Racialized healthcare or adventures in the emergency room- with a 9/15 update

This month marks 7 years for this little space and its been an evolving process for me both as a writer and as a person. As a result over the years, particularly in recent years I have intentionally become a bit less personal in what I share here. Yet the nature of this type of writing is personal and people often come back because of the feeling of personal connection. Which is why despite my intentionally sharing less of myself, I suspect that more long time readers especially  those who follow me in social media spaces have been astute in noticing that I have grappled with personal issues. The past year has been a year of physical challenges for me, a year where to be honest I have seen far too many damn healthcare providers in a search for answers. A year where I have seen the inside of the ER a few too many times but thankfully I am on the road to answers and feeling quite optimistic that the worst of it may be behind me barring a biopsy and some other treatments.

Pain and discomfort have become regulars in my life, throw in a predisposition towards anxiety and you have the makings for a stew of of physical hell. I have been fortunate that my daily yoga and meditation practice keep me from allowing the discomfort to feel like a nonstop threat to my very being. Yet there are days when the discomfort becomes too much; throw in regular garden-variety anxiety with a dash of perimenopausal heart palpitations and discomfort and it’s the death spiral of Oh, no

Which is why when in the middle of a conference call several days ago in my office—when I felt a thump in my neck, excruciating pain in my upper body and the world started spinning the same time that I felt my body temperature rise—I realized that when one is 105 miles away from home, the ER might sometimes be the best place to go to make sure that all was well.

However. not living in Boston and not having my road dawg—better known as my husband—with me, I got off the conference call as fast as I could and asked the program assistant at my office to help me get to the nearest ER. Little did I know that I was about to embark upon an adventure from hell that I wouldn’t wish on my worst enemy at one of America’s top-rated medical centers.

My office is located in downtown Boston, right in the Beacon Hill area, and the hospital closest to my office is Tufts Medical Center. Which, while it may be one of the best in the country is…well… lacking greatly in people skills. I have seen friendlier medical personnel at the old Cook County Hospital in Chicago, which is saying a lot since County specialized in trauma and the indigent.

From the moment my assistant and I stepped into the Tufts ER, I started to wonder if  I had made a terrible mistake. When one walks into an emergency room waiting space and is greeted by a woman in a wheelchair puking into her hospital-provided barf bag and wailing loudly that she needs help, you start to wonder.

My initial contact with the check-in staff was interesting as I explained my plight. Look, I understand, it gets busy, you are overwhelmed but a minimum wait of two hours?  Ok, it is what it is. Nevermind that the check-in guy seemed surprised that I had health insurance but after waiting patiently for two hours to be seen and listening to puking lady barf every 7 minutes (I counted) it became clear that most of us in the ER had one similarity: non-white skin…and that all the staff that I encountered had something in common as well: white skin. Most  of what my program assistant and I witnessed during my two-hour wait was downright chilling especially as we witnessed a white social worker speak in a chilling and condescending manner to a young Black man who was clearly in the midst of a mental health crisis. If I hadn’t been in grave discomfort and pain, I would have walked out the door.

The real fun though began when I was finally called and settled into a space—to call it a room would be a bit too much. Nurse number 1…”you look real nice”…um, what the hell does that have to do with why I am here? Enter the PA, a bored, disaffected looking white woman who treated me as if I were a junky looking for a fix. Gulp.

Nope, the real fun began when nurse number two came to give me an EKG, since I had complained of upper-body pain. Never mind that if I had been having a cardiac event that having me sit for two plus hours was probably a bad idea. No, helpful man nurse number two was there to assist and that is when the weirdness became so clear that even Stevie Wonder could have seen it.

So the nurse wheels in the EKG machine and offers to help me take off my boots since I was sitting up as laying down was uncomfortable. Great, thanks dude…Upon helping me take off my boot, he holds up my boots and comments on the brand and states that these are expensive boots, then proceeds to ask my opinion of them.  A bit strange but whatever. However, as he was placing the tape on me and hooking me up to the EKG machine, in a strange attempt at bonding, he leans over me while my body is exposed and proceeds to tell me that I smell good and ask me what am I wearing.

