Bias landmines.

12: 01 P.M.

My intern was presenting this patient to me at this exact time. My tumbly was feeling pretty damn rumbly and lunch couldn't come soon enough. But we were almost there. Last patient of the morning. Fairly straightforward. Acute decompensated heart failure--one of the most common things we see.

Good.

I have to admit that I was glad it was something "bread and butter" and not something exotic. Nothing about this seemed to be a diagnostic conundrum. And that was a relief considering it had already been a long morning of medical mysteries. On top of that, I was hungry.

Real hungry.

Yup. I'm human so yes, I get hungry. And that can feel more urgent as the noon hour approaches. My mind wanders off for a second and then I mentally smack my own face. Terrible, I know. I shadowbox internally, ignore my growling stomach, and keep listening.

He described a youngish guy admitted for severely elevated blood pressure, heart failure, and fluid on his lungs. "He takes his medications faithfully," my intern said. "And, for the most part, he eats right. Not really sure why this current set back happened."

"Okay," I said. "Where does he get his meds?"

"Grady," he replied quickly. "Right at our pharmacy. And I checked to see if he's filling his meds and he totally is."

"Hmmm. Okay." I thought for a second. "And you said no dietary indiscretions?" My intern shook his head. My belly made another audible protest. "Chest pain?"

"Fleeting chest pain--but his EKG and cardiac enzymes are all normal."

Just then, there was an interruption. A man in a hospital gown shuffled past us, IV tubes dangling from his wrist and forearms. Definitely not much older or younger than me. The ashiness of his skin was amplified against his espresso-colored complexion. He looked over at my intern and smiled revealing the tell-tale dentition of limited resources and a hard life. "Just hitting this commode," he said in our direction.

"We'll be right there," my intern spoke back to the man. "Just telling my team about you."

And the patient nodded and disappeared behind the sliding door to his room.

"Hey--did you check a urine drug screen?"

My intern paused. "I actually didn't, Dr. M. But I did ask him about illicit drug use. He doesn't do any of that."

I nodded and twisted my mouth. "I'd recommend checking anyway."

He looked perplexed. "Check a UDS?"

"Yeah. Cocaine could unify all of this, honestly."

"But. . .he doesn't use cocaine."

"I've been burnt many times."

My intern's face flushed crimson. "Oh. Okay. Sorry about that."

And that was it.

Of course, you know what happened next. I walked in and met this gentleman who told me the exact same story. And the pharmacy record and his appointment history supported what he said. He denied any drug use and, on top of that, had prior screens that all were negative.

Yup.

He just had bad heart failure. Period. And sometimes bad heart failure just misbehaves without much provocation. And yeah--he had eaten a little bit too much salt but that wasn't on purpose. It was because eating fresh, non-processed foods is expensive and hard. But the brother was trying. Damn, he was.

I gritted my teeth and felt my masseter bulging. Between my stomach growling and my intense remorse about the microaggression I'd just committed against my patient, it was hard to think straight.
Hallelujah for bread and butter medical problems.

We gave him IV diuretics to get fluid off. We optimized his blood pressure meds. We restricted his fluids. And we consulted the heart failure team. And that meant rounds were over. The team broke up and that was it. Before I could even think of a way to right my wrong.

Yup.

I walked into our team room a few moments later and was relieved to find everyone there. They were all getting their lunches and preparing for the resident conference. I could already feel my face getting hot.

"Umm. . .guys? Can you give me a minute of your time?" They all sat down and obliged me. Even though I'm certain they were hungry, too. I cleared my throat and spoke. "I was wrong."

Their eyes all widened.

"Ummm. So yeah . . . . when Mr. Mackey walked by I sized him up. I saw a youngish, poor black man walking through Grady. And my bias was at play when I asked for that UDS. I looked at him and considered crack cocaine. I was wrong." My intern was staring intently. "I know if he was a white woman at Emory or even an insured black patient somewhere else, I probably wouldn't have suggested that. Please cancel the urine drug screen if it hasn't been collected yet." I sighed hard and looked at the patient's name on my list. "I'm sorry Mr. Mackey."

