Posted on July 15, 2020
Throughout my medical training, there were situations of patient’s refusing treatment based on the color of my skin, even in emergencies.
One night, in Charlottesville, Virginia, the buzzing of the pager on my scrub top collar awakened me from a light sleep. I had learned long ago that heavy slumbers were impossible on nights like this. The emergency room and inpatient service were both full. These were not the nights that I was up at 3 a.m. to add a bowel regimen order for a patient.
These were the nights that I expected to be up all night but tried to catch a snooze here and there. Even 15 minutes could seem like an eternity of rest. These were the nights where floor patients became ICU patients. These were the nights that it would require me to use several hours to get to sleep after a shift. That night the page read: “Come now. Patient X has shortness of breath and chest pain.”
I arrived to the bedside to find an elderly white man. I asked for an update from nursing. She reported new onset chest pain and sweating that started about five minutes earlier. I hooked my stethoscope into my ears and proceeded to listen to his heart. He threw his hands over his chest in defiance. I spoke clearly about my concerns about his symptoms and my wishes to do a cardiopulmonary exam if he was willing to comply.
His oxygen saturation by pulse oximetry continued to drop to the mid-80s. I attempted to assist the nursing staff with applying a nasal cannula. He hit my hand away stating, “I don’t want any help from your kind.”
I worked with nursing to continue to get him support, including getting a bedside electrocardiogram (ECG). I also placed verbal orders for bringing morphine, aspirin and nitroglycerin to the bedside. As I turned back to the patient, I noted that a STEMI (ST elevation myocardial infarction — a heart attack) was confirmed by the ECG.
I had a quick curbside discussion with some of the gathering nurses and the newly arrived cardiology team. We developed a plan for me to place patient-transfer orders and hand off care to the cardiology team. He was at the cardiac catheterization lab within 20 minutes of his symptom onset. In cases of heart attacks and strokes in medicine, doctors often say, “Time is tissue.” We are referring to the heart muscle or brain tissue that can be lost when blood flow is compromised during a heart attack or stroke. This damage can cause residual effects that last a lifetime.
I was comforted in knowing his outcome would not be related to a lack of efficiency on the part of his medical team. Despite everything that had transpired, I still believed that ignorance should not be a barrier to medical care. I did not recall the Hippocratic oath distinguishing between types of patients. It did, however, state, “While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men in all times.”
I did not deserve to be disrespected in this way.
It was insisted to me by my administration that there was a zero-tolerance policy for the behavior the patient displayed, but the blow had already been dealt. I knew that no amount of education could lift me out of experiencing inequities in both my work and personal life in a society where racism still existed. Not even a doctor’s badge could protect me. To many, I was still just Black. My challenge was to avoid carrying over my past experiences from patient to patient.
I have chosen to continue to wake up every morning, put on my white coat, and indiscriminately give my passion and advocacy to medical services for people from all backgrounds while being treated unequally by the written and unwritten laws of society.
Ashley V. Austin is a family medicine/sports medicine physician from Atlanta, Georgia, living in Seattle, where she works at University of Washington Medicine.