His jaw loosened just enough for him to say, “Dominic.”
“Yes. And your last name?” I asked.
“Thomas. Dominic Thomas.”
“Hello, Mr. Thomas. I’m Dr. Harper. I’m the doctor in charge here, so I just have to ask you a couple questions. I’m sure they’re the same ones everyone else has asked you. Please just bear with me. Can I first ask you why you’re in the emergency department today?”
“I don’t know. I didn’t do nuthin’,” he said, his voice rising. I saw his neck and shoulders begin to tense and his arms extend behind him. Nearly shouting, he continued, “They arrested me and brought me here for nuthin’.”
Officer Quigley, one of the four large white officers standing around the patient, spoke up. “Dominic here is under arrest for drugs. We raided the house and saw him swallow bags of drugs when he was trying to flee the scene. That’s why he’s here. We need you to examine him and get the bags out.”
Turning back to Dominic, I asked, “Mr. Thomas, did you swallow bags of drugs?”
He sucked his teeth and then replied, “No! They don’t know what they talkin’ ’bout!”
I looked back at the officer who’d spoken. He rolled his eyes and looked away.
“Mr. Thomas, of course I have to make sure you understand that if you or anyone swallowed bags of drugs, it is really dangerous. The bags could cause a blockage in your bowels. Even worse, they could leak and cause all sorts of things like heart attack, an inability to breathe, pain, and even death.”
“I got it, miss, but I didn’t do it, so it’s not an issue.”
“Okay, can I just ask you a couple more questions? It’ll be fast.”
“Yeah.”
“Do you have any medical problems?”
“No.”
“Do you take any medications?”
“No.”
“Are you allergic to anything?”
“No.”
“Any surgeries?”
“No.”
“Any alcohol or drugs today?”
“No.”
“And my last question. Mr. Thomas, would you like us to examine you today?”
“No. I wanna get outta here.”
“Okay, then we will discharge you.”
At this, the officers bristled. Officer Quigley exclaimed, “We brought him here for an examination. You have to examine him. That’s the procedure.”
“What procedure are you referring to?” I asked. I didn’t accept what the cop was telling me, and I questioned why he felt comfortable instructing me to do anything at all.
“Ma’am, we do this all the time,” he said, sighing. The sigh telegraphed to me that this man, this older, taller, heavier white cop, felt I was both missing a critical point and wasting his time.
“Oh, do you all have a court order for us to examine this man against his will?” I asked, implying that this must surely be the missing piece of information.
“No, but he’s under arrest for a crime.”
“I do understand what you’re saying, but it is against the law to force a medical examination on a competent adult human being. If you don’t have a court order, I would be breaking the law to do further medical evaluation on this man against his will. So, if Mr. Thomas does not want a medical examination, there will be no medical examination, because this is his right and this is the law in the entire United States of America.”
Officer Quigley, the charge nurse, and the resident all stared at me. Then they began to explain to me that other physicians had forced such exams on patients.
“I’m sorry to hear that,” I told them. “I’m sorry to hear that there are doctors who will break the law for this reason. I am not one of those physicians.”
Lauren turned around and went back to her desk.
Carl, whose face communicated total disbelief, asked, “So we’re just gonna let him go, with no triage or anything? Because he wouldn’t even let me triage him.”
I turned back to the patient. “Mr. Thomas, is it okay to just take some quick vital signs on you? Just a couple of things like your blood pressure and heart rate? I promise it won’t even take two minutes. As long as your vitals are okay, we’ll get you right out of here.”
“I’m not putting on that gown.” He scowled.
“You don’t need to change for this at all.”
“Okay, go ’head.”
“Thank you.”
I turned to Carl. “Excellent. I already got the history, so triage is done. He refuses any examination, which is his prerogative, so I’ll start on his discharge papers now. Just give a yell with those vitals when you get them.”
I turned away from the triage area, the dumbfounded police officers, and the annoyed charge nurse. I overheard nurses on both sides of the department debating the ethics of my letting the prisoner go. I heard them telling stories of how it was common hospital practice to make an intervention; of how just the other day Dr. Brisbane, another ER doctor, had placed an NG tube up the nose of a patient, down the back of his throat, and into his stomach to pump gallons of GoLYTELY, the fluid used in a colonoscopy prep, into his gut until his stool ran clear, to remove the alleged drugs from his system. This was the first I’d heard of this frankly horrifying malpractice. Because attending physicians in the ER tend to work in parallel to each other, with their sole focus on expediting the care of their individual patients, the only time I got wind of what my colleagues were up to was during sign-out or through rumor.
This work just got harder. While practicing medicine was feeling increasingly crucial personally, between the hospital bureaucracy and the colleagues who brought their limited perspectives to work—they were, after all, only human—the prospect of it being a sustainable career path for me was diminishing.
As I listened to the war stories of heroic medical efforts on unwilling captives, Maria, a feisty Latina transplant from the Bronx, chimed in. “Yeah, well, Dr. Harper is correct. You cannot force an examination on anyone just because the police or family member or any third party happens to request it. We need to treat people like human beings. I’m tired of people treating certain people like animals.”
