When A Patient Gets Political

Disclaimer: This blog post reflects the author’s present recollection over time. Characters and dialogue have been recreated and rearranged. Events have been fictionalized and any resemblance to actual persons, living or dead, is purely coincidental.

A well-groomed, middle-age woman walked into my office and said, “Doctor, my anxiety is shooting through the roof!”

I expressed dismay and asked her what has changed since our last visit.

“It’s this damn fake election!” she exclaimed. “The Democrats are going to undo all the great things that Trump has done for this country. I can’t stand seeing these BLM rioters and Muslim invaders and Antifa terrorists on television. And now they’ve stolen our democracy! It’s terrible! And so many businesses are still shut down because of this stupid Chinese virus. I felt safer with Trump as president.”

Okay. I felt my heart pounding. I heard a low buzz in my ears. My body was entering fight-or-flight mode. I repressed the urge to stand and leave the room.

This puzzled me. Why was I feeling so afraid?

It made no sense. My patient was sitting in a non-threatening posture and more than six feet away, the result of social distancing precautions. She spoke at a moderate pace in a mildly anxious tone. She was even smiling at me as if she expected me to agree with her.

In my role as a psychiatrist, I take care of people who are intoxicated, delirious, and emotionally labile. This happens, especially in an emergent setting. Many of my patients had been brought to the hospital against their will, and they are usually afraid. Fear leads to irrationality, irrationality leads to unpredictability, and unpredictability leads to violence. I have tolerated a lot of verbal abuse from patients. I’ve endured misogynistic comments and racial slurs. I am trained in verbal de-escalation. I have talked many, many people down from screaming at me to thanking me. Despite these measures, I’ve had several patients attempt to physically assault me. One actually did.

Any front-line healthcare worker understands. As a group, we are remarkably prone to encountering verbal and physical abuse. Nationwide, 78% of emergency department physicians reported being targets of workplace violence (Behnam 2011). 82% of US nurses have been assaulted at least once during their careers, and 73% believe that assault was just part of their job (Speroni 2014). Verbal aggression is just as serious. In a 2016 review article, Phillips writes, “The importance of recognizing verbal assault as a form of workplace violence cannot be overlooked, since verbal assault has been shown to be a risk factor for battery. When verbal abuse and low-level battery are tolerated, more serious forms of violence are invited.” Verbal violence affects not only the victimized individual but also the entire health care system. Verbal violence can lead to demotivation, poor job satisfaction, early burnout and compassion fatigue. Overall, workplace violence affects the delivery of health care, decreasing quality and accessibility (Watson 2020).

I can handle that. But this smiling woman in my office was different. This felt new, in a strange, subtle, gut-twisting way. Maybe it was because this patient was not intoxicated or psychotically delusional and was speaking with a linear thought process. Maybe it was because this took place in the ostensibly safe space of my office. Maybe it was the inflection in which the word “Chinese” is said – with an elongated and emphasized sound of “chai” followed by the derisive sneer of “neez”. Maybe it was because I never expected this type of hate speech from this particular patient, who I had formerly thought of as a friendly, pleasant lady. Or maybe it was because I was vividly reminded of past hurts, of the childhood peers who would smile to my face and then make fun of my “chinky” eyes behind my back.

I took a slow breath. She seemed to sense my emotional turbulence. We looked at each other silently. I wondered what she saw.

My physical presentation is as a petite, Asian-American female. Would she think of me differently if she knew that I was not born in the United States? That despite my adopted American accent and soft southern drawl, my mother tongue is Mandarin Chinese. Or would she tell me that, oh no I’m not racist, you’re one of the good ones, without thought of how that implies the opposite – that in order for me to be different, the rest of my peer group must share common negative traits.

As a rule, I don’t bring up politics with patients. But what do I do, when a patient gets political?

“I don’t agree. I feel less safe,” I said. “You know, it has been really difficult being an Asian person in this pandemic.”

To my relief, she offered an olive branch.

“I’m sorry for talking about politics,” she said. “I don’t mean to bring all that negative energy in here.”

And we talked about it. I told her that I want my office to be a safe place where she can bring her worries. That I wanted to hear about the triggers for her anxiety, so that I could better understand her and be a better doctor for her. At the same time, I told her that her words can be hurtful. That although she was certainly not responsible for my feelings, perhaps she could be a little more mindful and understanding about what she says and how she says it – because I am a person, too.

Then we moved on to discuss her medical care.

Although it may be uncomfortable, I think that it is important to think about how race and politics can color interactions between health care providers and patients. As we seek to understand each other, these conversations need to be ongoing and authentic. NBA player Jeremy Lin spoke out earlier this week as a guest on “Race in America: A Candid Conversation.”

