I’d cried all the tears I owned, so when I heard about hospital administrators serving pancakes, I walked down to the cafeteria hungry for comfort. A dear friend served me and asked if I was OK. She knew I wasn’t. She couldn’t stop to eat pancakes with me just then, but as I poured on the syrup –thick like all the emotions I’d felt that morning – I knew that she cared not only about my well-being but the reasons behind my bloodshot eyes. It had been a long call night during my second trimester of pregnancy. A very sick newborn required stabilization and transfer, so I hadn’t slept much. I accessed the EMR to check on the baby’s status at the receiving hospital. “Race unknown.” A sigh of relief escaped. The baby was Black. And Black babies have worse outcomes in the NICU. If the receiving team didn’t know his race, maybe he’d have a better outcome. And that’s when the tears started. I wished that the newborn’s race didn’t matter. After coverage of Ahmad Arbery’s death, I looked down at my pregnant belly and wondered why I was bringing another Black boy into this world. In a neighborhood where police had shot an unarmed, naked Black man, how would I ever send my son to check the mail without worrying about his safety? It seemed I was already creating stress for my unborn son, so the pancakes were welcome. I visited with the mother of the transferred baby. Black women don’t initiate/continue breastfeeding as often as white women, and pumping in the first few postpartum hours is critical. I was the first person to suggest it. I offered all my patients the best I could and recounted lessons from residency. When a recent African immigrant toddler was hospitalized for mild influenza complications, we repeatedly reassured the mother (via translator) that her child “just had a virus.” Each time we discussed her child’s improvement, she’d wail. This left the team confused, uncomfortable, and borderline annoyed. I talked more with mom, curious about our strained interactions. I discovered that “a virus” for a recent African immigrant meant HIV/AIDS and possibly death. She was wondering why we were so comfortable with the outcome. When a resistant hospitalized Black teen needed a transvaginal ultrasound, I could talk in culturally accessible language to help her understand why she needed the study. I provided company and reassurance during the scary exam. When I referred obese African immigrant patients to the dietician, I read dietician notes recommending culturally unfamiliar foods. My shoulders sank when the shiny brochures displayed white families eating salad. Without culturally thoughtful dieticians, I learned how to give more actionable recommendations. When I was the first Black person on the medical team that Black families encountered, they expressed how proud they were. It made call nights better. I especially remember when my own biases impacted my care. I received verbal report on an inpatient who had been hospitalized for abuse and neglect. The patient had a last name common to Black families. During the depressing report, I envisioned a Black family. When I walked into the room and saw a white family, I was confused. I was so convinced that the family was Black that I apologized to the white family for walking into the wrong room. On a resident salary, I made more money than many family members and helped them meet basic needs from time. My mom had always dreamed of getting her master’s degree. I helped her pay for school. When I learned that many of my white co-residents’ parents gave them down payments on homes so they could benefit financially during residency, I could see one example of the racial wealth gap at work. I’ll never regret helping a family member pay rent or taking photos of my mom in her cap and gown. But while I was helping my family along, my co-residents’ parents helped them start to build wealth. I could be energetically hopeful that there will be more less health disparities in time, more Black physicians (although there are less now than a few decades ago) and that they will (as a group) be on the same footing as their white peers. But I’m only cautiously optimistic. It’s safer. I respond politely when the administrative assistant reminds me that the section chief meeting is “only for section chiefs,” even though I am a section chief. I remember to wear my white coat to the next meeting. I “translate” for our mostly white nurses when a post-partum Black woman seems frustrated. I remind them that medical mistrust intensifies the anxieties of all new moms. I explain that Black anxieties aren’t always expressed in comfortable ways. I tell Black women in culturally thoughtful language about the benefits of breastfeeding. I am still sustained when Black families tell me how proud they are to see a Black doctor. Through the local Black physicians’ organization, I mentor students and raise scholarship money. I advocate for improved services for all women and children in my health care system. This fleeting moment of interest in systemic racism and bias will pass, but I will still remain cautiously optimistic. I am optimistic that physicians of all racial backgrounds will talk openly about their biases and practice concrete skills (and develop impactful systems) that address health care bias. I am optimistic that we will dismantle the barriers to closing the racial wealth gap, and not just among physicians. My cautious optimism guards me from fear of knowing that even despite my education, healthy diet, and exercise, I’m still three times more likely to die in childbirth because of my race. I invite you to be cautiously optimistic too. I invite you to move your feet, make room in your schedule, and think deeply about ways you can use your power as a physician to make change. And maybe one day we can enjoy pancakes together. No tears required. Danielle Plattenburg Arnold is a pediatrician. Source