I wanted to stand up and second everything Maria had just said, but I already had, in my management of the case. Besides, I needed a rest from standing, knowing that just seconds after I finished wrapping up Dominic’s case, I’d have to stand up again. For those few moments, I typed. To the extent it was possible, I’d stay out of the line of gossip. I leaned toward Lauren, who was positioned at the computer station just in front of mine. “Don’t worry about this case. I’ll write him up. Just move on to the next patient. Nothing for you to do here, since I already took care of it.”
Lauren looked at me with her typical antagonism. “Are you sure? I can write it up. I’m actually waiting for a callback from Hospital Ethics. I told them the whole case because I don’t think he can refuse an exam and medical interventions. We really need the Ethics Board in on this one if you’re going to let him go. I’ve worked with Dr. Linden and Dr. Jacobson on similar cases, and we just tell the prisoners what we are going to do. They don’t have a choice. I don’t understand what you’re doing.” Her tone was more indictment than question. It was the tone she used to assert that she knew more than I did, and for reasons she would never have dared articulate.
It was the very fact that Lauren felt comfortable assuming greater inherent wisdom on the part of the white, male physicians Linden and Jacobson that might have horrified her to examine in herself. For these same reasons—their white privilege—she would have followed their instruction anywhere, even if they directed her to literally break the law. While she wouldn’t have spoken the words, her tone communicated one of the ubiquitous microaggressions faced by people of color and the content of her words showed how such a microaggression is inextricably linked to the gross aggress
ion that follows.
Although I had been having issues with Lauren over the past sixteen months we had worked together, it occurred to me that, in this moment, she was being entirely honest. Yes, there was her typical peevish passive-aggressive tone, but I saw now that she genuinely didn’t understand. I knew her only within the confines of work, so I couldn’t pretend to know why she hadn’t considered these issues more deeply. Certainly, there was a type of privilege in it. Willingly or not, Lauren had donned the cloak of white male privilege, and it fit snugly over her own skin. After all, this is the only way oppression can function: It requires the buy-in of a certain percentage of those it actively oppresses in order to pit those groups of subjugated people against one another.
I thought about the powerful underlying assumptions that had made it so easy for the police to transport this patient to a hospital and for his sovereignty to be taken away. It could be related to his dealing drugs—though, we see all sorts of patients with drug-related issues, and they are not typically brought to the emergency department in chains. And there is certainly no expectation that we will simply accept that their bodies should be violated because of their alleged illegal drug use.
But for Dominic, it seemed somehow warranted, somehow a commonplace, that his rights as a patient should be tossed aside. I looked at him; his autonomy was so provisional. But then, had he ever had self-determination? Had he even been considered to have ownership of his black body? There was no medico-legal reason for a doctor or a hospital to usurp his decision-making capacity, and yet, for some people, it was expected. In the face of these truths, we are reminded that for many people, their bodies are not considered their own. For those whose bodies are viewed as suspect and threatening, those bodies, at the preference of a more privileged body, could be manipulated, even assaulted.
As I stood there in my white coat, I was reminded of Dr. J. Marion Sims, often referred to as the father of gynecology, who in the nineteenth century conducted experimental surgeries on enslaved women. The women, who had hopes of treatment from a purportedly competent physician, instead were pinned down on operating tables screaming in agony while he sliced into their pelvic regions without the benefit of anesthesia. Sims continued to torture enslaved women in these barbaric ways until he felt he’d perfected his techniques and felt comfortable performing them on white women, but in their case, with the humane addition of anesthesia.
I was reminded also of the Tuskegee syphilis experiment, in which for forty years, beginning in 1932, the U.S. Public Health Service recruited 600 black men, 399 of them with syphilis, ostensibly to offer them treatment for “bad blood.” The men with syphilis were intentionally denied treatment so that the U.S. government could study the progression of the disease over the course of their lives and then autopsy them after they had died. Not only were the men in the study not informed of their disease or treated for it, but steps were taken to prevent them from receiving treatment elsewhere; for example, STD clinics were provided with a list of study enrollee names so that they would be refused treatment should they have sought it. The long-running study was not put to an end until 1972, when public pressure led to a federal investigation that deemed the Tuskegee syphilis experiment unethical.
I was reminded, too, of Dr. Albert Kligman’s experiments on imprisoned men in Philadelphia from the 1950s to the 1970s. Kligman biopsied, burned, and deformed the bodies of prison inmates to study the effects of hundreds of experimental drugs. Men were subjected to such atrocities as inoculation with herpes, gonorrhea, and various carcinogens. Kligman went on to become a millionaire after co-developing the popular acne medication Retin-A via his studies on inmates, while many of his victims were left with chronic medical conditions that irrevocably damaged their organ systems.
While significant advances have been made in areas of racial equality, we still have miles to go. That day in the ER, Dominic was evidence.
