Black Man in a White Coat (36 page)

As physician Danielle Ofri writes:
See Danielle Ofri,
What Doctors Feel
(Boston: Beacon Press, 2013).

Black women are more likely to die from heart disease:
Adjusting for age, black women are about 1.4 times more likely to die from heart attacks than white women. Nearly 22 percent of deaths from heart disease in black women occurred before age 65; only about 8 percent of such deaths occurred in white women under 65. See Michele Casper et al., Women and Heart Disease; an Atlas of Racial and Ethnic Disparities in Mortality, Centers for Disease Control and Prevention, 2000;
http://stacks.cdc.gov/view/cdc/12169/
. See also American Heart Association, African Americans and Cardiovascular Diseases, Statistical Fact Sheet 2013 Update;
http://www.heart.org/idc/groups/heart-/files/15/45/38/f154538/public/@wcm/@sop/@smd/documents/downloadable/ucm_319568.pdf
.

hypertension and diabetes are far more common:
Hypertension is about 40 percent more common among blacks as compared to whites. In 2010, the prevalence of diabetes for adult blacks was nearly twice as much as for white adults. See High Blood Pressure Facts, Centers for Disease Control and Prevention, 2014;
http://www.cdc.gov/bloodpressure/facts.htm
. See also Minority Health, Black or African American Populations. Centers for Disease Control and Prevention, 2014;
http://www.cdc.gov/minorityhealth/populations/REMP/black.html
.

black women are almost twice as likely as white women to be obese:
During 2006–2008, nearly 40 percent of black women were classified as obese in contrast to about 22 percent of white women. See Liping Pan et al., Differences in Prevalence of Obesity Among Black, White, Hispanic Adults, United States 2006–2008,
Morbidity and Mortality Weekly Report
2009; 58 (27):740–744;
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5827a2.htm#tab1
.

Grady was caught in the vortex of political and economic forces:
For articles on the various troubles Grady experienced in the early 2000s, see “Portrait of an ER at the Breaking Point,”
Newsweek
, May 7, 2007; Shaila Dewan and Kevin Sack, “A Safety-Net Hospital Falls into Financial Crisis,”
New York Times,
January 8, 2008; Chris Megerian, “Night Falls on Grady,”
The Emory Wheel,
December 6, 2007; and “Three Part Series: The Past, Present, and Future of Grady Memorial Hospital,”
Creative Loafing Atlanta,
February 28, 2013, March 7, 2013, and March 14, 2013.

problems were evident:
For example, A 2006 study ranked Grady near the bottom nationally in the treatment of heart failure and pneumonia. Hospital inspectors around this time reported broken medical equipment, sanitation issues, and poor recordkeeping that threatened the accreditation the hospital needed to participate in Medicare and Medicaid. In the emergency department, wait times routinely approached eight hours, sometimes longer. See the citations in the previous note for further details.

between 3,000 and 3,500 trauma victims:
See Helen Kelley, Grady Hospital. Life and Death 24/7,
M.D. News, Metro Atlanta Edition
5, no. 8 (August 2004).

I estimated that about 20 percent of the doctors were black:
For an article examining the racial diversity within Emory University's Department of Emergency Medicine, see Sheryl Heron and Leon Haley, Diversity in Emergency Medicine—A Model Program,
Academic Emergency Medicine
2001; 8: 192–195. The authors state that when Emory's program was started in 1975, all of the faculty and residents were white. By 2000, however, more than one-third of the faculty was black, and more than 20 percent of the residents were black.

For black male teens, homicide is the leading cause of death:
See Arialdi Minino, Mortality Among Teenagers Aged 12–19 Years: United States, 1999–2006. National Center for Health Statistics Data Brief, No. 37, May 2010.

more than 90 percent of the time, young black homicide victims are killed by another black person:
See Erika Harrell, Black Victims of Violent Crime, Bureau of Justice Statistics, August 2007;
http://www.bjs.gov/content/pub/pdf/bvvc.pdf
.

blacks make up more than 40 percent of inmates:
See Heather West, Prison Inmates at Midyear 2009—Statistical Tables, U.S. Department of Justice, June 2010;
http://www.bjs.gov/content/pub/pdf/pim09st.pdf
.

talks often about his narrow escape from a life of crime:
See Sampson Davis,
Living and Dying in Brick City
(New York: Spiegel & Grau, 2013).