“I feel bad for somebody who harbours hate for somebody else, who they’ve never met, just based on skin colour,” he said. “That makes me want to do something. It makes me want to educate people… speak out and find ways to make a difference. Honestly, it goes from anger to just heartbreak.”

He also posted on his Instagram: “Being an Asian American doesn’t mean we don’t experience poverty and racism. Being a 9 year NBA veteran doesn’t protect me from being called ‘coronavirus’ on the court. Being a man of faith doesn’t mean I don’t fight for justice, for myself and for others.” (Didion 2021)

There has also been a rise in hate crimes against people of Asian descent. Recent data released in major cities show a shocking growth in the number of racially-motivated attacks (Wells 2021, Sturla 2021). As I discussed above, serious physical assault does not occur in a vacuum; it is frequently preceded by verbal abuse and low-level battery. I strongly suspect that there are numerous unreported events of verbal abuse and microaggressions. Knowing this, I can begin to understand why I felt the way I did. My feelings of danger have root in truth.

What happens out in the world gets brought into doctors’ offices. And when this happens again – when, not if, because problems of hate and intolerance do not simply fade away – then I can be better prepared for it.

More Information

Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med 2011;40:565-579

Speroni KG, Fitch T, Dawson E, Dugan L, Atherton M. Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. J Emerg Nurs. 2014;40(3):218-228. doi:10.1016/J.JEN.2013.05.014

Phillips JP. Workplace Violence against Health Care Workers in the United States. N Engl J Med. 2016 Apr 28;374(17):1661-9. doi: 10.1056/NEJMra1501998. PMID: 27119238.

Watson A, Jafari M, Seifi A. The persistent pandemic of violence against health care workers. Am J Manag Care. 2020 Dec 1;26(12):e377-e379. doi: 10.37765/ajmc.2020.88543. PMID: 33315330.

Didion, A. Warriors’ Jeremy Lin Reveals He Has Been Called ‘Coronavirus’ on Court. NBC Sports Bay Area. February 26, 2021. Accessed February 27, 2021. Link: Warriors’ Jeremy Lin Reveals He Has Been Called ‘Coronavirus’ on Court – NBC Bay Area

Wells, N. Anti-Asian Hate Crimes Are Up 717% In Vancouver. Canadian Press. February 18, 2021. Accessed February 27, 2021. Link: Anti-Asian Hate Crimes Are Up 717% In Vancouver | HuffPost Canada (huffingtonpost.ca)

Sturla, A, et al. Anti-Asian attacks are on the rise in NYC. The city is pushing to combat it. CNN. February 27, 2021. Accessed February 27, 2021. Link: Anti-Asian attacks are on the rise in NYC. The city is pushing to combat it. – CNN

A Fear of Words

“I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.”

– Dune, Frank Herbert

Writing is scary because words on paper are meant to be read. When I write, my writing is not meant to be hidden in a private journal. I yearn to communicate to others. I want my words to reach out to the outside world and say, “I exist.” 

But for me, there is also a terrifying push-pull between the desire to be heard and the fear of being judged. To write, I need to have something to say. And behind that comes with a whole host of fears. Is what I have to say worth saying? Is my writing worth reading? I feel afraid of being judged and found wanting. 

Sometimes I fear that my writing will become devoid of emotion because in my day-to-day work, my writing is mostly scientific and technical. This happens in my daily interactions as well. I have conversations all day, often about very similar topics. Although each individual person and interaction is unique and different, there are inevitable similarities which develop into pattern recognition. When I am asked the same question for the thirtieth time in a week, I frequently begin to speak from rote memory. I worry that my words are robotic. The thing is, connection with another human being evokes an emotional response. I don’t want my words to be meaningless.

Sometimes I fear being wrong. Or more exactly, I fear inconsistency. Even after I leave training and become a board-certified, licensed psychiatrist, I am only human and I know that I can be wrong. When confronted with opposing evidence, I gladly revise my opinions. Minds change. But words on the Internet do not. I want to write words that I can stand behind, that I can look back upon proudly even years later. But I cannot predict the future. I cannot predict what new scientific revelations may change the medical and scientific communities. I cannot see how society’s values may change. I can only look at the information I have now and write from my current experiences.

Sometimes I fear being attacked. There are people who disregard scientific evidence. There are people who ignore medical authority. There are people who disparage psychiatrists and the field of psychiatry. When hidden behind the anonymity of a computer screen, keyboard warriors can be vicious. I am afraid of the emotional pain, or even the potential physical threats. Even if I do everything right, there may be people who hate me not because of who I am, but because of what I represent.

