Tuesday, August 24, 2010

Reflection on a Tuesday: Black and White

pt. names, details, etc. changed . . . you know the deal, man
a "black and white" cookie, Brooklyn style


"Sir, I know that was a lot of information. I just want to be sure I did a good job explaining to you, okay? Can you tell me why we said you were in the hospital?"

"Sure, Miss Mannings. Y'all said I got pneumonia in my chest but then when you looked closer you saw a spot, too. Since I smoke, you want to be sure that it ain't more than just pneumonia and not something like a. . .cancer?" He smoothed the covers out over his long legs and rested his pecan colored arms on top of the blanket. His cheeks were covered with a smattering of moles and skin tags, likely from years of working out in the sun doing construction.

I drew in a deep breath. "Yes, sir. That's correct." I felt the need to make it sound less daunting. "But we aren't saying that what we saw looks exactly like cancer either, sir. I admit it was concerning." Great, now I'm backpedaling. "I mean, it's just that it's important to be sure, sir. That's why we are having you get that test by the pulmonologists or lung doctors. Do you remember what I said that test was?"

"You talking 'bout that test with the camera down your throat?"

I wished that his graphic description wasn't spot on, but it was. His wise sixty-something year old eyes didn't look the least bit fazed by the idea of something sounding so noxious as a "camera down your throat." Again, I wanted to dampen it a bit. "Umm, well. . .you know they do make you drowsy for the test and then carefully put this very small tube with a camera on it through your mouth to get to your windpipes. That's how they are able to see inside your lungs."

"Right. Down your throat, and then they stuff it in your breathing tube. That man said it's like a tree that they look down all the branches of. As I thank of it, I'm guessin' sometimes it ain't nothin' but leaves when they look, but sometimes it's something else growing on the tree that ain't 'posed to be there. Like cancer." He let out a nervous laugh.

I couldn't argue with his accurate description, and was admittedly quite impressed with the metaphor he used. The timing couldn't have been better--we had just had a lecture earlier that week on "Health Literacy" that was really driving home the importance of making certain that our patients understand what we are doing and saying. The lecture emphasized the need to say things in black and white, instead of chartreuse and celadon. Even though the plan itself wasn't that great for him, this was an example of a successful "teach back." The team listened quietly and seemed to acknowledge this as a teachable moment.

I turned toward the team and said, "It sounds like Mr. Chambers has an excellent understanding of what's going on with him!" I looked over at the patient and smiled. He returned the expression, but shortly after furrowed his brow and turned his lips to the side. Something was puzzling him. "Wait, Mr. Chambers--did I speak too soon?"

He chuckled and said, "Naw, I know what y'all doin' today. This my body. . .shoooot. . . you know I'm gon' know when it come to my body!" But then he narrowed his eyes and looked like his wheels were turning again. It was confusing.

So then I remembered the other health literacy guru tip that often gets forgotten. Instead of asking folks "do you have any questions," you pose the question the way I asked Mr. Chambers:

"Sir, what questions do you have for us?" I gestured to the medical student, Ania, who'd been carefully doting over him throughout his hospitalization.

I felt pretty sure that he would have at least one, especially with that puzzled expression he kept offering me. I was right.

"I don't have no questions for her," he spoke firmly while pointing directly at Ania the way Zachary points at Isaiah when I ask who did something, "but I DO have questions for you, Miss Manning."

I felt relieved that he was willing to ask what was obviously becoming a pressing question. "Okay, Mr. Chambers, go right ahead."

He stared at me for a few seconds like he was deciding on a Final Jeopardy answer, and finally broke the silence by saying, "Miss Manning, are you black or white?"

I raised my eyebrows in surprise and looked over at Ania who immediately blushed, initiating a domino effect with the rest of my all fair-skinned team.

Now here's the deal: I am not offended by this question, nor are my feathers ruffled in the least when it is asked--but the thing is that I usually see it coming. (See this post about Grady and the race to determine my race.) Furthermore, it always amuses me since when I look in the mirror, I see a black woman looking me squarely in the eye, albeit one with freckles.

"Am I black or white?" I repeated for clarity.

"Yeah. What are you?" He looked at me as if this were not a not-so-PC way of asking such a thing. For him, obviously it wasn't.

"What do you think I am?" My team couldn't figure out if I was embarrassed, amused or what. They shifted on their feet, somewhere between uncomfortable and intrigued.

He studied me for a few minutes and then said, "I was thankin' you was black, but I don't know. You sound black. If you ain't black, you sho' sound black."

My team was now crimson. I laughed out loud to lighten things up and let the team know that I was okay. "Okay, so here's the deal, Mr. Chambers. . .my mama, she's black and my daddy, he's black. Does that help?"

Instead of thinking this was cute, he sat there thinking as if I was Rumplestiltskin asking him to guess my name. He tapped his finger on his lip and sighed. Still in Final Jeopardy mode. I knew I'd need to let him off the hook.

"Mr. Chambers, I'm actually black." He nodded his head like that's what he was going to say and smiled. "Was there a reason you wanted to know this?"