Many black men face this dilemma:
See Wes Moore,
The Other West Moore
(New York: Spiegel & Grau, 2010); Ben Carson,
Gifted Hands
(Grand Rapids: Zondervan, 1990); and Otis Brawley,
How We Do Harm
(New York: St. Martin's Press, 2011).

we could let down our guard:
The conversation that I had with Dr. Mason and Dr. Stephens is one of dozens I was part of in college, medical school, and law school. It underscores the tension between middle- and upper-class blacks and our poorer counterparts. This theme has been explored in the writings of several African American writers. See for example, Lawrence Otis Graham,
Member of the Club
(New York: Harper Collins, 1995); Sheryll Cashin,
The Failures of Integration
(New York: Public Affairs, 2004); and Eugene Robinson,
Disintegration
(New York: Doubleday, 2010).

Ultimately, the value of Grady was such that it was deemed too important to fail:
For an insider's perspective on the process of saving Grady, see, Katherine Neuhausen, Awaking Advocacy: How Students Helped Save a Safety-Net Hospital in Georgia,
Health Affairs
2013; 32 (6): 1161–1164.

one white, one black, reminiscent of many buddy cop shows and movies:
This is a staple formula; see
Lethal Weapon, 48 Hrs., Beverly Hills Cop, Miami Vice,
and
Men in Black
, for example.

Emergency departments are obligated by law to evaluate those who show up at their doors:
In 1986, Congress passed the Emergency Medical Treatment and Labor Act (EMTALA) in response to the prior practice where private hospitals would transfer poor, medically unstable patients to public hospitals. For further history on the origins of EMTALA, see David Ansell,
County
:
Life, Death and Politics at Chicago's Public Hospital
(Chicago: Academy Chicago Publishers, 2011).

speculated that it is a way for the hospital to conduct a “wallet biopsy”:
Arthur Kellerman quoted in “Portrait of an ER at the Breaking Point,”
Newsweek
, May 7, 2007.

Atlanta had one of the highest crime and murder rates:
Based on 1993 crime statistics, Atlanta was ranked by one publication in 1995 as the most dangerous city in America. Baltimore and Washington, D.C., were also near the top; see
http://www.morganquitno.com/1st_safest.htm
.

5: C
ONFRONTING
H
ATE

chart notations and abbreviations that had once looked like inscriptions from ancient times:
For example, a typical opening to a patient write-up might read: Mr. Jones is a 51-year-old male with a PMH of CAD s/p CABG x 3, CHF, IDDM, and CVA who presents with a two-day history of SOB. The translation is that Mr. Jones has a past medical history of coronary artery disease for which he has previously undergone cardiac bypass surgery with three grafts. He also has congestive heart failure, insulin-dependent diabetes mellitus, and cerebrovascular disease (prior stroke) and comes to the hospital with a two-day history of shortness of breath. This is a standard introduction. They are often far more complicated.

not uncommon for patients to question the skills of interns and residents and ask to see the supervisor:
From both a legal and financial standpoint, the supervising physician, often referred to as an attending, is in fact the patient's “real doctor.” However, in an academic hospital setting, the patient typically spends more time with the intern and resident doctors-in-training. Affluent patients, especially those requiring highly specialized medical or surgical treatment, are more likely to request/demand the supervisor's direct involvement. For an interesting discussion on this subject, see Atul Gawande,
Complications
(New York: Henry Holt and Company, 2003).

But that didn't mean things were easy:
There have been several excellent accounts of the struggles of internship year. Among the best nonfiction books covering the subject include Danielle Ofri,
Singular Intimacies
(Boston: Beacon Press, 2003); Robert Marion,
Intern Blues
(New York: William Morrow and Company, 1989); Sandeep Jauhar,
Intern
(New York: Farrar, Straus, and Giroux, 2008); and Fran Vertosick,
When the Air Hits Your Brain
(New York: W.W. Norton, 1996). The perils of internship training have also spawned widely read fictional accounts; see Robin Cook,
The Year of the Intern
(New York: Harcourt, 1972), and Samuel Shem,
The House of God
(New York: Richard Marek Publishers, 1978).

black players make up more than 75 percent of NBA rosters:
See Richard Lapchick, The 2013 Racial and Gender Report Card: National Basketball Association, Executive Summary. According to their analysis, blacks made up 76.3 percent of NBA players in the year 2013;
http://www.tidesport.org/RGRC/2013/2013_NBA_RGRC.pdf
.

encountered a family that didn't want her to treat their grandchild:
Women in Duke Medicine, An Oral History Exhibit, Dr. Jean Spaulding interview, October 3, 2006. Interview conducted by Jessica Roseberry.

