The horrifying events of Charlottesville happened while I was away on vacation.
My one week of respite from the stream of suffering that I often see while I work days and nights in the hospital was interrupted abruptly by watching humans yell at other humans. These humans were birthed by other humans, wishing for a good life for them, an event that I see every single day at work. How did we end up this way?
I read blog posts, talked with my family and friends, and tried to reason my way out of it. But one quote I heard kept coming back to me, "What can I possibly do? I smile at black people.” All I could think about was myself - am I doing everything I can? All these thoughts left me as soon as I arrived back at work, to a deluge of patients in need of my medical care. I felt like I was under water with responsibilities.
Then came Tuesday morning. I walked in and was told there was a woman screaming in pain with a fetal demise and placental abruption - I would be doing her c-section. I immediately went to see her, sign her papers, get her back to the operating room as soon as possible. For the next two hours, I was focused on delivering her dead baby, clearing her uterus of 2 liters of blood and clot, and ultimately removing her uterus due to profound uterine atony. I felt like I had done what any great hospitalist should be able to do - take care of an emergency with skill, grace, calmness, and a stable safe patient at the end of it all.
Little did I know that I haven't been practicing medicine the way I aspired to - I, in fact, was practicing racism in a way I never realized before.
After she woke up from surgery, I went to see her. She didn't have much to say. I thought of the last patient I cared for who presented with a similar tragic situation in which she lost her baby and I had to take her to emergent surgery as soon as she arrived. This part of my job is like reverse dating - I have to make a relationship with the patient postoperatively instead of preoperatively, because we started our relationship so abruptly and with such urgency.
I was able to make a strong connection with the last patient who went through a similar situation - so why couldn't I do that this time? The last patient was white. This patient was black. I didn't think this mattered to me...until I spent more time with her and gave myself the chance to really evaluate my actions.
I took time to reflect on my feelings while I saw in her room with her. I was unbelievably self conscious. I was worried she assumed that I hated her. I was worried that she thought I would treat her differently and even though I thought I wouldn't I WAS TREATING HER DIFFERENTLY. Because I WAS SCARED. I was scared that I wouldn't be able to make a connection with her the way I've made connections with my white patients, my Hispanic patients, my old patients, my poor patients, my young affluent patients. She helped me learn in such an acute way that I was terrified that we wouldn't be able to make a connection so I simply stayed away from the opportunity. This is racism. Stepping away from opportunities to connect with fellow humans is RACISM. I have such potential to impose my implicit bias on my patients. I've been doing it, for years! How horrifying to know that I've been doing this AND HAD NO IDEA.
So the rest of the week I just kept trying. I forgave myself for my past. I gave myself a second chance. I was kind to myself. And I kept going to see her, checking on her, trying to make a connection if she wanted one.
I went to her room and asked if she got some photos of her son. She was holding him and was fairly quiet. She didn't make eye contact with me. She was going to be started on magnesium for preeclampsia with severe features, so I recommended she get some photos of her with her son and I went to find a nurse who would take the photos. I asked if she wanted a hat for him, and she responded that she had really wanted the pink and blue striped one, so I brought her two. I tried to offer other hats but she declined.
I put the hat gently on his head, didn't feel right putting on gloves before I did it, not wanting to seem like his body was something I refused to touch. Still no eye contact, but I at least felt like I had performed an act of kindness. I offered to call someone from her family, but she said her mother hadn't answered and she didn't want me to call.
The next day she didn't respond much to my visit. I told her I would come back later and take her on a walk in the halls that I thought would help her pain and mood. She reluctantly agreed.
When I returned to her room that afternoon, she was sitting in bed, holding her son, sobbing over him. I couldn't bear to leave her alone like that, even though I felt so very awkward and sad. I sat on her bed with her, put my hand on her leg, and let the silence wash over me. After several minutes without her saying a word, I asked "are you the praying type?" and she replied, “Yes.” I stumbled through a prayer for her and her baby - thanking God for the months of pregnancy she had with him, thanking him for letting her feel his movements while she went about her day. I prayed for him to be with her as she sits in the grief of not only him not being alive, but the death of all the hopes and dreams she had for him. I prayed for her other children, that they would find support in their grief of losing their littlest brother. I prayed that she would be strong enough when she arrived home to support her other children while in her own grief. I prayed for healing.
She didn't respond to my prayer. I finished and left. I felt the fright creeping back in that maybe I had said something wrong. Self doubt is a strong emotion.
A day later I returned, and visited quickly. She didn't say much other than she was feeling better. I was sure that I wouldn't ever be able to make a connection with her and that surely I'd never be able to make it over this hurdle, because I was too racist - a trait I didn't know I had but just picked up after Charlottesville. My playing favorites is racism. My spending more time with people I feel more comfortable around is racism. My “not acting like myself” is racism.
I saw on her white board that it was her birthday. I immediately left her room and asked her nurses if it was her birthday - we looked in the computer and confirmed that yes, she was here, admitted to the hospital, alone, with a dead baby in her room, on her birthday.
I frantically searched labor and delivery for small gifts. I found a pre-wrapped cookie, a pack of gum, a chapstick, a nail file, and three flower stems from a flower arrangement on one of our tables. I found colored paper and made a card writing, "Happy Birthday - We are happy to be here with you on your birthday, and hope you will get to celebrate when you are feeling better." It took me far too long to come up with acceptable words for the situation, and again doubted that I was doing it right.
I took her the makeshift gift.
She was standing in her room, holding her baby next to the sink with the water running, a baby hairbrush in her hand. She was startled, and looked embarrassed that I had arrived to see her grooming her child who had now been dead for 4 days. "He just had a little blood on his head I was trying to get off, and his scalp and hair have gotten dry and......." Her words trailed off. I told her it was her son, and she should do what felt right. "This is all just so weird" she responded, finally making eye contact with me. "Damnit. It is, isn't it?!" I responded. We both laughed at life, because there was nothing else left to do. We laughed at how no matter how old you are there are still situations that you have no idea how to handle.
I realized in that moment that I had been with other moms in these rooms - I've been with other moms who have to lay in bed, no longer pregnant, with their previously wiggling fetus now cold and still in a bassinet next to them. I'm no expert, but I do know that the emotions that this situation conjures up are strong and undulating and so unpredictable. I had that to offer her, and after 4 days she took my offer of connection.
After we got him settled back into his bassinet, onesie just so, blanket where she liked it, I gave her the small gift. She laughed and thanked me. We talked about birthdays as adults, and how your children's birthdays take such precedent that she can hardly remember the last time she celebrated a birthday..Maybe when she was 21?
I apologized for it not being much, to which she responded, "At least you tried. No one else did."
The experience she gave me has stayed with me, the courage she had to let me in after 4 days. I can't stop thinking about my experience with her - the incredible amount of growth I had in one short week, one week that I worked too many hours and missed my family. I am not immune to racism. I'm surrounded by it in the news, in my colleagues, but most importantly, in myself.
I've made huge mistakes! I've let huge opportunities slip away! WHAT THE HELL HAVE I BEEN DOING!?
As health care providers, we take an oath with something along these lines:
“I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.”
I realized this has not always been me. I have work to do. We have work to do.
Let us carry onward and upward, giving ourselves courage for introspection and kindness for second chances.
With love and courage,