At Grady, unlike at Duke, I regularly worked with black doctors. I estimated that about 20 percent of the doctors were black; whereas at Duke, the number was less than 10 percent. Part of the discrepancy was the emergency room setting, which likely drew black doctors for the reasons Dr. Mason and Dr. Stephens stated. Morehouse, a predominately black medical school, also sent its doctors to Grady. Moreover, Atlanta’s reputation as a mecca for well-to-do blacks also added to the hospital’s appeal to black doctors. Dr. Mason, from Queens, New York, and Dr. Stephens, from Chicago, trumpeted the philosophy often used to justify affirmative action in medical school: black doctors were more likely to practice in areas that served black patients.
Our conversation about race and medicine was abruptly halted as a nurse approached us: “Got a GSW on the way,” she said.
Despite enjoying crime and medical shows, I didn’t recognize the abbreviation at first—GSW was short for gunshot wound—because I hadn’t seen any cases at Duke.
“How old?” Dr. Stephens asked.
“Eighteen,” the nurse replied. “He took at least one to the abdomen.”
Dr. Mason shook his head. We rushed to the trauma bay, where nurses and a respiratory therapist checked various equipment and supplies in preparation for the patient’s arrival. About five minutes later, the paramedics wheeled Sean into our area. He was awake, but barely, his eyes flickering open and shut. He’d likely gone into the early stages of shock.
Dr. Stephens, two paramedics, and a male nurse carefully but quickly moved him from the gurney onto the trauma bed as Dr. Mason supervised their actions. We were soon joined by a trauma surgeon. With three doctors on hand and at least that many nurses, I stood toward the rear as they rapidly assessed Sean from head to toe. Dr. Stephens used industrial-strength scissors to cut through Sean’s bloodstained Air Jordan sweatshirt and Nike sweatpants. A nurse hooked him up to a cardiac monitor, inserted a second IV line, and drew blood. Dr. Stephens then inserted a large caliber IV into the femoral vein in Sean’s groin area that allowed rapid replenishment of blood and other bodily fluids. Dr. Mason shouted orders for medications and X-rays.
“What happened?” the trauma surgeon asked.
A fight had broken out on a basketball court in one of the worst neighborhoods in the city. Somebody came back with a gun and started shooting.
On the X-ray it looked as if one bullet had punctured the inner depths of his abdominal cavity while the other hadn’t. The doctors wouldn’t know for sure until they opened him up, so Sean was rushed to an operating room. I followed Dr. Mason and Dr. Stephens into the physician work area as they began the paperwork.
“Is he going to make it?” I asked.
“Fifty-fifty,” Dr. Mason said. “It’s a damn waste. He should be thinking about college.”
But we all knew the painful reality. For black male teens, homicide is the leading cause of death; for all other teenage groups, accidents (primarily motor vehicle) are the biggest killer. We didn’t know for certain the race of Sean’s shooter, but more than 90 percent of the time, young black homicide victims are killed by another black person. Sean’s shooter, if caught, would be headed to prison. There, blacks make up more than 40 percent of inmates, compared to just 13 percent of the national population. In the span of only a few weeks, I’d seen violence disrupt the lives of Sean and the family of Lucy’s son Tony. College—which had placed me, Dr. Stephens, and Dr. Mason on the path to success—appeared beyond their reach. We had succeeded while so many of our brothers had been left behind.
It was a familiar story. In my neighborhood, two boys, both just a few houses away from where I lived, wound up doing serious time for drug-related crimes. I’d also had relatives on both sides of the family find their way to prison. Sampson Davis, an emergency room doctor raised in Newark, talks often about his narrow escape from a life of crime. In his memoir Living and Dying in Brick City, Davis returns to Newark after medical school only to discover that one of his childhood buddies had died, at the hospital where Davis was working, from gunshot wounds: “Why? Why me? Why had I survived? Why had I made it out?” he guiltily wondered.