No one said anything. So I went on. "Look y'all. I'm a work in progress. I'm still messing it up sometimes, too. But I want to own my biases and do better, y'all."

My team was so gracious. After that, we discussed "bias landmines" such as being hungry, tired, rushed, or stretched too thin. We also talked about owning your biases and trying to do better. It was super powerful.

I cried as soon as they left the room. Not out of shame but more because I honored my patient and believe that I taught my team more about bias through that one moment than any lecture they could ever get.

Yup.

Look, man. I do NOT have all this stuff figured out. Mr. Mackey fell in a group that I believe myself NOT to be biased against. Still, my actions said otherwise. That's what's so troubling about implicit bias. The heart feels one thing but the mind goes rogue.

And so. I call it what it is and vow to keep fighting. Fighting the monsters that hurt my patients and my community--even when that monster is me.

Yeah.

*name and details changed to protect anonymity

The little girl who didn't cry wolf.

Your chest was hurting. This was your chief complaint. "Like pressure," you'd said. Then you shook your head and closed your eyes. Your hand pushed into the center of your chest for emphasis.

I asked what you were doing when it came on. You shrugged and insisted that it was nothing out of the usual. Then you scratched your shoulder vigorously. The suddenness of the gesture startled me.

"You okay?" I asked.
"Yeah," you said. "I just be itching sometimes."

I nodded. And then went back to the discussion.

Pressure like chest pain at rest that made you miserable enough to come to the emergency department. A little bit of shortness of breath. But not much. No numbness or tingling in your arms. You weren't exerting yourself in any way.

Nope.

And yeah. You USED to use crack. But not any more. You were adamant.

"I fell to my knees," you said. "I was so tired, Miss Manning. I fell to my needs and asked God please. Please take this stronghold away from me."

I kept listening. Almost feeling like I didn't deserve to be on the other end of this testimony given my mood. My team was surrounding me during this conversation. They followed my lead, saying nothing.

You went on: "Then? Just like that. He took it away from me. I swear. It's been three whole months. THREE WHOLE MONTHS." You repeated that last part.

"Wow," I said. My 'wow' didn't sound wow-ish. It sounded mechanical and fake. My hand was rubbing the side of my neck. I was listening to you and watching you. Your eyes were dancing and your hands were animated. The laxity of your jaw as you spoke reminded me of the many heavy crack users I'd seen over the years and the patient years ago who pointed to Bobby Brown on the television and said, "That way he move his jaw like that? That's when you use a whole, whole bunch of crack." So yeah. This was what I was thinking about. The whole time that you were talking about what God had taken away from you.

Sigh.

I didn't fully believe you. Not that I didn't think you believed what you were saying. But I was tired. Very tired this day. And I just needed something to just bark exactly like a dog and say, "Hello. My name is Fido."

Sigh.

The third year medical student, however, was new to this. He'd heard your story and presented you to me as the last patient at the end of a busy day. And every drop of your kool aid, he'd lapped it all up, gleefully reporting your newfound abstinence. "I believe her," he said about you. His young face was emphatic and his greenish eyes glistening with advocacy and defiance. He repeated himself. "I believe her."

I wanted to. But my bias against you was so strong. And I was tired. Like so, so tired. Not take-a-nap tired. But emotionally tired of watching how this sickening crack epidemic decimated my people and how it was all beginning to feel like a hopeless version of that movie Groundhog Day.

Uggh.

I remembered what I'd learned about ways to fight bias. Being aware of triggers like exhaustion and such. And so I held your hand and did the things we do for chest pain. I nodded my head and mumbled words of affirmation about God's intervention like "Won't He do it."

Then I said sorry in my head right after that. To God for fronting and using his name in vain.

"We didn't check a urine drug screen," the student said outside of your room. "I mean, we can. But I will be so disappointed if it's positive."

I was tired. So I just dragged a breath of air and said, "Me, too. But still. Check it." Which he did.

Yeah.

Today when I came to see you, you looked so happy to see me. Your face was still full of light. The gladness in your eyes to see this black woman doctor was palpable. I could see it before I even turned the light on. "My doctor! Heeeeey Miss Manning!"