"Honestly, doc? I was just curious. I just be wantin' to know stuff like that and I get real curious, and you seem cool so I figured I could ask."

"Does it make a difference to you? I mean, are you okay with a black doctor and . . .the rest of our doctors?" I nodded my head to Polish Ania, Taiwanese Emily, and the rest of our team of varied European descent.

"Oh yeaaaaaah," he laughed in the most unassuming way ever. "Don't matter what y'all is. I just be wantin' to know little stuff like that, tha's all. All y'all cool wit' me. Black, white, blue, whatever!"


So that was that. My patient who might have a primary lung cancer--a possibility that he fully understood--did have a question indeed. It wasn't the kind of question I expected but that's what happens when you ask, "What questions do you have for me?" -- and that's what happens when you have the distinct pleasure of working at a place like Grady Hospital.


  1. You are so much kinder than I am. I have to admit, that I get annoyed when strangers ask, "What are you?" "Where are from?" In my case, it's mostly white folks. I know, I know, most of the time they're just curious. But I feel like, "Why do you have to know so bad?" It's not like I'm some necklace that you saw and now you just have to know where it came from so that you can run out and buy one for your very own. ANY question that you are asked over and over again causes some type of annoyance. At the same time it doesn't give me an excuse for going postal on someone just for asking. I am typically polite and respond.

    You have a much better attitude about it. Something I should work on.

  2. Oh dear. I hope it turns out to be nothing. How stressful for him.

    I get that question all the time: what ARE you? It's never bothered me, because my racial identity is such a huge part of who I am that I would hate for someone to assume something and be wrong (which happens a lot, too) without me having a chance to say--this is who I am! But I have a relative whose family is from Trinidad, and when people ask her she always says, it's none of your business! Which is interesting to me too.

    Sounds like you handled it great. :) My goodness, every day with your patients is such an unpredictable and incredible adventure!

  3. Of course no one would mistake my racial class but my girlfriend gets that question all the time and she feels so offended by it...She just doesn't understand how and why that should be an important question wrt to the medical care she provides. She gets very sensitive. I think you handled that very well...

  4. What's funny is that I realize that it just isn't that heavy. People are really funny about trying to pin down origin. . .especially folks of color (wink, Kelly!) You can TELL when it's being asked in that insulting way, you know? This so wasn't that. This was like one of those totally random questions that make no sense.

    I think it only gets heavy when you make it heavy. Besides. . .I see it as a compliment, you know? Folks generally ask origin questions when they think you seem a little exotic. . . .errrr. . at least that's what I tell myself! MLD, I bet folks are so intrigued by your gorgeous mixture of Taiwanese and African features that they lose their manners, girl. Just take a deep breath and say three times fast in your head, "exotic beauty, exotic beauty, exotic beauty. . ."


  5. When my family moved to US from Russia, we lived in a predominantly African American neighborhood. I had not seen a very dark-skinned person ever in my life at that point (let alone lived next to one) and now I was living in "their" Californian neighborhood. I had not met more welcoming neighbors since then. These people "raised" my family, they helped us with food, clothing, taught us how to garage sale, where to get coupons, how to drive, and helped us on our feet in this big unpredictable country. But California has a different Caucasian-African American relations. My best friends were black while I was in middle school and I was accepted and it was a no-big-deal with my white friends. When my mom started her residency and we moved to Little Rock, Arkansas, everything turned around. I got in trouble and one girl in my high school scratched me for "talkin' to 'maaa' black man," the white-trash high school people made fun of me and said things like "once you go black, you neva come back" and etc. It was awful. It's so different in the south and I didn't particularly care for this difference. I give you a lot of credit for putting up with some people whose questions are loaded a lot more than this man's was. :)
    And did I mention, I love reading your blog?

  6. This blog is the bomb!!!! What you is for real? LOL

  7. This reminds me of something that happened to me while I was beginning my undergraduate studies in North Dakota.

    As you can probably imagine, there are not a lot of African Americans in ND, so I guess I was somewhat of a novelty.

    Anyway, I had a work-study job where I worked closely with the department secretary. One day, we were eating lunch and shooting the breeze when she just pops out and says "Rachelle, I like you."

    I was all like "Errrrr, I like you too [name]????" Then she says, "No, I really like you, I like you because you do not act like most black people...."

    At first, I was totally stunned by what she said. I just kinda sat there and didn't say anything for the rest of our time together that day.

    But then, I thought about it and tried to put it into perspective. Even though it sounded insulting and racist, I knew that she hadn't meant it that way. In her mind, she truly thought that her statement was some kind of compliment, so I got over it and we remained cool throughout my time there.

    I think when people say ridiculous stuff like that, they either aren't really thinking about how it sounds, they don't have the critical thinking skills to realize that it is rude and insulting, or they are just plain racist.

    I think most people fall into the middle category, because if they say it to your face, without malice or condescension, they must really not realize the err of their statement.

    I hope and pray that people aren't really that racist - that goes for reverse racism as well...


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