Many black men face this dilemma, both in public and in private. Wes Moore, a Rhodes Scholar and White House Fellow, explores this subject in depth in his memoir of the divergent path his life took compared to a young man from his community who shared his name. Physicians Ben Carson and Otis Brawley, in their respective books, recount their own escapes from the poverty of Detroit to prestigious colleges and successful careers. The common thread for each was a belief that education would transport them beyond their surroundings. Dr. Davis summarizes this recurring theme as he writes of his return to Newark as a doctor: “I would see lives that might have been saved if the industrious young men landing in my emergency room full of bullet holes had learned and believed that education offered a better alternative.”
Before Atlanta, I’d typically been the only black person on the medical team as we stood witness to the disparities that afflicted black people. I never knew for certain how white and Asian doctors felt about some of the black patients that we saw, the ones who abused illegal drugs, were more prone to early pregnancies and sexually transmitted disease, the ones who were perpetrators and victims of senseless violence. Did they secretly think, as Sampson Davis feared: “What’s wrong with those people?” Or were we projecting our own insecurities onto them?
For that matter, I wasn’t sure how black doctors really felt either. In the company of white doctors, whenever the topic veered toward race, a handful of black students and doctors were inclined to speak up and point to the legacy of slavery and Jim Crow as the cause of what they saw with black patients. Others, myself included, usually kept silent, figuring little good could come from fanning racial flames. But here at Grady, in segregated company, we could let down our guard.
“You know at some point, we’ve got to stop blaming white folks for all of our problems,” Dr. Mason said. “We’re our own worst enemy.”
“You’re right,” Dr. Stephens replied. “A lot of us could be making much better choices.”
“Don’t get me wrong,” Dr. Mason said as he looked at me. “I’m not a right-winger. Pulling the rug out from under our community isn’t the answer either.”
They went back and forth for a while. They believed, as I did, that while government efforts to help poor black people sometimes failed, the obligation to keep trying remained. Local governments, in concert with nonprofit groups and the private sector, had to work smarter, they said, to reach them, to help them make better decisions. But what did that mean in the realm of health care? And was this social responsibility part of our role as doctors?
I found out a few days later that Sean had survived. He suffered no major complications. If his post-operative course went smoothly, he had a good chance for a full recovery. This spoke to the excellent trauma care he’d received, the kind that the Atlanta area had relied on Grady to provide for decades. Ultimately, the value of Grady was such that it was deemed too important to fail. In November 2007, after much contention, the hospital’s leadership was transferred from a politically appointed board to a nonprofit corporation that, within a few years, steered the hospital from the verge of financial ruin to solvency. Grady, top-notch trauma center and massive safety-net hospital, was here to stay.
Yet as vital as Grady was to the Atlanta area, it felt as if we at the hospital were only scratching the surface of larger health issues. Sean’s second chance would not have been possible had the bullets traveled a slightly different trajectory. What could be done to reduce the chances of more young black men becoming GSW statistics? What was happening outside Grady’s walls to cause the carnage we saw inside it every day? As my month in Atlanta drew to a close, I got a firsthand look at the surrounding world that fed its patients to Grady.
* * *
During my final week, I spent one day experiencing the life of a paramedic. This was required of all students on the rotation to ex
pose us to the first step in emergency care. I began the day irritated that this exercise would replace an ER shift. The smell and feel of the ER had grown on me and my clinical skills had rapidly improved: I had stitched lacerations, drawn arterial blood tests, and assisted on lumbar punctures. What could I learn from paramedics that a doctor couldn’t teach better?
My two paramedic guides—one white, one black, reminiscent of many buddy cop shows and movies—were unaware of my condescending attitude and eagerly greeted me outside the main Grady Hospital emergency room. Both were in their forties and a little soft and wide around the mid-section. They wore their usual work garb—dark slacks and shoes and a short-sleeve shirt with a sewn-on patch indicating their official title.
“I know where we have to go first this morning,” Ron, the black paramedic said, with a gap-toothed smile.
“This should be fun,” replied his partner, Kurt. “Let’s do it.”
