I entered the office of the Community Health Council of Wyandotte County, Kansas City, on a muggy, late-summer day during my family medicine rotation. The air-conditioned building boasted a large front room with sporadically placed desks, children’s books and toys, and what looked like a large food pantry. I flexed my elbows and wagged my arms to fan out the sweat from my Black body enshrouded in my white coat.
My colleagues and I pooled into a back room and sat at long tables arranged in a square. We were each given a hefty book covered in red and black ink called “The HEAT Report.” Though I grew up with a baseline knowledge of the disenfranchisement of Black and Brown communities, this book was my formal introduction to the concept of “redlining.” Essentially, arbitrary red lines drawn around a community by policymakers could starve residents of financial capital and choke access to equitable healthcare. Our conversation led to discussion of how redlining impacts minority health. I felt the familiar pangs of pity from my peers directed at me — the only Black male medical student. These looks felt like an apology for the health implications of having a Black body, for my inevitable prostate cancer or my future wife’s death during childbirth.
Months later, I learned of a patient from my colleague while on the labor and delivery service of my OB/GYN rotation. The young woman, admitted for symptoms of preeclampsia, was refusing hourly vital signs checks and pelvic exams. For two days, my peer reported the patient’s curt responses and “difficult attitude.” My peer was eventually assigned a different patient.
On my third day of service, the last of my patients was discharged. I noticed that our so-called “difficult” patient had an expected delivery date in a few days; that date happened to be my birthday. I figured that simple fact might help me connect with this patient. I walked into her hospital room and immediately recognized her expression. She looked to be carrying the pangs of hollow pity from people who could not possibly understand her struggle as a Black mother.
She remarked, “Wow, you’re the only Black doctor I have seen since I’ve been here.”
I reminded her that I was only a medical student, then followed with excitement that her son and I might share a birthday. She scoffed, “I don’t want my son to be a Leo. I want him to be a Virgo.” She appeared closed off. She acted toward me as she had to my colleague. She did not trust me.
In Wyandotte County, Kansas, the Black infant mortality rate is twice that of White infants. Perhaps my patient was aware of these numbers and was frustrated by the inadequacy of our local government and healthcare system to address these disparities. Each day following her was a challenge, but I felt her cold exterior slowly melt away as I continued to make patient progress. One day she lowered her shoulders and lightened her voice. The next day she greeted me at the door. The following day, she smiled when I entered the room. We discussed mutual interests, and by the end of our conversation, she confessed her fear for her future son’s life. She worried her providers would not appreciate her struggle as a Black woman from a poor neighborhood.
The following morning before rounds, I pulled my resident aside. The resident was familiar with “The HEAT Report” and the alarming statistics in Wyandotte County but had been unaware of the patient’s fears. We entered the hospital room together and reassured the expectant mother with compassion.
Diversity in medicine is emphasized because of its true impact on patient well-being. I believe we must reflect and recognize that we share experiences with patients that unite us on a deeper level. Our connection to our patients through these experiences can often be felt, even if never directly addressed in the moment. We begin to mitigate the adverse health effects of redlining by understanding our patients beyond their physical complaints. As a Black man, I carry many of the same fears as my Black and Brown patients. I accept that quelling the fears of a patient is of equal importance as their treatment goals. Addressing fear helps establish trust, which is the most essential component of an effective physician-patient relationship.
I was the primary caregiver for the expectant mother’s delivery. She gave birth with no complications. Afterward, the new mother called her own mother on video chat. The words she spoke often echo in my mind: “Ma, look, this is the doctor that delivered Adrian!” She was proud a Black healthcare provider delivered her Black son.
Her mother replied, “What?! Let me see the baby!”
Image credit: Striving for Survival (CC BY-NC-ND 2.0) by Truthout.org