I'm Believable

There’s a good chance you saw a story recently about Serena Williams and a frightening experience she endured last year, facing life-threatening blood clots shortly after giving birth. It’s a story that has sparked fresh disagreements about the many ugly facets of racism entrenched in so many of our systems, and it’s one I’ve thought a lot about the last couple of weeks.

For those who haven’t heard, I’ll give a quick version: The day after her emergency C-section she became suddenly short of breath and suspected, due to her history of blood clots, a pulmonary embolism. She asked for a CT scan and heparin drip but was given an ultrasound instead. It revealed nothing, and only after advocating for herself repeatedly got did she get the medical care she needed: the CT scan and heparin drip she had been asking for.

My first reaction on seeing this story was to shrug.

It just felt very familiar to me, and I'm sure it didn't seem all that unusual to many who have spent a good deal of time in a hospital setting. Medical professionals constantly have to judge whether a patient knows what’s going on in their body and can be trusted, or if they exhibit hypochondria or have spent too much time on WebMD. That’s not an easy assessment. And I think most people can agree that if there’s any doubt, it’s better for medical professionals to follow protocol and go with what they suspect, rather than follow what a patient thinks they know.

I’ve been through a couple similar episodes. I’ve asked for more hydration, well beyond what I should need for my height and weight, and not gotten it until there was a shift change and I had different people in charge of my IVs. I’ve also asked to have my hydration slowed and gotten a 2 liter bolus instead, based on the numbers of my urine output rather than how I was feeling. I gained a bunch of water weight and my legs swelled up significantly. I’d still prefer the people caring for me to follow established protocols, rather than pay too much heed to my semi-coherent ramblings when I’m on multiple painkillers and do the wrong thing because I thought I had a hunch about what I needed. To an extent, these kinds of events are inevitable and will always be a part of medical care.

So I truly understand where people are coming from when they dismiss Serena Williams’ story as an anecdote that could happen to anyone, rather than an example of racism at work in our healthcare system. I was tempted to agree at first. It is an anecdote. These types of events do happen to anyone. They always will to some degree.

Then I thought about this story for a minute.

Enough anecdotes pooled together can point to statistics. Sobering statistics, like the fact that black women are three to four times more likely to die from childbirth than white women in this country. We can debate why that is, talk about risk factors, discuss the systemic racism that contributes to these risk factors, and probably argue over a host of other topics related to this that I, a white male, am terribly unaware of. The fact remains that Serena Williams was very nearly another statistic, another black women who died from childbirth, and at least in part because she was not listened to.

So was Serena Williams not listened to because of racism, as many suggest? Honestly, I don’t know. It’s certainly suspect that a top-tier professional athlete—someone who doubtless has extremely well-developed bodily awareness—wasn’t listened to more. I have a hard time imagining Tom Brady being ignored by his doctors. It strikes me as suspicious that someone with a history of blood clots wasn't heeded more, too. But I wasn’t there. I don’t know all the circumstances around this story. I don't know the doctors, nurses, and others responsible for her care, and I don’t know what the protocols are for C-sections or post-surgical blood-thinner regimens for people with histories of blood clots.

But I do absolutely believe that, when medical professionals make their judgements of whether or not to believe a patient—whether a patient knows what they’re talking about or should be ignored in favor of following protocol—race plays a role. I don’t doubt for a second that black women are, as a whole, listened to less than, say, white men. This is true whether or not Serena Williams was herself a victim of racism following her C-section, and it is true whether or not such events happen to other people. As I said already, I’ve had a couple experiences in over three years of treatment when I was not listened to initially and advocated for myself several times before I finally got what I needed.

And yet I’ve had only two such instances that I remember. In over three years. I’ve also been believed hundreds of times in that same period, for relatively minor issues like hydration and a host of other, more serious matters. Like the time the space surrounding my lungs filled with over two liters of fluid and I could hardly breathe, and I said I had fluid that needed to be drained, and they drained it as soon as possible.

I don’t doubt for a second that my being a white male makes me more believable in the eyes of many people, medical professionals included.

Prejudicial Awareness

I’m back on some pretty intense chemotherapy now. It tends to weaken people’s hearts, so I can only have one more round of it before I reach my lifetime limit. I also need to have an echocardiogram before I start each round to make sure my heart is doing alright. So far it’s been fine, but it’s best to be prudent. My hair is pretty much gone now too. It’s not exactly the ideal time of year to go bald and I didn’t realize just how insulating my beard was until I lost it, but it’s alright. I’m really not having too serious or debilitating of side-effects right now, and I know all too well that it could be much worse, so I won’t complain.

Now that I’m bald again, I look like a proper cancer patient. Anyone who looks at me could pretty easily make that judgement. This wasn’t the case last year, even though I had a bunch of chemo, an experimental clinical trial, and a handful of surgeries in 2017. None of it took my hair though, so you wouldn’t have judged me as a cancer patient on looks alone. And you’d have been very wrong.

That’s ok. It really didn’t do me any harm.

That’s just not the case with a lot of judgements. It’s not the case when judgements are informed by prejudice and it’s especially not the case when judgements informed by prejudice are accompanied by an imbalance of power.

Now, it’s impossible not to hold prejudices. It’s difficult to even become aware of all our prejudices, much less rid ourselves of them entirely. It’s also impossible not to make judgements based on appearances. I’m not even convinced that it would be entirely beneficial were it possible. Judgements about whether or not others appear like they could use a helping hand aren’t exactly terrible. Not all the time, at least.

That’s why we need to become more aware of our prejudices. We need to acknowledge when prejudices misinform our thinking so we can combat them and change our outlook. We need to be vigilant against ourselves, to take a step back and rethink everything when we realize we allowed prejudice to alter our view of the world or others. And we need to humbly listen when other people try to make us aware of our prejudices. Claiming reflexively to be the least-prejudiced, least-racist, or least-biased person around just reveals how little we understand these issues. Let's all stop being so offended by charges of racism, prejudice or bigotry, and start being more offended by these things themselves.