You reached for my hand. I grabbed it. "Hey sis," I said softly. Then I sat down. My face was serious. And my eyes almost immediately welled up with tears.

"What?" you queried. Your eyes looked worried. About ME. "What?"

I swallowed and gained my composure. "I owe you an apology." Your eyes widened. "I. . .I just got back your urine drug screen. The student didn't want to get it. But I insisted." You kept listening. "It was negative."

The expression on your face was inexplicable. Then what you did next surprised me. You held open your arms and asked for a hug. I obliged you.

"You be wanting to believe, don't you? But you can't always believe."

I nodded and sighed. "I do want to believe. I do."

"It's okay. That's the thing about a stronghold. It make reality and fantasy look like one and the same. Bet you heard a whole bunch of folks cry wolf before."

I tapped my foot and bit my lip so I wouldn't cry. "I am very proud of you. And so happy for you."

"And I believe you," you said. Then you squeezed my hand.

When I left your room, I went to a stairwell to cry. Mad with myself because every day I am preaching to my teams to believe that today could be the day. Here "today" was staring me in the face and my bias and exhaustion wouldn't let me believe it. Or at least try to believe it.

Sigh.

No. I don't have all this shit figured out. No, I do not. But you were right. I be wanting to believe. Damn, I do.

Yeah.

P.S. I told my medical student I was sorry, too.

***
Happy Wednesday.

Bias is heavy.

There is this thing I had to fight off the moment I laid eyes on you. This feeling, this bias that I wish I didn't have toward you but that I know I do. As soon as I stepped over the threshold into your room, I could feel my heart shadowboxing to try to press it down, hold it back.

Sigh.

They make whole television shows about you. And people tune in as appalled voyeurs, wondering how someone could reach the kind of weight that renders them immobile. Or totally isolated. Or maybe not isolated but still unable to fully participate in the kinds of things that most people can do. Admittedly, I don't watch. But I'd be lying if I said it was because of my tremendous empathy and disapproval of people making your reality into a spectacle. Instead, it just reminds me of those who come before me as my patients who are like you. And how helpless I always feel.

Yes. That.

See, that's my bias. I like feeling like I can do something. And a body mass index that matches my age always makes me feel like my hands are tied. And like there is nothing I can really, truly do. Especially when resources are low on top of it.

Sigh.

So after I saw you, I told my team what I am saying now. That I am struggling with my bias and I want to do better, be better. And that I would try. Like, really try.

"How?" my student asked me.
"I don't know," I said. "But I think first? I'm just gonna be still and think about it."

Which I did.

And so. I came back. And this time, I didn't just go through the motions. I sat down and spent some time talking to you. I told you flat out about how sometimes I struggle with seeing my patients who carry as much weight as you. And then I said sorry in case it sounded mean. You said it was cool.
But then we started talking. About music. About family. About parents saying crazy stuff and what we put them through as kids. We laughed about land lines and how kids now will never know how it feels to have somebody pick up the phone and start dialing while you're trying to ask somebody to go with you. Or pretend you ain't eavesdropping on a three-way call. We cracked up laughing.
Then, after that, you took out your phone and showed me a picture of yourself. Not in the hospital. Standing outside at a cookout. And yes, you were still as heavy as you are now, but your eyes were dancing and you looked alive. You did.

"You still struggling?" you asked me.
I thought for a minute. "You know what? No."
"People don't see me," you said.
"I didn't before. I do now," I replied.
"It's crazy because when you real, real big, people treat you bad and the world seem like they cool with it." You shook your head. "I'm not talking about being husky. I'm talking about when you get like me. Like people let they kids stare or they look at you and frown right to your face. Like 'Uggh.' And don't nobody say nothing."

"Dang." That's what I said.

Because that was all I could think to say. And because I felt my toes squishing under the weight of that truth.

I'm learning that confronting our biases head-on is one of the only ways to overcome them. I'm also constantly reminded that the longer you stay with someone, the more you'll find where you intersect. And the more you'll see them.

