- I have come to understand
that in the fight
for health equity, my presence
as a Black woman physician
is welcome so long as I
am seen and not heard.
This conditional acceptance
has been a painful realization,
and dissent is not
without its consequences,
a lesson I learned one
night while working
on the adult inpatient
medicine ward.
I received a call from
the nurse of Patricia,
a Black sickle cell patient.
I learned that a pill find
while cleaning out her handbag
had been identified as
a narcotic medication.
Security and nursing staff
requested our presence
for a room search.
Patricia's mental
status had not changed.
There had been no change
in her vital signs
or clinical status, and
there was no indication
that she had consumed any pills
preceding security's presence.
Upon relaying this to the nurse,
and asking for time
to review the policy,
she paused briefly before
asking me to confirm
that I would not
be participating
in the room search.
I sat for a while
in stunned silence.
If a room search was
indicated for Patricia,
why had it not been
indicated earlier in the week
for my other patient who
happened to be a white male,
when he left the unit,
returned somnolent,
and returned to normal
when he got Narcan,
the antidote for opioid
pain medication overdoses.
By the time I had learned
there was no defined
room search policy,
it had concluded.
When I visited Patricia
later, she wept
while recounting the
indignity of being separated
from her belongings,
and being patted down
by uniformed staff.
Nothing had come
of the room search,
but she was left to pick up
the pieces of her mistreatment.
My internal response
was a visceral thing.
A living, breathing
amalgamation of ancestral voices
coalescing into a single
reverberating word.
No.
This was wrong.
But even rooted in the
assurance of advocacy
and social justice, an
insidious, intoxicating fear
pressed forward,
determined to lull me
into the safety of silence.
Speaking up would be a
radical act of defiance
for a Black woman who
has been conditioned
to keep her head
down, to be agreeable,
to not make trouble.
When Patricia's nurse
asked to debrief,
I steeled myself in a
stance of curiosity,
and asked many questions.
What was the concern from
a nursing perspective?
How could we have improved
our communication?
How do we make decisions
on when to implement
a room search?
What alternatives did we have?
When invited, I shared
my own perspective.
Together, we created
a plan to address
similar concerns in the future.
We shook hands and hugged.
The chasm between us
didn't feel so wide.
While it wouldn't change
what happened with Patricia,
we could prevent harm
to another patient,
and that was something.
The next night, I was
informed that nursing staff
had filed a complaint stating
I had been unsupportive,
and refused to act
collaboratively.
First came shock.
Then anger.
And when the anger was spent,
an overwhelming
emotional exhaustion.
I cried for days afterward.
It had taken me years of
training and education
to learn to abandon
the lessons handed down
by my forefathers to
keep my head down.
To be agreeable.
To not make trouble.
I wonder if they understood
that through the weaponization
of their feedback,
they had taken something from me
that I couldn't get back.
What had they given up?
I was ready to have
difficult conversations
to bridge the divide.
But even though I had arrived,
had been welcomed, even,
I am still subject to
the same inequities
that my patients face.
I think of Patricia often.
I worry that the damage
done to her is irreparable.
I worry that
progress is too slow,
and patients are being harmed
while we strive
for what could be.
I worry that while I believe
being the dissenting
voice was right,
I may not always
have the fortitude
to always be a voice
for the voiceless.