Comments on GeriPal - Geriatrics and Palliative Care Blog: Judged by the Color of their Skin

Thanks Chrissy for bringing up this challenging si...

2010-01-02T22:04:24.866-08:00

Thanks Chrissy for bringing up this challenging situation (and to DieLaughing for your warm story). I find patients who make racist statements to be some of the most difficult to work with. The very first hospice patient I cared for made racist comments. I was a third year medical student and had absolutely no idea what to do.

How have I changed? I think I try and understand why they are saying what they're saying. Is it "just" a sign of their age and socialization, or is it something more? For many patients, it is an attempt to gain power in the relationship by making a provocative statement. Are they feeling powerlses in the face of loss, or death - and striking out against other? For others, it's a sign of disinhibition. Having a deeper sensitivity to the underlying reasons patients make these statements helps me to help them...and to renew my sense of compassion.

If I tuned in, I could probably hear 5 or 6 racist...

2009-12-30T02:15:51.414-08:00

If I tuned in, I could probably hear 5 or 6 racist comments a week from a patient or their loved one.

I've grown accustomed to ignoring the them, but the words chip away at my morale.

Just last week, a beloved, albeit surly, patient wanted to "tell me a story" about his CNA. "She's a mixed-breed, you know", he said in a low voice.

My heart sank. I'd come to enjoy caring for this patient and his family for over three weeks, finding them to be a warm and inquisitive bunch. This rotten spot was unexpected and harshly disappointing.

Moreover, his CNA had cared for him with her trademark tender devotion and crisp professionalism. She'd anticipated his many needs, vital-signed him without intrusion, smiled at his corny jokes, and kept him more comfortable than I ever could.

And, yes, the U.S. Census will ask her to check the "Two or More Races" box.

I ignored his remark and got up to leave. He grabbed my arm. "It's true", he rasped more loudly,
"she IS a mixed breed!". I turned to go, slipping my sleeve from his gnarly grip.

"She's half CNA and half nurse!", he called after me. "There oughta be a pay grade just for her! Get me Human Racehorses on the phone!"

I shared the story with the CNA. We laughed. I did contact Human Resources to pass along the back-end of his comment and she'll receive a commendation.

I love surprises.

I think we need to accept that we don't have t...

2009-12-24T10:27:41.496-08:00

I think we need to accept that we don't have to "like" our patients to care for them.
(from a Christian viewpoint, since it is Christmas, maybe we don't need to like our patients to love them?)

It's wonderful if we truly like our patients--but someone has to care for the unlikeable among us, too...

Yes, like you did, you need to set limits for bad behavior. But we don't need to judge them. We have no idea what their history was, how they were raised, their experiences, that made them this way...

Even though we still have a lot of work to do to not judge people by their color, ethnicity, or religion--I think we are becomining more and more open minded as a group in the U.S.
You don't notice the changes in culture unless you really look back to the past and remember how it used to be...and we've come a long way...

Difficult and unsettling, to be sure. When I was ...

2009-12-23T23:25:57.892-08:00

Difficult and unsettling, to be sure.

When I was recently putting together a classroom presentation on ethics, I used the ANA code as one example of ethics in the context of professional standards.

I also rephrased the first provision as simply, "We're obligated to take care of everybody who needs care, no matter the reason."

We don't get to choose our patients, or pick through a list of conditions to find those that we will, or won't, get involved with.

For the purpose of illustration, I also found it helpful to present this as - "Imagine the person, or kind of person, that makes you most uncomfortable. Think about a disease or clinical situation that's also distressing to you. Now put the two together, and ask what your obligation is in such a situation."

Difficult and unsettling.

Or, as my buddy from down in Jersey says, "Ehh, whaddya gonnado?"