Because I saw you, I took better care of you. The plan became more meaningful and, as the leader of the team, allowed me to help my whole team see you, too. Like, for real see you. I also told them what you said and we all promised to do better. Or at least try, man.

Thanks for helping me to be a better doctor. I'm a work in progress for sure. But today--thanks to you--I think I progressed.

Yeah. 

***

Top Ten: The Hair Salon Inauguration Recap.

 

Oh man, y'all. So much has been going on in the world that I was absolutely delighted to discuss it all in the hair salon today. (From the perspective of the sistas getting their hair done, that is.) Clearly this warrants a top ten.

Clearly.

So. . . yeah. . . the inauguration. Yes. That. This was our hottest topic, of course. Once we got past the whole "We love President Obama" and "Isn't it wonderful to see him getting inaugurated on the Martin Luther King Holiday!" part, we moved straight into the absolutely, positively unimportant parts that we'd all saved up for the beauty shop. 

Therefore. Without further ado, I bring you:

THE TOP TEN THINGS I EITHER DISCUSSED OR OVERHEARD SOMEBODY DISCUSSING IN THE HAIR SALON TODAY.

Like to hear it? Here it go!

Note: Whenever I don't indicate who was speaking, it means that nearly everyone in earshot was chiming in. (Which is nearly all of the discussion points.)

Alrighty then. . . . .


#10  BANG-UP JOB

 

"What y'all think about them bangs?"

"What bangs?"

"Michelle's bangs."

"Oh. Those. I think they were fine. Not as big a deal as everyone made out of them, though. But fine."

"Girrrrl, you TRIPPIN'! I thought they was BANGIN'!"

#9  CLINTON AND KELLY

Stylist: "Did you see your boy Bill eyeballing Kelly Clarkston when she came on that stage?"

Client #1: "Girrrrl! No! What did he do, girl?"

Stylist: "That man about broke his neck when that girl walked out!"

Client #2 (across room): "That's his type you know."

Me:  "His type? Say what?"

Client #2: "Yeah, girl. That's cause Kelly kinda thick. Sorta like Hillary and Monica."

Me:  >_<

#8  CONTACT PRECAUTIONS.

 

"Damn! Doesn't Hillary Clinton have some contact lenses? Did you see her with them Coke bottles on? Poor Bill."

"That's jacked up. You know she just had a clot on her brain!"

"What's that got to do with her putting in some contacts or at least getting some new glasses?"

"You're going to hell."

"And so is Hillary's stylist." 

#7  EXTRA! EXTRA!

"Let's discuss whether or not Miss Beyonce was mouthing or singing live."

"No! First we have to discuss what she had on and her hair!"

"I thought she looked nice."

"I thought she looked extra."

"Extra?"

"Hell yeah. Why was she giving us sequins and sparkles and big hair at the daytime inauguration? I mean, she was giving us red carpet and Golden Globes and it just wasn't even called for."

"I agree! And you know the only reason she took that ear prompter out when she was singing was 'cause it was irritating her with that big ass emerald earring in her ear."

"No, guys.  I actually think it was because she was trying to hear better when she sang."

(side-eye glance) "Hmmph. You can believe that if you want."

"Girl! Where is you goin' in that ball gown?!"

"I'm with you, girl. She walked out and I was thinking, 'Uhhhh, Dreamgirls called. They want their dress back." 

*laughter*

#6  LIP SERVICE

Me:  "Well? Who thinks she was lip syncing?

Sister-getting-a-relaxer:  "You know what I think?"

Me: "What's that?"

Sister-getting-a-relaxer:  "I think Beyonce is a bad ass b@%h and it don't matter what she did."

Me:  "I heard that!"

Sister-getting-a-relaxer:  "Did you see how she walked up there looking all around like a diva when that music came on? She was giving us Diana Ross, Aretha Franklin and Barbra Streisand!" (looks around and bats lashes.)

Me: "I know that's right!" 

Stylist:  "It totally looked live to me."

Sister-getting-hair-shampooed (yelling over rushing water):  "Well you know what I think? I think it just made me want to hear the Whitney Houston version from the Super Bowl. That's all it did for me."