Nor were these stereotypes restricted to the South:
See Otis Brawley,
How We Do Harm
(New York: St. Martin's Press, 2011) and Pius Kamau, A Case of Mutual Distrust,
Journal of the American Medical Association
1999; 282:410.

detailed interviews of twenty-five African American physicians practicing in the New England states:
See Marcella Nunez-Smith et al., The Impact of Race on the Professional Lives of Physicians of African Descent,
Annals of Internal Medicine
2007; 146: 45–51. For commentary on this article, see Joseph Betancourt and Andrea Reid, Black Physicians' Experience with Race: Should We Be Surprised?
Annals of Internal Medicine
2007; 146: 68–69.

I hadn't given thought to what other minority doctors might face:
Several Asian American physicians have explored this subject. For example, see Pauline Chen, “When the Patient Is Racist,”
New York Times
, July 25, 2013. See also Sachin Jain, The Racist Patient,
Annals of Internal Medicine
2013; 158:623. For a particularly thoughtful essay looking at this issue from several minority perspectives, see Malathi Srinivasan, Today's Learning Point,
New England Journal of Medicine
2001; 344:1474.

Neurosurgeons Ben Carson and Keith Black described similar breakthroughs in their early years as doctors:
See Ben Carson,
The Big Picture
(Grand Rapids, Mich.: Zondervan, 1999), and Keith Black,
Brain Surgeon
(New York: Wellness Central, 2009).

Patients with sickle-cell anemia have a reputation in the medical community for what is called drug-seeking behavior:
For two compassionate but realistic overviews on the subject see Samir Ballas, Ethical Issues in the Management of Sickle Cell Pain,
American Journal of Hematology
2001; 68:127–132; and Pamela Pentin, Drug Seeking or Pain Crisis? Responsible Prescribing of Opioids in the Emergency Department,
Virtual Mentor
2013; 15 (5):410–415;
http://journalofethics.ama-assn.org/2013/05/ecas2-1305.html
.

Tuskegee syphilis study:
For a comprehensive, historical overview, see James H. Jones,
Bad Blood: The Tuskegee Syphilis Experiment
(New York: The Free Press, 1981).

popular works have explored how the Tuskegee study was not an isolated incident:
For a detailed look into the history of how race has adversely affected the medical care of black Americans, see Harriet Washington,
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
(New York: Anchor Books, 2006). For another gripping story that explores the historical intersection of race, poverty, and science, see Rebecca Skloot,
The Immortal Life of Henrietta Lacks
(New York: Crown Publishers, 2010).

hone their skills on a disproportionately poor, black patient population:
Many of the top medical schools in the nation are located in cities with black populations that far exceed the national average of 13 percent. For example, Durham has a black population of about 39 percent; Boston (Harvard), 24 percent; Baltimore (Johns Hopkins), 64 percent; Philadelphia (University of Pennsylvania), 43 percent; St. Louis (Washington University in St. Louis), 49 percent;
http://quickfacts.census.gov/qfd/states/
. These inner-city residents are more likely to present to emergency room and other acute-care settings where medical students and residents often work.

Now it was my turn:
For excellent writing on the ways that doctors navigate death with patients and their surviving family members, see Abraham Verghese,
My Own Country
(New York: Simon and Schuster, 1994); Pauline Chen,
Final Exam
(New York: Albert A. Knopf, 2007); Jerome Groopman,
The Measure of Our Days
(New York: Viking Penguin, 1997); and Victoria Sweet,
God's Hotel
(New York: Riverhood Books, 2012). Danielle Ofri also poignantly explores end-of-life moments in her books (
Singular Intimacies, Incidental Findings,
and
How Doctors Feel
). Atul Gawande's most recent book,
Being Mortal
, deftly examines this subject.