Mom whispered to me from her hospital bed, her eyes bulging with urgency, Something is not right. I've been in pain all night.
Just a few weeks earlier, she had some heart palpitations and was admitted to the hospital for a routine work-up. The news came back that all of her test results were normal. But now her body appeared tense; she looked panicked and afraid. At her bedside, the attending physician suggested endoscopy, offering that her pain may be related to a gastrointestinal condition. I introduced myself immediately as a medical student and quickly advocated for a consultation with a cardiologist.
I shared that a few months prior, she had been rushed to this same hospital by ambulance with idiopathic ventricular fibrillation. The attending shook his head. He started moving toward the nurses' station and I followed behind.' He reviewed her case with me again and then he shouted, 'Endoscopy!' I said, 'Cardiology consult.' Trembling with fear, I left quickly, without waiting for a response.
For a medical student, learning to observe in clinical settings is a skill that comes with practice and time as well as teaching.' Furthermore, practicing medicine well involves seeing the whole patient, looking beyond the chart to examine the situation. My concerns about Mom were influenced by both my first-hand knowledge of her complaints over time but also concerns about being sure that as a black woman she received the best care.' The recently released book by Dr. Augustus White, Seeing Patients: Unconscious Bias in Health Care offers the following:
'the race and sex of patients [influences] physicians' decisions about whether to refer patients for catheterization If you were black, the report concluded, you were less likely to be referred. If you were a woman, you were also less likely to be referred.' And if you were a black woman, you were especially less likely to be referred.
As I sat outside trying to figure what my next steps would be, my phone rang. It was the nurse, calling to tell me that the attending had in fact agreed to the cardiology consult. I returned to our house to care for my grandmother. In the absence of my mom, she had no caregiver. In the afternoon the cardiologist called me to express his concern with mom's condition. He recommended, pending insurance approval, that she be transferred to another hospital with full cardiology services for more tests and further observation.
Mom was transferred that night. Additional test results showed significantly blocked coronary arteries. Early the next morning, she had cardiac catheterization to open her blocked blood vessels. After a short hospital stay, she returned home.
As an African American woman training to be a physician, I was glad to witness good medicine, as well as Mom's progress.