I had no idea what they had planned at my expense. I crouched into a seat behind Ron, who took the wheel. It was my first time inside an ambulance. On the surface, it wasn’t very impressive: it rode like the van my high school basketball coach had driven me to practice in every day. Behind me, however, I saw the tools of medicine: a defibrillator, several bags of intravenous fluid, a folded gurney. What must it be like, I wondered, to lie back there, semi-conscious, bleeding, in intense pain, with strangers hovering over you, rushing to a hospital with sirens and flashing lights, not knowing if you were going to survive? Would you worry about family? Friends? Your accomplishments and failures? Or whether you’d had enough faith?
We parked at a local fire station where Ron and Kurt gave me a brief tour of the facility. They explained how they often worked together with firefighters as first responders. Ron stepped into a small office and emerged with a well-worn basketball in his hands.
“Let’s see what you got,” he said, motioning to the basketball hoop in the parking lot.
Ron suggested that we play 21, the popular playground game I’d grown up with, but Kurt reminded him that the last time they’d done that, Ron had injured his back and missed a week of work. So instead, we settled for a few games of the much less strenuous H-O-R-S-E.
Afterward, we stopped for doughnuts and coffee, surely negating any benefit from our twenty minutes of light exercise. As they traded sarcastic stories about their work and families, I felt as if I’d been transported onto the set of the popular TV show Law & Order with Detectives Briscoe and Green. My initial reservations were fading; I was having fun.
Just as we finished eating, we received our first call of the day: “Old guy with chest pain,” said the dispatcher on the other end. “He’s fully conscious.”
“We’re on it,” Ron said, as he turned to me. “Bread and butter.”
We trotted back to the ambulance, where Ron pushed an orange button that generated the siren and its accompanying flashing lights. I felt a rush of anticipation. Many times, I’d been in my car and panicked at the sound of an approaching ambulance, desperately trying to decode in which direction the siren was heading. As it finally whisked past, I’d nudge myself toward the steering wheel and grip it with both hands, trying to insulate myself against its deafening blare. Now, from inside the ambulance, I saw this same reaction in other drivers. The world looked different from here, as if the other cars were operating in slow motion, our flashing and beeping putting them in a state of confusion.
Our drive took us through a run-down area of check-cashing joints, liquor stores, and fast-food stops. Steel bars covered the windows to deter would-be burglars. About a half-dozen black men between twenty and forty years old congregated in a pothole-infested parking lot. They smoked cigarettes while laughing and talking. The scene reminded me of childhood trips with my mom through New York Avenue on the way to my grandmother’s apartment in Northeast Washington.
This commercial strip gave way to an area of old houses, the kind that were probably once part of a nice community but had fallen into disrepair as the surrounding neighborhood declined. After parking outside the address the dispatcher gave us, we hurriedly unloaded our supplies—a gurney and two large bags of tools—and jogged up the narrow driveway. An elderly black woman wearing a white bathrobe opened the front door. Her hand trembled as she pointed to a room inside the home. “He’s in the kitchen.”
“Are you his wife?” Kurt asked.
She nodded. “Is there anyone else who lives here with you?” he asked.
She shook her head. “When did all this start?” he asked.
“About a half-hour ago,” she said. “I was making breakfast.”
“How old is he?”
“Seventy-two.”
“Does he have heart or lung problems?”
“No.”
“Does he take any medications?”
“They’re on the kitchen table. I gave him an aspirin when his chest started hurting.”
In thirty seconds, he’d gotten the information it often took me at least a few minutes, sometimes longer, to obtain. We found our patient in the kitchen, his torso folded over in pain, forearms crisscrossed as they rested against the wooden table for support. Dressed in a checkered robe, plaid pajamas, and black slippers, he looked as if he’d been sitting down with the newspaper over a cup of coffee. Chest pain had intruded on his morning routine.
Kurt asked the man a few questions while measuring his vital signs and placing rubber tubing in his nostrils that hooked up to an oxygen tank. Ron reviewed his medications. We carried him to the living room where we put him down on the family couch. His EKG was normal so they gave him a nitroglycerin tablet to ease his pain and got him ready for transport to the emergency room. I asked if we were taking him to Grady.
