intuition

When my son Avery was 5 years old, I moved out to suburbia for the “great public schools.” Mistake. Doesn’t quite make my “top ten worst decisions” list—I’ve made some doozies. It wasn't all bad because it let me know for sure just how into me Robert was when we started dating. A brotha drove those 36 miles from Richmond to see this sista several times each week! (Two snaps up.) But it was close to the top for many reasons. And the biggest was because my baby was bullied. Avery is the color of caramel—a perfect blend of his father, black coffee no cream, and me, coffee with 3 creams, maybe 4. And judging by skin color avery5and hair texture, Avery was the only boy in the school who obviously had two black parents. Not just in his kindergarten class. In the entire school. And clearly there weren’t enough kinky-haired male people in the entire town to justify a black barbershop. I had to drive the 26 miles back into Oakland to get my baby a haircut.

It was near the end of the school year when Avery told me kids were making fun of him on the playground.

“They laugh at me cuz my hair doesn’t lay down on my forehead like this,” he said with his little palm on top of his head and fingers spread over his forehead. His brows were knitted in confusion and hurt feelings. My heart twisted in response.

“Oh, baby…” I began and went on into an age-appropriate explanation of hair types and textures and colors and how handsome his tight curls were. I had known the differences between black hair and not black hair so long it seemed I always knew. It hadn’t occurred to me that I needed to teach them to my son.

I think when we learn something so well it becomes ingrained in us, we sometimes forget how basic the explanation must be in order for a newcomer to begin to understand. Like years ago when Robert called his mother to find an address on his computer. We were in the car on our way to a party. He couldn’t just say, “Double-click on the file named ‘contact list’ and find such-and-such’s name.” He had to start with, “See that big box on the floor? It’s called a modem...A MODEM!..Never mind. On the side facing you, about in the middle, there is a button with a circle with a line going through the top of it….See it?...Good. That’s the power button. Push it.” Fifteen patience-of-Job-testing minutes later, Robert was able to talk his mother through all the steps to get to the address, including what the hell a “double click” is and how to do it.

I felt the same throughout my medical training. Many a day I wanted to say, “Just because you understand this so well doesn’t mean it's intuitive.” But since one can’t say a thing like that and survive medical training, instead I would raise my hand and say I didn’t understand. In these rooms full of people desperately trying to appear not stupid, raising ones hand to admit confusion can be daunting. And in response, usually, unfortunately, the lecturer would just repeat the exact same words. Only louder. Like I was hearing impaired. Thanks.

I think of myself as a doctor who can effectively explain complex concepts to patients, even when faced with issues like language barriers and low literacy. I use interpreters. I speak slowly. I draw pictures. I don’t say words like “ultrafiltrate” and “cannulate.” But, still, I have been surprised to learn the misconceptions some patients have about dialysis. Misconceptions are the fears. The fears are paralyzing. They prevent the patient from taking the well-advised steps towards preparing for dialysis. Paralysis creates emergencies.

“They said dialysis ‘cleans the blood’. I think dialysis burns the blood to clean it.”

“They said your blood goes into the machine to take out extra water and toxins and then brings it back to your body. I am afraid I will die while all my blood is taken out of my body.”

I’ve learned to give more information to preemptively allay some fears. “Dialysis removes toxins or cleans the blood by passing it through a filter,” I’ll say. “No more than a cup of your blood is outside of your body at a time.”

But, still, I can’t be sure that I’ve reached the person in front of me, especially the ones unwilling to prepare for what is coming for sure. So I’ve also learned to say, “Sometimes people think things about dialysis that frighten them and simply aren’t true. If you tell me what it is that frightens you about it, maybe I can help put your mind at ease.”

It’s not intuitive on either side of the stethoscope.