Today, I was in clinic and a notorious patient came in to be seen. A review of the chart had a slew of documentation preparing me from what could be in store- various encounters in which Mr. W had dismissed doctor after doctor at the VA where I sometimes train. His complaints had ranged from typical ones like frustration at the difficulties of navigating the system, to more telling ones, like accusations that he was receiving substandard care because he was at a 'teaching' hospital and that none of his doctors knew what they were doing because they were foreigners.
This is not unusual in the practice of medicine.
Mr. W had tangled with his last physician in my clinic, and it had gotten ugly quickly. He had asked her to write down her diagnosis. She had put it on a piece of paper in admittedly small and fine print, and Mr. W had peered at it with his poor eyesight and declared, "what is this, in Chinese? I can't read this." The doctor who had seen him that day, another fellow in my program, had reacted. She called him out flatly for what she had taken to be an ethnic slur. Mr. W subsequently flipped, and said "if you were born in this country, you'd know that's a common saying; people say it all the time."
As he recounted the incident to me, I wanted to tell him that I, in fact, was born in this country, and I said no such all the time.
But I grew up in EBF. The advantage and misfortune of my upbringing is that I can dissolve into a wall. I can seem non-judgmental, I can adjust, I can bob and weave, and I can avoid such missives hurtled in my direction. The blessing in that is it allows me to do my job. The curse is that I have to listen to the ugliness that lives in the deepest places in some people's hearts.
Mr. W is dying. He has a form of leukemia for which he cannot be treated, and just to add insult to injury, he has a solid tumor that has spread past its original site. He is dying without a doubt. And this is also par for the course in my clinic. Many of my patients are dying. Every one of them deals with death and mortality in their own way. Mr. W's way was to lash out and throw blame at anyone who he viewed as not his people.
Were I treating diabetes or back pain or arthritis, I might react differently I suppose. I might react like my colleague and tell the man he couldn't say such horrible things. But he is dying, and trying to school him on the ways of the world was not compatible with my job today. And so I listened to him list out every one of his grievances. I did not tell him any of his grievances were justified. I did not condone him. I just wanted to do my job. The man needed a blood transfusion, and he also needed to go to the hospital because his kidneys were now failing.
By the end of our visit, he took my hand so that he could make his way to the desk to sign his consent to receive blood. But I have no doubt in my mind, not even the slightest, that tomorrow he will be complaining about me, and talking about me as a foreigner too. I will be on that list of grievances soon enough. I know that. But I don't ever want to think I didn't treat someone to the best of my abilities because of their beliefs.
What I don't know is whether Mr. W is typically this racist, or if his illness had brought out all his distrust and underlying biases, things he would have otherwise suppressed as inappropriate. And it made me think about this country and the moment we're having. How there is so much hate and rage in the world. In clinic today, one of the other fellows was reading off headlines from his desk-
LA schools shut down due to threat of violence
Unarmed man shot in Butte County by police officer, caught on tape
Man with gun seen on Purdue University Campus
Man with road rage drives into front of hotel
I had this reflexive reaction to laugh, because that is what I do when things get this bad, when it's almost absurd. I sputtered out, "what is going on?" He looked drained as he just shrugged at me, as if to say we could only expect more of the same. And that does seem to be true. But why? Why has it gotten this bad? What cancer do we as a society have lurking inside of us that is causing these inherent biases and frontal disinhibition? Because something is going on.
In California, don't think we are immune to backwards thinking, because we are not. All the time, among my colleagues, who are highly educated white men, I listen to them bemoan the cultural competency classes they have to attend, and the unfairness of having to give a job to a minority or a woman. I have listened to them talk about how it is not right that they have to hire a minority or a woman when they 'click' more with a white male applicant. One white attending, who considers himself forward-thinking, said "it's hard out there for white men, we have to be so careful about what we say."
I wanted to ask why. Why is it so hard? Why do you have to be so careful? I manage to get through my entire day, every day, seven days a week, without saying something insensitive or inappropriate or borderline/totally racist. It takes hardly any effort at all. Why is it so hard for them? And why don't they ask themselves that question? What would be so horrible about admitting there was a problem?
Mr. W told me today the only physician worth a damn in this place was, predictably, the one white physician he had seen. Now, I know that physician, and he is a good doctor. But so was the Chinese woman Mr. W saw last week, and so were many of the other physicians he had seen. The other white men who are physicians, with whom I work, they think it is amusing when these patients come in with their racist ramblings, with their extreme distrust, with their demands to see an American doctor. They don't acknowledge that this is the very definition of white privilege; they don't recognize the toll such patient encounters take on the rest of us. Or that this is why even as a South Asian-American, which, let's not kid ourselves, is still a place of a lot of privilege, especially in the medical field, I remain at a disadvantage to my white colleagues. They will score higher on patient satisfaction surveys, frequently, just because of the color of their skin, and not once will they acknowledge that this is why they score higher. Partly, it's because we all work hard. Partly, it's because they've been raised to believe they are exceptional, and so they believe everything they've gotten is simply because they are better. And partly, it's because it's just a lot easier to believe it's fair than to acknowledge an inherent problem.
When you're living in one of the most liberal parts of the country, and you work in a profession that is at least 50% represented by women, it's disheartening to realize how far there is still to go.
My friends and I were talking once about what the cut off should be. We were talking about how, as physicians, we let a lot slide, especially in the way of inappropriate remarks, when it came from an elderly patient. We dismissed a lot by attributing their behavior to a different time in the world, when such thinking was more commonplace. We said eventually that population would simply age out, and we wouldn't have to tolerate racism and chauvinism from our older patients 10 or 20 years from now. But lately I am starting to think that's not true.
