reflections of a victim of unconscious bias

A few weeks ago, a primary care physician colleague (white man)—who I’ve known for over a decade—sent me the note below by way of our mutual patient’s caregiver (white man) open, not in a secured envelope.  In the past nearly 4 years the patient has been under my care, the colleague has not once reached out to me by email, phone, text, tweet, telegraph, or carrier pigeon regarding our patient.

 

He did, however, reach out to my boss (white man) and a hospital executive (white man) a few months ago when the caregiver (reminder, white man) first complained no one in the dialysis unit was listening to him (though the caregiver has never spoken to me directly about his concerns because, I just learned, he found me “intimidating”).

When I suggested to my colleague that he would not have sent this note (that was not accurate physiologically or even as to what actually happened) to me had I been a white man or if the caregiver was not a white man, he said, “I reject that,” for all the reasons, he explained, he could not possibly do such a thing. Ultimately, he did apologize for sending the note, but then went on to explain how there were some kernels of rightness in how he handled the situation.

 

Now, I don’t know if this person’s actions were driven by my race or my gender. I don’t know how to separate the parts of myself to pinpoint exactly what drives someone else’s “ism.” But what I do know is all but me are white, all but me are men, and it doesn’t matter which part of me that allowed my colleague to inappropriately, unprofessionally, disrespectfully engage me. Racism. Sexism. The results for me are still the same, whether he is conscious of it or not.

 

I have felt negativity from my blackness since I was 10 years old, which may have overshadowed my awareness of negativity towards my femaleness. I’ve been followed in stores. I’ve been told by peers and superiors that the only reason I was accepted at prestigious Duke University and Medical School was because I’m a black woman. I’ve been deemed so intimidating that people have gone to my boss rather than directly speaking to me for incidents that others would have had the opportunity to handle themselves. 

 

This isn’t new to me or any other black person existing in this society. One could argue that I’ve been fortunate—I have not been the victim of a BBQ Becky, a Delta flight attendant, or a police officer.  Yet this incident and others that have happened since, bother me more than they have in the last nearly three decades.

 

When I reflect on why this incident has so infuriated me, saddened me, and made me feel that there is no end to this regardless of my education, income, or accomplishments this is what I’ve come up with:

1.     To be profiled by a stranger is one thing. To feel like one is being profiled by someone who has known you for more than a decade is another. One would think they could see me through whatever experience they’ve had with me, not by what they carried around in their subconscious.

2.     The primary care colleague considers himself progressive, an ally. If an “ally” is unable to even consider, much less accept, that their actions may have been driven by an unconscious bias, then my hopes that we as a society will ever overcome racism are dashed. One doesn’t stand a chance against an enemy if this is the way an ally receives you.

3.     This is taking up headspace, attention, energy that non-minorities don’t have to surrender. Headspace, attention, energy that I could be giving to further honing my knowledge in nephrology and to the next scientific research article, research grant, book. One could argue that I shouldn’t be giving my power away in this way. That I should shut all this out and just focus on becoming the person and professional I know myself to be, unrelated to race. I wish I could.

Note redacted.png

the meaninglessness of an eye flitter

A couple of weeks ago, I was the attending nephrologist for our hospital consultation service when I met Mr. Jones. He had suffered a severe heart attack. His heart was stunned into stillness and couldn’t effectively pump oxygen-filled blood to his kidneys or any of his other parts for the however many minutes it took for the ambulance to get to him and start resuscitation. Once he was transferred to the hospital, the cardiologists successfully reopened the major coronary artery responsible for the attack, but his kidneys weren’t working as well as they had been before. But his kidneys were the least of his troubles. My interaction with his family reminded me of an experience in my own life from about twenty years prior.

irrelevant words matter

It was Friday afternoon and the last patient of the clinic day had arrived. A new patient to me. While the medical assistant asked her screening questions (Do you smoke cigarettes? Do you have pain? Have you fallen recently?) and checked his vitals (blood pressure, heart rate, weight), I started to get to know him through his medical record. I began with the clinic referral to find out why he was in my clinic in the first place. Would I be figuring out why he had an electrolyte problem (like low potassium levels) or thousands of grams of protein in his urine (when normal is less than 30 milligrams)? Or would I find the usual, a case of irreversible kidney damage caused by high blood pressure and/or diabetes? The first line read: 70 year-old formerly incarcerated man with recent hospital admission for…

the ethics of the right care

Julie* was 22 years old, but she looked like a frail frightened 13 year old curled up in the hospital bed. She spoke like a petulant one.

 

“I don’t want to be here! I want to go hang out with my friends!” she yelled when I asked her what she wanted for her care. I was in her hospital room as a representative from the Ethics Committee, my goal to help relieve the conflict between her and the team of doctors trying to take care of her.