. Stephens used industrial-strength scissors to cut through Sean's bloodstained Air Jordan sweatshirt and Nike sweatpants. A nurse hooked him up to a cardiac monitor, inserted a second IV line, and drew blood. Dr. Stephens then inserted a large caliber IV into the femoral vein in Sean's groin area that allowed rapid replenishment of blood and other bodily fluids. Dr. Mason shouted orders for medications and X-rays.

“What happened?” the trauma surgeon asked.

A fight had broken out on a basketball court in one of the worst neighborhoods in the city. Somebody came back with a gun and started shooting.

On the X-ray it looked as if one bullet had punctured the inner depths of his abdominal cavity while the other hadn't. The doctors wouldn't know for sure until they opened him up, so Sean was rushed to an operating room. I followed Dr. Mason and Dr. Stephens into the physician work area as they began the paperwork.