Me:  "Now Whitney Houston definitely lip synced." 

Sister-getting-hair-shampooed (still hollering like she's deaf): "Yeah, but she was Whitney so she could do whatever the hell she wanted to do!"

*Everyone sits in quiet reflection for a bit trying to recall the Whitney performance. *

Everybody nodding and in unison:  "Yeah. . . Whitney pretty much killed it."

#5  POETRY IN MOTION

"Who else besides me fell asleep when dude was reading that poem?"

"Okay. Now you really, really going to hell."

#4  JAY Z

 

"It woulda been hot if Jay Z got up there and spit a few rhymes instead of the Star Spangled Banner. Bet nobody woulda been accusing him of lip syncing then!"

"And Barack coulda jumped in and free styled."

"Yeah. That woulda been hot."

#3  LADY IN RED

"Girrrrl! Did y'all see how Barack was looking at Michelle in that red dress?"

"He was looking like, 'It's 'bout to be ON when we leave here.'"

"Y'all are disgusting."

"Oh come on! Everyone knows that dressing up in black tie puts you in the mood."

"True dat."

"Yeah. That and waking up the morning after a big argument."

*everyone nodding their heads*

#2  MRS. BIDEN

 

Client #1: "While we talkin' about dresses, don't sleep on Tipper in her dress. She was killin' em in that blue bias cut!"

Stylist:  "Yeah, girl. And you know bias cuts are totally unforgiving."

Client #1: "Totally! They show every lump, bump, nook and cranny! She was workin' it, though."

Client #2:  "Mmm hmmm."

Client #1:  "I was like, 'Tipper, boo, you DID that!'"

Me:  "Uhhhh, am I the only one who's tripping off of you calling her 'Tipper' and not 'Jill?'  Uhhh, Tipper was Gore's wife."

Client #1:  "Oh, hell. Y'all knew what I meant."

Client #2:  "Didn't she have blonde hair, too?"

Me:  0_0

#1  UH OH, UH OH, UH OH!

"I love me some Michelle. Lord knows I do. But can I just go on the record and admit that I look at her husband in ways that she wouldn't like. For real, girl."

*high fives all around*

"Especially with that gray hair he has now. Girrrrrl."

"I know that's right. If I was at that ball she would have been like, 'Who is this broad hunching all up on my husband like that?'"

*laughter*

"I wouldn't go near that dude."

*heads swing in the direction of person speaking*

"Yeah, he's fine and all, but Michelle from the south side of Chicago. And have you seen her arms? She'll kick somebody's ass if they get up in her man's face."

*laughter*

"When Beyonce walked up, Michelle was all like, 'Why you got to be all hugging and kissing all on my man and just giving Joe Biden the nod?'"

"Ha ha ha! I bet that's what she said in Beyonce's ear when she got up close to her."

"It is! This is what she said:

Beyonce: "Yes, ma'am."

 (teeth gritted) 

"Loook, little girl. I'm from the south side o'Chicago and I will s-natch you up by that weave if you pull some mess like that again! Do you hear me?" 

*laughter*

See? I told you that there's never a dull moment in the beauty shop. Never, not ever. Ha ha ha!

Yeah, so that's what we were talking about. What were y'all talking about that had zero relevance or importance regarding this monumental moment in time?


Good times, y'all.

***
Happy Wednesday.

And here's Miss Whitney lip syncing and killing it--simultaneously.



And yes, Miss Beyonce--personally, I loved your rendition. But I have to agree with my shampoo bowl sister. . .something about hearing you sing that day made me wish for Whitney in her warm up suit a little bit, too.




BONUS TOPICS:

* Michelle and the Boehner eyeroll. Hee hee.
* Whether or not Michelle Obama's bangs were cut or just clip ins."
* How fun it seems like Joe Biden is to have around
* Whether or not Michelle's mama spanks the girls when they act up
* Why Hillary hasn't gotten Lasik eye surgery yet
* How Jennifer Hudson manages to get such high profile gigs all the time
* How Michelle Obama needs to give Condoleezza her hair stylist's contact information