Ron shook his head. “He has Medicare since he’s over sixty-five. Most hospitals happily take it. We’ll go somewhere closer. If he was one of the young jokers we passed on the way over here, he’d have to go to Grady.”
Emergency departments are obligated by law to evaluate those who show up at their doors. But that doesn’t stop them from screening out people before they arrive. According to Arthur Kellerman, former chair of Emory University’s Department of Emergency Medicine (during which time he also worked as an attending physician at Grady Hospital), some hospitals will operate under case-by-case or selective diversion, where they can limit or weed out certain patients by diverting ambulances elsewhere. Kellerman speculated that it is a way for the hospital to conduct a “wallet biopsy”—accepting paying patients while rejecting nonpaying ones. Medicare, although not as desirable as private insurance, pays doctors and hospitals better than Medicaid, and certainly more than the hospital gets from uninsured people, many of whom pay little or nothing at all. These uninsured patients invariably wound up at Grady, and many of them were the ones who filled its waiting room beyond capacity.
Once we got to the private hospital, we handed our Medicare-insured patient off to a charge nurse and physician. Kurt delivered a bullet-point summary that gave all the relevant information in less than thirty seconds, a stark contrast to the several-minute variety often expected of medical students. Their competence and efficiency impressed me. I had underestimated their medical knowledge and the extent of their responsibilities.
Just minutes after leaving the local hospital, we received a call about an alcoholic man who reported being suicidal. Ron made a U-turn and took a winding city road into another gritty area. There we drove past a dingy rent-by-the-hour motel from which a young black woman in high heels, a short skirt, and bright lipstick emerged. A few miles later, we found our patient on the sidewalk next to a food joint. With his leathery skin and lined face covered with gray stubble, he looked the part of someone who spent his days submerged in alcohol. The restaurant manager had called 911 after the man vomited while standing in line. Evidently, he was a frequent-flyer to the paramedic team, as Ron called him by name.
“Are you ready to get your act together, Gordon?” Ron asked.
�
��Yessir,” Gordon said, his hands shaking.
Ron looked over at Kurt, who shook his head. “No reason to bullshit me. We’re going to take you to the hospital either way. But you’re wasting your time and everyone else’s if you’re just going to be right back here in a few days.”
“No,” Gordon protested. “I’m ready. I can’t keep goin’ on like this.”
“Let’s hope you mean it this time.”
Kurt handled the medical side, checking Gordon’s blood sugar and setting up an intravenous line for fluids, while Ron completed the paperwork.
“That might have seemed harsh,” Ron said, “but hand-holding doesn’t work for addicts. I’ve been there. Got fifteen years clean time. I never got quite this bad, but I was pretty close.”
The contrast between Ron and Gordon at that moment made it nearly impossible to imagine one in the other’s shoes: alcohol and drugs stripped away people’s dignity in a way that few other things could. We dropped Gordon off at Grady, as he had nowhere else to go. He’d been there many times before, Ron and Kurt said. Usually he’d demand to be discharged after drying out so he could go back out and get drunk.
The pace slowed for most of the early afternoon, enough that we went back to the fire station and played more basketball until Ron started breathing too heavily. We traveled to a few other calls where we were secondary backup, but the injuries were so minor that our help wasn’t needed. Finally, a little more than an hour before our shift ended, the dispatcher called us. “Domestic assault,” she said. “Knife-related injuries.”
“We’re on our way,” Ron said, as he fired up the siren again.
“This should be fun,” Kurt said, when he heard the dispatcher announce the location.
We merged onto the highway, which by midafternoon was already starting to be jammed with Atlanta’s notorious traffic. With little room to navigate, Ron took to driving on the bumpy shoulder. About ten minutes later, we exited into a wooded area that, at first glance, looked as if we’d left the city limits and entered into the semi-rural suburbs. For a split second, I allowed myself to imagine we were headed toward a mansion or gated community. But based on the day thus far, I sensed otherwise. As the towering trees parted, our destination came into view.
Black Man in a White Coat Page 10