Contributing Writer Emeritus
Tulane University School of Medicine
Corbin Pomeranz is a Class of 2016 medical student at Tulane University in New Orleans. He received his B.A. in Psychology and Studio Art from Kenyon College in 2007.
“In all seriousness,” the attending physician says, “he can wear women’s underwear to minimize the pain.” “Can he really?” “Absolutely,” replies the attending. “If we can’t prescribe any pain medication, then tighter fitting clothing can help keep things from jostling about too much.”
Her story started pretty similarly to any other patient I had over the past week and a half since starting my family medicine rotation. The nurse told me she had another patient who was checking in. I asked her for the name and began looking up the previous clinical notes and labs in the computer while waiting for her arrival from registration. She had a history of arthritis, GERD and uncontrolled diabetes — all diagnoses I had become comfortable discussing with patients.
Looking out and seeing the beautiful colors that surround me, I always used to feel bad for those not able to experience the power of the colors of the world. See, I was born without sight. No ability to distinguish red from white. For the longest time I thought I had missed out on something and I was mad at my creator for not giving me such a blessing.
A winter chill can trigger quite the flurry of activity on the floors of an urban safety-net hospital. Patients trail in from the cold with a telling set of problems: their asthma seems to be getting worse; shoveling caused a worrying chest pain; their toes are changing color; they have nowhere else to go. Senior staff begin wandering the wards, desperate to create room for those in need.
Much has been said about the growing crisis of mass incarceration in our country, especially how it disproportionately affects people of color. And it’s true, the United States currently houses 2.2 million people behind bars, a greater percentage of the population than that of any other nation in the world. Sixty percent of those incarcerated today are people of color.
In the recent White Coat Die-In demonstrations orchestrated by medical students across the nation, aspiring physicians displayed solidarity with the message that racial injustice is a public health concern that merits the attention and efforts of health care professionals. It is clear from the mobilization and investment of our medical community that there is a desire to engage in clearer articulation and understanding of the health disparities landscape.
As health care reform begins to take hold in America, we are beginning to see some significant departures from our “ways of old.” The new forms of payment that are taking hold seem so foreign to us because they are in direct opposition to our past system. Our previous method, primarily fee-for-service, was one where there was an incredible amount of wiggle room for what payments should be. Individual hospitals or practitioners would negotiate with an insurance company as to what their reimbursement should be for a given service or procedure. This has led to enormous disparities in what individual hospitals may receive for the same procedure and the same outcome.
It was a tough week for many of us. Scary events in the news. As phrased so eloquently by a fellow writer here, community injustice is intimately related to patient care. On my psychiatry rotation, I regularly hear about unbelievable violence that stems from and leads people into substance abuse, mental illness and crises resulting in hospitalization. I ended the week feeling sorry for our country and socially isolated from my peers.
This afternoon, medical students across the country, from Providence to San Francisco, will lay down on sidewalks and atrium floors in their white coats to express solidarity with ongoing victims of racial violence. As aspiring health care professionals, we don our white coats for these “die-ins” to express our commitment to the idea that racial injustice can and should be framed as a public health issue demanding our attention and efforts.
A mere five weeks into my third year of medical school, I met a patient who would leave an indelible mark. Jose was a Hispanic man that teetered between overweight and obese; I am a tall, medium-build Chinese-American who was thin in high school. He struggled with depression during 40 odd years of life; my biggest worry growing up was excelling on the competitive piano circuit. He spoke of a family rife with discord and unhappiness; my family is intact and supportive. He dropped out of college; I want to stay in school forever. He ate rice and tortillas; I ate rice and tofu. We were different but for a moment, our lives intersected.
“Which one of you idiots gave my patient a homosexual dose of diuretic?” Unbelievably, this is what the senior surgeon “growled” at Dr. Pauline Chen and her cohort during surgery training, according to her article in The New York Times entitled “Does Medicine Discourage Gay Doctors?”
You can’t ask your co-worker for narcotics the same way you can ask for extra Advil stashed in their purse or backpack. There are good reasons for this. Drugs like Advil or Tylenol carry no association with danger and can be easily bought at any local drugstore. While they are perfectly good for minimal pain relief from headaches or muscle soreness, they are underequipped for addressing major sources of pain. In comparison, opioid narcotics are serious painkillers.
Writer-in-Training and in-Training Staff Member
Warren Alpert Medical School of Brown University
The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.
I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!