A part of me wants to suppress these fears. But it is difficult, perhaps even harmful, to ignore them. I think that these fears are quite reasonable, and furthermore, they serve a purpose. They motivate me to examine my choices, to research my ideas, to truly push towards bettering myself. They help me keep watch, temper my expression, and protect myself. It doesn’t mean that the fear is irrelevant, or that it can’t be prohibitive. Sometimes, I wish that I could work less carefully and more quickly, and be more tolerant of mistakes.

We all carry within us a secret inner world, hidden from others’ eyes. Writing is a way for our inner selves to reach out to the outside and attempt to connect with others. Writing is a form of communication. Writing is a form of vulnerability.

In the end, like many things in life, I need to write for myself. And I need to keep writing, despite my fears. 

Because even worse than being afraid is being silenced.

A Day with Monet

A few days ago, I went to see an exhibition of the early years of Claude Monet, a French artist, at the Kimbell Art Museum.

A classmate of mine had managed to procure free tickets for a small group tour and invited me along. I was assigned to be on call that day, but could not pass up the opportunity. After explaining to my residents and attending, they graciously allowed me to leave the hospital an hour early to attend.

I saw over fifty paintings, from his first studies of landscaping to his eventual move towards Impressionism. It was an awe-inspiring journey of color and expression and story of a young, struggling artist.

The Magpie
Claude Monet, 1869

At the museum, I also learned a new word. A docent is “a person who leads guided tours especially through a museum or art gallery.” How posh, I thought. The word seemed to convey education and expertise. And indeed, the docent who guided our group had a vast pool of knowledge about the paintings displayed. She knew from which museum or collection each painting had been procured. She knew where Monet had painted each piece. She explained how two seemingly very different paintings could simply be two different points of views. How many times had she given this same presentation? Yet as I watched her speak, I could see her delight and joy in the simple act of sharing her passion for art.

do·cent | noun | ˈdōsənt | a person who leads guided tours especially through a museum or art gallery

The docent told us that Monet and other Impressionists rebelled against the tradition of painting shadows in grey or black. They saw that there were colors to be discovered in shadows too. Critics initially rejected Monet’s famous snowscape The Magpie (see above) for its innovative depiction of shadow using delicate tones of blue. Today it is hailed as one of his best work.

As I listened, I thought about the importance of balancing tradition with transformation. Monet had been trained as a traditional landscape artist before beginning to branch out into new studies of light and shadow. Without that foundation of study, perhaps he would not have been as successful. Yet he also did not allow himself to be entrenched in the “rules” of his work. Likewise, my medical school has given me a foundation to build upon. But my learning will surely never end. In the course of my career, I will see vast changes and discoveries. What colors lay hidden in the shadows of medicine? Will I be able to learn and adapt?

Afterwards, my friends and I went out for dinner. It was wonderful to see them again. Last year, I saw my classmates nearly every day. Now as third years, we are all busy running around in our different electives and choosing our future path.

Of course, as with any collection of medical students, we had the usual circle where we all went around and talked about how our minds have changed after more exposure to different specialties. A former aspiring radiologist now has her mind set on obstetrics. A former hopeful surgeon now wants to do pain management. Last year, I thought of becoming a neurologist or internist – now I have decided on psychiatry.

My declaration was not met with surprise.

“I wouldn’t have guessed it, but I can see it,” one person told me. “It suits you.”

“He’s calling you insane,” someone else joked.

Then we talked about the exhibit.

“When I’m a resident, I’d like to involve art in my study,” someone said. “After all, medicine is both a science and a humanity.”

I thought of the dozens of patients whom I have met over the last six months. I thought of all the challenges that we had yet to face and all the lessons we will learn. I thought of the docent and her love of art. I thought of Monet and the Impressionists and their shadows of color and light.

I couldn’t agree more with my friend.

The Right Things

Disclaimer: This blog post reflects the author’s present recollection over time. Characters and dialogue have been recreated and rearranged. Events have been fictionalized and any resemblance to actual persons, living or dead, is purely coincidental.

Everything must be used until it falls apart. Clothing should be worn and handed down until it became threadbare. No grain of rice should be wasted.

The man walks up to the volunteer table where we are performing free blood pressure and glucose checks. He is Asian, in his fifties or sixties, with greying hair and a smiling, weather-worn face.

As I prep his finger for the glucose stick, he tells me, “Do you want to know a secret?”

“What is it?” I ask, politely.

“I have a bad liver. My doctor gives me medication to take every day. But here’s the secret. I can make the medication last longer if I only take it when my skin is yellow. See?” He presses on his skin so that it turns pale. “That’s how I check.”

He tells me this with the confidence of a man who does not expect to be challenged. After all, I am a young Asian woman, fresh out of college. In most traditional Asian cultures, the young do not correct the elderly. I probe delicately, with deference and respect.

“Why do you want to make the medication last longer?” I ask.

“To save money, of course!” the man exclaims.