This is all jumbled up, as are my thoughts, as is my life. it's all connected, my microcosm somehow does seem to be a reflection of bigger issues. But I'm too tired to connect the dots just now. I'll keep trying to treat the racists and chauvinist pigs who have cancer. Maybe some day, someone will recognize the effort that takes.
This is not unusual in the practice of medicine.
Mr. W had tangled with his last physician in my clinic, and it had gotten ugly quickly. He had asked her to write down her diagnosis. She had put it on a piece of paper in admittedly small and fine print, and Mr. W had peered at it with his poor eyesight and declared, "what is this, in Chinese? I can't read this." The doctor who had seen him that day, another fellow in my program, had reacted. She called him out flatly for what she had taken to be an ethnic slur. Mr. W subsequently flipped, and said "if you were born in this country, you'd know that's a common saying; people say it all the time."
As he recounted the incident to me, I wanted to tell him that I, in fact, was born in this country, and I said no such all the time.
But I grew up in EBF. The advantage and misfortune of my upbringing is that I can dissolve into a wall. I can seem non-judgmental, I can adjust, I can bob and weave, and I can avoid such missives hurtled in my direction. The blessing in that is it allows me to do my job. The curse is that I have to listen to the ugliness that lives in the deepest places in some people's hearts.
Mr. W is dying. He has a form of leukemia for which he cannot be treated, and just to add insult to injury, he has a solid tumor that has spread past its original site. He is dying without a doubt. And this is also par for the course in my clinic. Many of my patients are dying. Every one of them deals with death and mortality in their own way. Mr. W's way was to lash out and throw blame at anyone who he viewed as not his people.
Were I treating diabetes or back pain or arthritis, I might react differently I suppose. I might react like my colleague and tell the man he couldn't say such horrible things. But he is dying, and trying to school him on the ways of the world was not compatible with my job today. And so I listened to him list out every one of his grievances. I did not tell him any of his grievances were justified. I did not condone him. I just wanted to do my job. The man needed a blood transfusion, and he also needed to go to the hospital because his kidneys were now failing.
By the end of our visit, he took my hand so that he could make his way to the desk to sign his consent to receive blood. But I have no doubt in my mind, not even the slightest, that tomorrow he will be complaining about me, and talking about me as a foreigner too. I will be on that list of grievances soon enough. I know that. But I don't ever want to think I didn't treat someone to the best of my abilities because of their beliefs.
What I don't know is whether Mr. W is typically this racist, or if his illness had brought out all his distrust and underlying biases, things he would have otherwise suppressed as inappropriate. And it made me think about this country and the moment we're having. How there is so much hate and rage in the world. In clinic today, one of the other fellows was reading off headlines from his desk-
LA schools shut down due to threat of violence
Unarmed man shot in Butte County by police officer, caught on tape
Man with gun seen on Purdue University Campus
Man with road rage drives into front of hotel
I had this reflexive reaction to laugh, because that is what I do when things get this bad, when it's almost absurd. I sputtered out, "what is going on?" He looked drained as he just shrugged at me, as if to say we could only expect more of the same. And that does seem to be true. But why? Why has it gotten this bad? What cancer do we as a society have lurking inside of us that is causing these inherent biases and frontal disinhibition? Because something is going on.
In California, don't think we are immune to backwards thinking, because we are not. All the time, among my colleagues, who are highly educated white men, I listen to them bemoan the cultural competency classes they have to attend, and the unfairness of having to give a job to a minority or a woman. I have listened to them talk about how it is not right that they have to hire a minority or a woman when they 'click' more with a white male applicant. One white attending, who considers himself forward-thinking, said "it's hard out there for white men, we have to be so careful about what we say."
I wanted to ask why. Why is it so hard? Why do you have to be so careful? I manage to get through my entire day, every day, seven days a week, without saying something insensitive or inappropriate or borderline/totally racist. It takes hardly any effort at all. Why is it so hard for them? And why don't they ask themselves that question? What would be so horrible about admitting there was a problem?
Mr. W told me today the only physician worth a damn in this place was, predictably, the one white physician he had seen. Now, I know that physician, and he is a good doctor. But so was the Chinese woman Mr. W saw last week, and so were many of the other physicians he had seen. The other white men who are physicians, with whom I work, they think it is amusing when these patients come in with their racist ramblings, with their extreme distrust, with their demands to see an American doctor. They don't acknowledge that this is the very definition of white privilege; they don't recognize the toll such patient encounters take on the rest of us. Or that this is why even as a South Asian-American, which, let's not kid ourselves, is still a place of a lot of privilege, especially in the medical field, I remain at a disadvantage to my white colleagues. They will score higher on patient satisfaction surveys, frequently, just because of the color of their skin, and not once will they acknowledge that this is why they score higher. Partly, it's because we all work hard. Partly, it's because they've been raised to believe they are exceptional, and so they believe everything they've gotten is simply because they are better. And partly, it's because it's just a lot easier to believe it's fair than to acknowledge an inherent problem.
When you're living in one of the most liberal parts of the country, and you work in a profession that is at least 50% represented by women, it's disheartening to realize how far there is still to go.
My friends and I were talking once about what the cut off should be. We were talking about how, as physicians, we let a lot slide, especially in the way of inappropriate remarks, when it came from an elderly patient. We dismissed a lot by attributing their behavior to a different time in the world, when such thinking was more commonplace. We said eventually that population would simply age out, and we wouldn't have to tolerate racism and chauvinism from our older patients 10 or 20 years from now. But lately I am starting to think that's not true.
This is all jumbled up, as are my thoughts, as is my life. it's all connected, my microcosm somehow does seem to be a reflection of bigger issues. But I'm too tired to connect the dots just now. I'll keep trying to treat the racists and chauvinist pigs who have cancer. Maybe some day, someone will recognize the effort that takes.