“Lauren,” I asked, “do you know what ‘treating’ this patient would entail? We would be commanding him to have an examination he doesn’t want. We would have to restrain him in some way—physically and/or chemically. We would then put a needle in him to draw blood. We would force him to have an X-ray. If the X-ray didn’t show anything, and it probably wouldn’t, then we would force him to have a CT. We would have subjected this man to two studies of radiation to pacify law enforcement, who have no legal right to force anything on his body. Who would be legally responsible if there were an adverse event from these refused medical interventions? Not to mention who would be legally responsible for the physical assault that a forced examination would entail? You don’t even know if the police are telling the truth. Why is any of this acceptable? Furthermore, even if he did swallow drugs, he is an adult who is competent and sober, and who is medically and legally allowed to make his own decisions. We can’t force parents of children to allow immunizations that prevent epidemics of devastating pediatric disease; we can’t force a hemorrhaging Jehovah’s Witness to accept a blood transfusion; we can’t force someone having a heart attack to go for a life-saving cardiac catheterization if he refuses it. You know all these things. We have all had these very cases and simply signed the patients out against medical advice. Why would this be different, even if there is a potential life threat?”
Lauren stared at me in silence, her posture perfect. She gently chewed her lower lip.
I heard the clerk call out, “Anyone waiting for Hospital Ethics?”
Lauren waved vigorously at the clerk to send the call to her phone.
I watched and waited while she was on the phone. She didn’t say much, just a series of “ohs” and “ahs.” Then: “I see . . . really? Okay, well, thank you for your help.”
I sat still at my computer, attempting to breathe in for a count of three and out for a count of six (or something like it), to dampen the disgust as my anger mounted—anger that my resident, my privileged, highly educated white female resident, had felt comfortable being so disrespectful as to dismiss my judgment on this matter; that she had felt she had the right to invoke what she deemed a higher authority: older white doctors who’d done the police’s bidding in the past or whatever voice happened to be on the other end of the line from Hospital Ethics.
I looked down at my hands on the keyboard, my slender, dark brown hands, dry from constant washing and dousing with alcohol-based sanitizer between patients. As I noted the contrast of my dark wrists extending from the cuffs of my stark white coat, I was reminded of which costumes in America, even in the twenty-first century, are seen as legitimate and which are not.
I recalled the conversation with my department chairman that morning. I had sunk uncomfortably into the plush leather couch across from him. Part of me awaited congratulations upon my promotion to a new hospital position. The other part, the part that felt weighty and awkward sitting three inches deep on this sofa, anticipated the speech he would inevitably make. It was the same speech he’d had to make several times before, to the other women and black physicians who left before I had arrived at Andrew Johnson Hospital:
“Michele,” he said. “You know every time I try to make a change at this institution, I just can’t. I’m always blocked. You didn’t get the position. I’m sorry to say it. You’re qualified. I just can’t ever seem to get a black person or woman promoted here. That’s why they always leave! I’m so sorry, Michele. They’ve decided that even though you were the only applicant, and a super-qualified one at that, they’re just going to leave the position open. I’m so sorry. I hope you’ll hang in here with me anyway.”
His words had hung sadly between us. He had spoken with the heavy heart of a longtime liberal white man who would shake my hand, smile, close the door behind me, and then sit back down in his comfortable, secure chair. His effort was complete. His part was done. I was the one left to live with the limitations of that bigotry. I was the one left to get up and fight for Dominic and myself.
Ame
rica still has so many more strides to make. I am evidence.
Lauren turned to me. “Well, the hospital ethicist says that she reviewed this case and even spoke to Legal about it. Turns out it’s true that we can’t force any evaluation on this patient. Well, good to know. I’m gonna go see this little kid with a cold.” She closed her computer screen and headed over to Room 5.
I typed an extremely brief note on Mr. Thomas and swiveled in my chair to let Carl know the papers for his discharge were ready. Then I waved good-bye to Mr. Thomas; he gave me a barely perceptible nod and then continued to stare into space. Officer Quigley grabbed the discharge papers from Carl and mumbled something about everything being so ridiculous. The officer swept his arm across the room in the direction of Mr. Thomas. “Go ’head,” he said, in a manner that decisively conveyed his utter contempt for what had just unfolded.
What we had just experienced had offered an opportunity for all of us to recognize that America bears not just scars, but many layers of racial wounds, both chronic and acute. In order to move beyond them, we need to look at them for what they are, diagnose them, treat them, heal them, and then take care not to pick at the scabs, reopening the old wounds and creating new ones. I know how hard it is to stand and look at tortured and infected flesh. I know because it’s part of my job, and therefore something I cannot choose to look away from: soft skin splitting, macerated by brutality and time, half-eaten by maggots spilling out the sides, noxious gases spurting from the extremity of our trespasses. We need to stand face-to-face with it, to look and feel and smell and taste what we do, so we can choose exactly how we want to be in this world.
Just as we needed to look at the body of Emmett Till, the fourteen-year-old black boy who was murdered in 1955 by two white men who had accused him of flirting with a white woman while visiting relatives in Mississippi. They kidnapped the child, beat him, gouged out his eyes, shot him in the head, tied a cotton gin fan around his neck with barbed wire, and then threw his mutilated body into the Tallahatchie River. His mother insisted on an open casket at his funeral, so all of America could see how the nation treated its children, how we treated each other, how we were in this world.
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