Black Man in a White Coat (17 page)

The verdict was in: Chester was dying, and dying fast. The only question that remained was whether he could go home to spend his last days with family or would instead die in the hospital under a black doctor's watch.

*   *   *

During Chester's extended hospitalization, I admitted another man who openly doubted my competence because I was black. Only in this case, the patient was black too.

I had just come back from my morning outpatient clinic when the nurse paged me about Robert, our new patient. “He's a tough one,” she said.

“What do you mean?” I asked, feeling the earliest signs of a tension headache.

“Sickle-cell patient in a pain crisis,” she said. “He wants high doses of IV narcotics. But he's also got a history of cocaine abuse.”

People with sickle-cell anemia have a reputation in the medical community for what is called drug-seeking behavior. With an illness that is biologically based and very painful, these patients are often prescribed high-dose opioid painkillers that would render ordinary people unconscious. I had briefly rotated through a sickle-cell clinic in medical school, but the people that I saw there didn't fit the drug-abusing stereotype. If anything, they wanted to minimize their pain medications while their doctors encouraged them to take more. They took care of their health, held steady jobs, and seemed to have stable families. In the words of the doctors treating them, they were “high functioning.”

However, I saw the contrast when I rotated through the Grady emergency room. There, the sickle-cell patients engaged in common drug-seeking behavior: requesting early refills with stories about “lost” or “stolen” prescriptions, demanding a specific type and dose of medication, and traveling from one clinic or emergency room to another in search of their favorite drugs.

From the nurse's description, it sounded as if Robert veered more to the “difficult” side. When I walked into the room, he was at the sink washing his hands. He was five-nine and weighed less than 150 pounds. Plastic tubing that connected to an IV pole snaked into his vein and delivered narcotics, fluid hydration, and antinausea medicine. When I introduced myself, he immediately interrogated me.

“Does anyone in your family have sickle-cell?”

“No,” I said. This seemed to me a fair question, since it's far more common in blacks.

“What do you know about the disease?” he asked.

I suddenly felt defensive. In a casual conversation, I could have recited at least a dozen facts, but I stumbled under his scrutiny: “What do you mean?”

His sneer was penetrating. “Man,” he said, shaking his head. “Ain't this some shit?!”

“What do you mean, sir?”

“C'mon man, we both know what the deal is. I'm sure you did good in school and everything, but they're passin' you off on me. And they think I won't care because I'm supposed to be a dumb nigger. Go tell your boss I don't want no black doctor.”

I was suddenly aware of how tight my tie felt around my neck. “But sir…”

“I didn't come all the way to Duke to see no black doctor unless he's some kinda expert. I could have stayed home if I wanted to see a country ass doctor. I ain't gonna be no guinea pig.”

Dazed, I retreated a half-step. I felt my heart thump and blood pulse through my ears. In the clearest of terms, Robert was saying that black doctors were incompetent, and that I was the latest example.

It had been years since I had heard this stated so bluntly. Growing up in a working-class black community, subtle and not-so-subtle references to black inferiority were everywhere. Whether it was a communal preference for Asian merchants over black ones, or my grandmother's assertion that a Jewish doctor was better than a black one, the feelings of inferiority infected me like a disease that kept recurring, no matter how much I washed my hands, got the proper rest, or took the right medicines. With years of success, however, I had started to fight off this virus and develop at least a partial immunity against further attacks. But Robert had essentially coughed this nasty germ right back in my face.

In
The Big Picture
, Ben Carson recounts the difficulty he sometimes faced in earning the trust of certain black patients early in his medical career, writing, “They automatically assumed I had gotten my position not because I was qualified but because I helped meet some quota.” Otis Brawley, who trained a few years after Carson in the mid-1980s, echoed these feelings: “Black patients' prejudice against black doctors endures, now more as a fear that you got where you are not by brains and rigorous training but because of an affirmative action program.” Nearly two decades later, Robert seemed to be reading from this same self-doubting racial script.

In addition, with his use of “guinea pig,” Robert was also trumpeting the pervasive belief held by many blacks that the medical system wants to experiment on them. This is not bizarre paranoia; it is history. The Tuskegee syphilis study remains the classic example. There, the federal government staged an experiment where they watched hundreds of black men suffer and die from syphilis over a forty-year period (1932–1972) without treating them, even after curative treatment (penicillin) became available in the 1940s. These men were not told that they were in a research study. Nor were they ever told that they had syphilis or warned about possibly transmitting it to others. In recent years, popular works have explored how the Tuskegee study was not an isolated incident, but rather part of a larger sordid history of research abuses toward black Americans.

Even in present-day medicine, faint echoes of experimentation linger, as medical students and residents at many programs hone their skills on a disproportionately poor and black patient population. So for Robert, the son of modern-day sharecroppers, raised in a rural region of North Carolina in the era of Tuskegee, the idea of an inexperienced black doctor being responsible for his care had him on the attack.

After my initial stumble, I rallied and rattled off various data about sickle-cell anemia. For every question Robert had about one of his medicines, I answered, confident of my medical knowledge. This test of my competence probably took five minutes, although it felt much longer.

Evidently, he was impressed. “Forget what I said about changing doctors,” he said. “We'll see how things go.”

Over time, Robert seemed to look forward to our visits as he opened up to me about his life. He was divorced; he had a seventeen-year-old son who was being recruited to play college football. We shared a passion for Al Green's early music. On the medical side, his symptoms steadily improved. By the end of a full week, he was ready to go home. On the day of his discharge, he pulled me aside after the rest of the medical team had moved on to the next patient.

“Sorry how things started with us,” he said.

“No worries,” I said, as we shook hands. “Take care of yourself.”

“I wouldn't mind havin' you as my doctor when you get all finished up.”