I can’t speak for anyone else but when a man who I don’t know has access to my body when it is most vulnerable, I really am not interested in conversations about my scent of choice or where I shop. As an online nurse friend mentioned, nurses can sometimes be quirky. I get it. Yet when you work at one of America’s top hospitals, I expect a certain level of professionalism. The only person I had contact with wasn’t creepy or completely disaffected was the actual physician, who came in with the “oh” face but softened considerably when I mentioned that I lived in Maine and we started bantering about Maine.

In the end, I was released and while I was “fine” the fact is that racial health disparities are no joke. By and large Black people do not receive the same level of treatment or quality of care when they encounter healthcare providers—the data from many studies supports and acknowledges this. My early academic background is in racial health disparities but it is also personal to me as my beloved mother might have had a chance at life had her doctor actually listened to her. Instead she met an early death.

Living in Maine, I have encountered my share of clueless providers who aren’t knowledgeable about non-white bodies, but rarely have I encountered the lazy disregard for Black bodies that I both witnessed and experienced at Tufts Medical Center. It did not escape my notice that had I been a white woman with the same presentation and symptoms that I would almost certainly would have been treated with a modicum of respect. Though, as a local white pal shared with me, he had his own adventure at Tufts Medical Center ER that left him shook as a reasonably upstanding white man. In any event, implicit bias training and compassion need to be a part of the staff training at Tufts. The vast bulk of people who go to the emergency room don’t want to be there. We would rather be well. We certainly don’t want to leave feeling worse in a whole new way.

An update: After I wrote this initial post, I tweeted it to Tufts Medical Center, I had no idea what would happen but I knew that at the very least, I wanted to be heard. I damn sure wanted to be heard knowing that I would receive a bill for an experience that bordered on the horrific. A few days after writing this initial post, I received a call at my office from the Chairman of the Emergency Medicine Department and we had an interesting conversation. Well, this post, that call and a conversation that I had with the finance department at last resulted in a satisfactory ending. Today I received a letter from the hospital and it seems my words were not only heard but had been heard by the leadership staff at Tufts Medical Center. The result being that the bulk of the balance from that harrowing day is no more but more importantly the hospital is aware that while their policies may require kindness and respect as part of their organizational mission, too often implicit bias affects who actually receives that treatment. Baby steps of change…it is indeed a start.

9 thoughts on “Racialized healthcare or adventures in the emergency room- with a 9/15 update

  1. Wrong hospital ! Your colleagues should have triage you into either Mass. General or Beth Israel- Deaconess. I have never been into the ER at Tufts but just passing by as a patient at the Tufts Univ. Dental School….. I immediately sense disorder, dirt and an inner city despair here. Tufts has recently merged its medical school and staff into Maine Medical Center. Only because both needed each other. Tuft’s was being squeezed out of the Boston medical market and Maine Medical needed a partner to start up its own Maine based medical school. A very suspect arrangement if ever one !

    Living in Baltimore, Maryland, I am very aware of medical disparities in the ER at the Johns Hopkins Hospital. Studies have verified over and over again that when a man of color comes here – regardless of professional status- he is treated worse than a white man. Hopkins reflects that racism so prevalent in Maryland. But now close enough to Boston, I have used Mass. General Hospital for my specialty care since coming back to Maine; Beth Israel has been my backup. Nothing unusual or even that rare- but I just prefer to be with the best specialists. I have sensed none of the Tuft’s mentality nor Johns Hopkins at either one. Incidentally, a ” male friend of color” here in Maine swears by the cardio- care that he received at Beth Israel for the heart attack that Maine Medical Center had missed !

    Sounds like you are being taking for the usual railroading of medical care- sadly still experience in the State of Maine. While there are pockets of excellence here in Maine, the state never has had to develop its medical skill set—– since it was so close to Boston and its medical experts. Suggest that you checked out the medical sorts at Mass. General and get your foot in the door here.

    You may wish as well to checked out the Mass. General’s outreach programs in diversity ….

