Reflection on a Tuesday: Black and White

pt. names, details, etc. changed . . . you know the deal, man
a "black and white" cookie, Brooklyn style

_____________

"Sir, I know that was a lot of information. I just want to be sure I did a good job explaining to you, okay? Can you tell me why we said you were in the hospital?"

"Sure, Miss Mannings. Y'all said I got pneumonia in my chest but then when you looked closer you saw a spot, too. Since I smoke, you want to be sure that it ain't more than just pneumonia and not something like a. . .cancer?" He smoothed the covers out over his long legs and rested his pecan colored arms on top of the blanket. His cheeks were covered with a smattering of moles and skin tags, likely from years of working out in the sun doing construction.

I drew in a deep breath. "Yes, sir. That's correct." I felt the need to make it sound less daunting. "But we aren't saying that what we saw looks exactly like cancer either, sir. I admit it was concerning." Great, now I'm backpedaling. "I mean, it's just that it's important to be sure, sir. That's why we are having you get that test by the pulmonologists or lung doctors. Do you remember what I said that test was?"

"You talking 'bout that test with the camera down your throat?"

I wished that his graphic description wasn't spot on, but it was. His wise sixty-something year old eyes didn't look the least bit fazed by the idea of something sounding so noxious as a "camera down your throat." Again, I wanted to dampen it a bit. "Umm, well. . .you know they do make you drowsy for the test and then carefully put this very small tube with a camera on it through your mouth to get to your windpipes. That's how they are able to see inside your lungs."

"Right. Down your throat, and then they stuff it in your breathing tube. That man said it's like a tree that they look down all the branches of. As I thank of it, I'm guessin' sometimes it ain't nothin' but leaves when they look, but sometimes it's something else growing on the tree that ain't 'posed to be there. Like cancer." He let out a nervous laugh.

I couldn't argue with his accurate description, and was admittedly quite impressed with the metaphor he used. The timing couldn't have been better--we had just had a lecture earlier that week on "Health Literacy" that was really driving home the importance of making certain that our patients understand what we are doing and saying. The lecture emphasized the need to say things in black and white, instead of chartreuse and celadon. Even though the plan itself wasn't that great for him, this was an example of a successful "teach back." The team listened quietly and seemed to acknowledge this as a teachable moment.

I turned toward the team and said, "It sounds like Mr. Chambers has an excellent understanding of what's going on with him!" I looked over at the patient and smiled. He returned the expression, but shortly after furrowed his brow and turned his lips to the side. Something was puzzling him. "Wait, Mr. Chambers--did I speak too soon?"

He chuckled and said, "Naw, I know what y'all doin' today. This my body. . .shoooot. . . you know I'm gon' know when it come to my body!" But then he narrowed his eyes and looked like his wheels were turning again. It was confusing.

So then I remembered the other health literacy guru tip that often gets forgotten. Instead of asking folks "do you have any questions," you pose the question the way I asked Mr. Chambers:

"Sir, what questions do you have for us?" I gestured to the medical student, Ania, who'd been carefully doting over him throughout his hospitalization.

I felt pretty sure that he would have at least one, especially with that puzzled expression he kept offering me. I was right.

"I don't have no questions for her," he spoke firmly while pointing directly at Ania the way Zachary points at Isaiah when I ask who did something, "but I DO have questions for you, Miss Manning."

I felt relieved that he was willing to ask what was obviously becoming a pressing question. "Okay, Mr. Chambers, go right ahead."

He stared at me for a few seconds like he was deciding on a Final Jeopardy answer, and finally broke the silence by saying, "Miss Manning, are you black or white?"

I raised my eyebrows in surprise and looked over at Ania who immediately blushed, initiating a domino effect with the rest of my all fair-skinned team.

Now here's the deal: I am not offended by this question, nor are my feathers ruffled in the least when it is asked--but the thing is that I usually see it coming. (See this post about Grady and the race to determine my race.) Furthermore, it always amuses me since when I look in the mirror, I see a black woman looking me squarely in the eye, albeit one with freckles.

"Am I black or white?" I repeated for clarity.

"Yeah. What are you?" He looked at me as if this were not a not-so-PC way of asking such a thing. For him, obviously it wasn't.

"What do you think I am?" My team couldn't figure out if I was embarrassed, amused or what. They shifted on their feet, somewhere between uncomfortable and intrigued.

He studied me for a few minutes and then said, "I was thankin' you was black, but I don't know. You sound black. If you ain't black, you sho' sound black."

My team was now crimson. I laughed out loud to lighten things up and let the team know that I was okay. "Okay, so here's the deal, Mr. Chambers. . .my mama, she's black and my daddy, he's black. Does that help?"

Instead of thinking this was cute, he sat there thinking as if I was Rumplestiltskin asking him to guess my name. He tapped his finger on his lip and sighed. Still in Final Jeopardy mode. I knew I'd need to let him off the hook.

"Mr. Chambers, I'm actually black." He nodded his head like that's what he was going to say and smiled. "Was there a reason you wanted to know this?"

"Honestly, doc? I was just curious. I just be wantin' to know stuff like that and I get real curious, and you seem cool so I figured I could ask."

"Does it make a difference to you? I mean, are you okay with a black doctor and . . .the rest of our doctors?" I nodded my head to Polish Ania, Taiwanese Emily, and the rest of our team of varied European descent.

"Oh yeaaaaaah," he laughed in the most unassuming way ever. "Don't matter what y'all is. I just be wantin' to know little stuff like that, tha's all. All y'all cool wit' me. Black, white, blue, whatever!"

Nice.


So that was that. My patient who might have a primary lung cancer--a possibility that he fully understood--did have a question indeed. It wasn't the kind of question I expected but that's what happens when you ask, "What questions do you have for me?" -- and that's what happens when you have the distinct pleasure of working at a place like Grady Hospital.