Robert had paid me the highest compliment a patient could. Still, I was left with a bitter aftertaste. A white doctor might surely catch grief from a prejudiced black patient, just as I had from Chester and his family. But I could not imagine a white patient ever telling a white doctor that he wanted to switch doctors for no other reason than their shared skin color. In some ways, this rejection was more painful, given what it said about how we felt about ourselves as a race.

*   *   *

With each passing day, it became less and less likely that Chester would leave the hospital alive. As days turned into weeks, Audrey became more involved in face-to-face interactions with the family. She wanted the daughters to sign a DNR order, which meant that when the inevitable came and Chester's heart and lungs stopped working, there would be no electric shocks or breathing tubes. Along with our faculty supervisor, she spent nearly a half-hour one morning with the family discussing this order.

Later that day, one of the daughters asked me for my thoughts. My instinct was to deflect the topic back to Audrey and our supervisor, but she already knew their opinion and wanted mine. I was so caught up in the strain of my clinical duties that I failed to see this as a sign of their trust in me until later.

“I guess in the end,” I started hesitantly, “you have to decide what you think he would want as opposed to what you might want for him or for yourself in his place. But that's hard.”

His daughters ultimately agreed to sign the DNR order. A few days later, Chester went into cardiac arrest. It happened on a Saturday morning when I was exhausted, my goal to complete my rounds quickly and get home before noon. Audrey and Gabe were off, so aside from the distant supervision of our faculty physician, I was on my own. I received a page from one of the nurses just as I was getting ready to leave. “Your patient in room twenty-six has died,” she said without emotion.

That was Chester's room number. “What?!” I said. “When did this happen?”

“His family just called a few minutes ago to say he had stopped breathing.”

I was about to scream in panic and rage before I remembered that this was the point of a DNR order: to allow the patient to die without tubes or electric jolts. “What do I need to do?”

“You have to pronounce him and make it official,” the nurse said.

“I'll be right there.”

In medical school, I had seen many doctors in these situations. Some exhibited grace and compassion, while others were simply inept or too detached to provide any comfort. Now it was my turn.

When I arrived at Chester's bedside, his family filled the room. Cloudy eyes turned toward me. I recognized his sister, daughters, and a few grandkids; the rest were unfamiliar. I introduced myself to those I didn't know as I made my way to Chester. His eyes were closed; a blanket covered him from the shoulders down. He had not been dead long enough to look different from how he appeared in life. My medical job was easy: I had seen it done more than a dozen times in medical school. I pulled back the blanket and placed my stethoscope over his chest, where I held it for thirty seconds—no heartbeat. Then I put my fingers across his neck while my ear moved close to his nose and mouth: he had no pulse and was not breathing. The outcome was clear: Chester was dead.

I looked up at his family, scanning from one to the next. “I'm sorry for your loss.” After I let that linger for a few seconds, I spoke again: “Does anyone have questions?”

I had grown so accustomed to asking this to family members of the living that it slipped from my mouth.
You idiot
, I silently berated myself. What question could they possibly have other than:
Why couldn't you save him?
Suddenly on the defensive, I braced myself for racially tinged criticism. But what came from their mouths was the opposite of hate:

“Thanks for all you did for my daddy,” Molly said.

“We really appreciate all the time you spent with him,” the youngest daughter added.

“Thanks, sir,” said Thomas, the grandson who, at first, with his Confederate-flag clothing and scary tattoos, had looked to me like a budding neo-Nazi. “My granddaddy liked you.”

I nodded, speechless. It was all I could do to leave the room without stumbling against a wall. Their kind words were what families used when they felt their loved ones had been treated with dignity. I'd never expected to hear those words from Chester's family.

I was proud of the way I'd handled Chester's case, but I was also left with a twinge of guilt. Though I was certain I had worked as hard as I could, motivated in part to show Chester and his family that I was a competent doctor, I knew that my clinical diligence ultimately had as much to do with wanting to impress Audrey and my other supervisors. Despite the flashes of humanity that Chester showed me toward the end, based on initial impressions, I had regarded him and his family as beneath me.

As many people do, I had countered prejudice with prejudice. In my eyes, Chester and his family were high school dropout, Dixie-flag waving, trailer-park trash. From childhood, the black community and the broader society had nurtured these feelings. Without much thought, I had adopted them as my own.

Yet here was Chester's family, heirs to his bigoted ways, offering nothing but gratitude. I now saw how even racists such as Chester were capable of making genuine, human connections with those they professed to hate. Whether that meant I could now come over for dinner or marry their daughter I have no way of knowing, but ultimately, I had played a vital role in something even greater—life and death itself—and Chester's family had left our encounter grateful for what I had to offer them.

 

6

When Doctors Discriminate

A few months after Chester's death, I got a close-up view of racial prejudice clothed in white coats.

It was midafternoon at the hospital. After a busy morning where I'd worked alone managing our patient caseload, the pace had gradually slowed. I was able to write my daily progress notes for the nine patients on our medical service without interruption, a rare occurrence. I was even able to sit down for a peaceful lunch in the cafeteria. My pager went a full hour without beeping. Fearing that I might miss an urgent call that one of my patients was in dire distress, I double-checked to make sure that the pager's battery hadn't died.

Finally, it went off. “Are you the intern covering for the Med-One team?” a nurse asked when I returned the call.

Bruce, a fellow intern, had been on call the night before. He'd left an hour earlier due to new national guidelines that capped hospital intern shifts at thirty hours, sparked in part by stories of tired doctors hurting patients. Before that, thirty-six-hour shifts were commonplace. Someone had to cover his patients, and on this day, that was me. “Yes,” I said.

“Mr. Warren is ready to be discharged,” she said, “but no one has written the order.”