    ….http://www.massgeneral.org/careers/commitmenttodiversity/

    and a very welcomed and badly needed outreach program is as well ongoing between Mass. General and Maine medical providers …..http://www.lunderdineen.org/join-us

    In medical issues – you gotta to be your own advocate and this post affirms just this. The best,

    VFH

  2. What she said above. I came to comments to say if you ever need an ER from your office again go to Mass. General. Not all you’d hope it to be, but certainly much better than Tufts, and first rate specialists are right at hand.

    • Agree with you. As a training hospital when you go into the ER at Mass. General- Boston, you are under the care of “wet behind the ears” residents, so to speak. But the back up and oversight is good. The private wards are also available for the use of Partners (the private medical group overseeing the residents) and their patients. At Wang they have an excellent Medical Walk-in Clinic for less urgent care needs and the physicians here are all Internal Medicine specialists. Turn around time here can be up to 1 – 2 hours but if you have an urgent need – you will be seen sooner or triage to the ER. I have had good experiences here in the Medical Walk In Clinic. The issue here in bio- western medicine is that the treatment model is based on the white male, age 18- 35 … so the rest of us –female, non-while, elderly , etc. are basically left out of the loop — but medicine is revolving and MASS. General is tops here. If working or living in the Boston/Beacon Hill area, the ideal would be to get signed into one of their primary care clinics. It was Dr. James Dineen of Maine that starting up primary care at MGH. Normally there is a wait time to get into a practice — but worth it !

  3. I can’t agree more. As an RN and a woman who has had experience in many ER’s (both as a patient and health professional) this is an overlapping issue. I have to say when I moved to Maine with my biracial son I was on a mission to find a pediatrician who had experience with black and mixed children as well as hematology experience, due to my son’s blood issues (many doctors are surprisingly unaware of the differences in a white child’s blood from a black or mixed child’s blood). I have, with much help, found an amazing one who also happens to be from my home state of Ohio!

    Thank you for sharing Shay!

    • The World Health Organization (WHO) defines health care as involving social, financial and medical variables. The USA medical community falsely aligns health care ONLY with Medical care or disease management. I WOULD LIKE TO SHARE A RECENT POST FROM WHO :
      ” The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal:

      reducing exclusion and social disparities in health (universal coverage reforms);
      organizing health services around people’s needs and expectations (service delivery reforms);
      integrating health into all sectors (public policy reforms);
      pursuing collaborative models of policy dialogue (leadership reforms); and
      increasing stakeholder participation. ”

      Source http://www.who.int/topics/primary_health_care/en/

  4. I just wanted to say thank you Viola for the rundown on the Boston hospital scene. I will definitely be filing this info away. TWM, thank you for the links.

    Hannah, healthcare as a non-white person in Maine has been an adventure. I have tried to explain this to people and they really don’t grasp it at all. I recently met a white NP who lives in Maine but who works in MA and we talked at length about how many providers in Maine have had little exposure to non white bodies in their medical training and how problematic that is becoming as Maine’s demographics slowly change.

    • Thanks Shay ! Just want to add that getting competent health care in the State of Maine is an “adventure” for everyone ! My initial contact with Mass. General Hospital is owed to a friends dog that I was walking in early 2006 as I slipped down a grassy hill in Augusta twisting my knee After several months of orthopedic attention…. an MRI was finally done on my knee. A tumor was found in the bone. This was totally ignored by my Augusta primary care provider and specialists alike. Until meeting up with my South Portland orthopedic specialist in 2007. She thought it was benign but just in case I was referred to the Director of the Oncology/ Orthopedic program at Mass. General/ Boston …. since the “he knew more about Bone Tumors than anyone in Maine”. Still being followed annually by the same person— still seems to be a benign tumor…. but just in case…. I would be treated at the best and by the best. And Ditto ……etc. as I huge my MGH Blue Card !

      Seriously …..in this sharing you have delineated the very problematic health care concerns facing Maine as its “demographics” ….more older and more minority… are changing / have changed . That is why the MGH Lunder – Dineen outreach initiative into Maine is so critical to all of us. Most Maine health care providers are still not aware of this even tho the senior staffer behind here is an R.N. trained at Mercy Hospital – Portland……http://www.lunderdineen.org/Jeanette-Ives-Erickson-RN-DNP-FAAN !

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