He looks at me incredulously. However, after some more questions, I find out that he is financially secure. Why then, is he concerned about money? I don’t need to ask to understand. My parents and grandparents are similar. After World War II, conflict continued in East Asia for decades. The people became frugal by necessity. When my grandfather was eighteen, he fled to Taiwan with nothing but the clothes on his back. He instilled in my father the mindset of thrift, bordering on cheapness, that everything must be used until it falls apart. Clothing should be worn and handed down until it became threadbare. No grain of rice should be wasted.

I can see that same frugality in this gentleman.

“Maybe there is a reason that the doctor wants you to take the medication every day,” I suggest as I wrap a bandaid around his finger.

“Ayy, they just want my money,” he says with a smile. Then he becomes doubtful. “And I feel fine.”

I attempt to nudge him along.

“It wouldn’t hurt to ask your doctor.”

Then I tell him that his blood glucose is normal. He smiles and shrugs and raises his eyebrows as if to say, See? Everything is fine. He thanks me. I watch him leave and hope that I had said the right things.

Today’s Daily Post Writing Prompt: Yellow

Ten Minutes

Disclaimer: This blog post reflects the author’s present recollection over time. Characters and dialogue have been recreated and rearranged. Events have been fictionalized and any resemblance to actual persons, living or dead, is purely coincidental.

“It’s amazing how much you can learn about someone in ten minutes of casual conversation.”

The doors swing open. I bustle through, the tails of my short white coat fluttering behind me. It is my first day as a medical student in this hospital and I’ve been sent to see Mrs. “W”. I look around, a little lost, and hope that I’ve finally found the right floor. The nurse sitting at the desk looks up. Her eyes are very large and very blue.

“Welcome to the floor!” she says, with amazing cheer for seven o’clock in the morning.

I freeze in my tracks.

“Thank you,” I say.

Her wide, blue eyes continue to stare at me. Her lips are smiling, curved in a pink, plastic smile like a Barbie doll. I feel like an unwelcome intruder, a lost third-year medical student playing doctor and invading the daily churn and flow of the unit. And so I continue, stuttering nervously over my words.

“I-I’m here to see a patient.”

“Thank you for coming to see our patient!” she says.

Her enthusiasm remains unflagging. I introduce myself and mumble a few somewhat coherent sentences like Where-Is-Room-12? and something about the weather and Have-A-Nice-Day! Eventually I find my way to the patient.

Mrs. W is a thin 60-something-year-old woman with COPD (causing shortness of breath) and venous insufficiency (which causes severe pain in her legs) who, well, also does a bit of cocaine every now and then. While she came to the hospital for breathing problems, her primary complaint is her leg pain. She has been scheduled for an outpatient vascular surgery clinic. But until then, she must live with the pain. We discuss the benefits of walking.

“I know it’s hard to exercise in the hospital, but walking would really help,” I tell her.

“Maybe if I had someone to walk with,” she says.

And so that’s how it began. In the afternoon after rounds, I return to her room. We walk two laps around the unit together. She is surprisingly steady on her feet, requiring no assistance, though occasionally she leans against the wall and stops due to pain. And in those ten short minutes, I learn about her. She tells me about her children, two of whom live hundreds of miles away and are too busy to see her. The third is jobless and lives with her at home and helps her “sometimes” around the house. She tells me of how she used to work long days as a single mother to support the family. And how she struggled to quit smoking and finally stopped a few years ago, but hasn’t been able to quit the cocaine.

“I tell myself it’s the last time every time,” she says. “Then I have a bad day and I just do it. I know I gotta stop ’cause it’s bad for my heart, but deep down, I guess I’m not ready yet.”

It’s amazing how much you can learn about someone in ten minutes of casual conversation.

The next day, I am unable to return to her room until much later in the day. She nearly tumbles out of bed when she sees me.

“I thought you forgot about me,” she says.

“Of course not!” I reply.

After I ask about her day, she asks about mine. I share a little about my life. The astounding (but ever shrinking!) number of years of future education that I had yet to traverse. That no, I am not married, but I am in a long-term relationship with my boyfriend. And I tell her some silly things, like how I had ran through the pounding rain that morning and dropped my phone in a puddle. And somehow, it still works!

The nurses notice. They exclaim over how great Mrs. W looks. The exercise put some color in her cheeks, they say. And she is walking so well and so steady on her feet! They dote on her with genuine affection and when they turn to look at me, I can see their gratitude.

We manage to walk three laps.

“Maybe tomorrow we can walk four,” Mrs. W says with a smile.

When I leave that day, the blue-eyed nurse stops me in the hall.

“Thank you for walking with our patient!” she says, with her ever-present cheer.

This time, I smile back.

Today’s Daily Post Writing Prompt: Ten