Friday, October 30, 2015

Two months in review (9-10/2015)

In the past two months, I've been on Labor and Delivery, and on the clinic service. During this time, I clocked my personal best and worst weeks in terms of duty hours. I logged 92 hours on week on L&D (when I worked two weekends on either side of a busy week), and I logged 30 hours on a (very average) clinic week.

I got a lot done during that month of 30 hour work weeks: doctor visits, dental appointments, making curtains, a car wash, moving forward on research projects (18 patients recruited for my survey study, phone calls towards one patent, drawings for a manufacturer on another, and signing on to another device study at my hospital), and moving forward on fun projects (contacted an illustrator on two children's books [was turned down but hey at least I contacted someone], and went live for beta testing on another [sorry I can't link or it'd compromise anonymity]). I also furthered some of the NFP projects, completing fundraising on a video project for NFP-only interviewees (now that's gonna compromise anonymity when the video comes I'll probably have to delete that later), completing a final version of new-evangelization-style NFP handouts for patients in our metroplex (and getting half of the funds for that!), and half-finalizing the manuscript of the pocket-Napro book that myself and another NFP-only resident are working on.

I have learned to do a discharge summary in ten minutes. I have learned to do dishes once every two weeks without inviting every bug in the metroplex. I have started walking to work more (because I hate scraping cars).

I'm still chronically exhausted. A major spiritual battle right now is how to deal with fatigue; it's actually the core battle of my life. At the same time, I am tempted to think I do not pray, sacrifice, or love God enough. But the reality is, that my prayer (outside the starvation rations of just MP, EP, and meditation) is the prayer on the Cross: complete obedience and self abnegation. And my penance is the penance of Christ's ministry: who needs flagellation when all personal time is lost in a 90 hour work week?

P.S. There are two additions that need to be made to OB/GYN Ethics 101: methotrexate for ectopics, and emergency contraception. I'm also working on elevator speeches and details on the post-fertilization effects of IUDs. Thank you for being patient! The next five months will be very, very hard for me and I have posts scheduled through that time, but new material will be slow to come out.

Thursday, October 15, 2015

Racism or Love?

This post conforms to the blog rules.To my surprise, one of the things I'm adjusting to in my new city is the tension of race. Perhaps it's because the population is less diverse (where I came from most recently, the population was about 40% white, 25% black, 25% Hispanic, and 10% Asian, while my new hospital is about 40% white, 60% black). Maybe the events surrounding Ferguson have made racial tension more dramatic everywhere. But I think it's probably because I'm more immersed than ever before (eighty hours a week with a 60% black population), and I've realized that being black in America is not just a color; it's a well-developed and different culture.

I've spent much of the past month thinking, talking, and working through my reaction to this culture. In so doing, I've realized I've held most of the predominant mentalities on the question. Let me take you on the tour.

Mentality 1: Classism
Src: Joe Pappillon
I was raised in the geographic south. My parents are upper middle-class white homeowners and I was raised in a neighborhood of the same demographic. Our neighborhood was across the street from a large swath of low-income apartments which were primarily occupied by black people. In the name of safety, I was raised to see that neighborhood and those people with an unfortunate lens of distrust, pity, and even occasional pitilessness (because "they're doing it to themselves"). The expressions "trashy" and "work ethic" floated around our house when race came up.

Mentality 2: Positive Discrimination

Src: Slate on Fisher v. Texas
As a kid, I played T-ball. There was one black girl on the team and I recall a perfect memory from left field, as it dawned on me that my ancestors were on the cruel side of history, and hers were the victims. I wanted to do something to make it up to her. Childlike, I imagined bringing her an armful of presents, before I realized that she wouldn't understand or really benefit from them. Ever since, I've thought the desire to atone for the past in the complicated present is childish. Then I realized how many black people think it's a great idea. (This only makes sense. I'm sure my T-ball teammate would have loved an armful of presents.) It seems like a good idea for some issues in some communities, and an unnecessary crutch in others.

Mentality 3: Color-blindness
At my upper-class, white all-girl high school, I received a nauseating overload of privilege-awareness, minority-empowerment, and bias-shedding. (My teachers were young and teaching the hip doctrine of cultural acceptance, or they were old and had unresolved guilt from the era of segregation.) In our white, upper-class bubble with little to no involvement with the cultures we were supposed to tolerate and nurture, all this had the opposite of the intended effect: I ached for the day when people would please stop talking about race. Freeman said it, and he's black, so isn't it true? (No: watch how easy it was for me to snap right out of it into something dangerous).

Mentality 4: Overt Racism
Then I started residency and realized how well-developed and different black culture really is. I was repulsed by one particularly bad experience during a clinic month: a childish, obese woman and two badly behaved, screen-dependent toddlers made me extremely angry. I felt like I needed the "control of the classroom" that my teaching friends talk so much about! There had been so many patients who were kind and well-behaved of various races, but an unfortunate run of those who were not, all of a single race. And here I met the most frightening mentality I'd ever had: true racism. I was an inch away from attributing my frustration to the wrong thing (race), an inch away from thinking, "All these people are so juvenile and disgusting."

I caught myself, terrified that such a thought could cross my mind.

Gone was my idea that racism doesn't exist: as long as people will enjoy spending time with people who look like them, we'll have different cultures that cluster around different races. And as long as we have different cultures, we'll have the potential to attribute our frustration with individuals to race. But the problems in that exam room was so deeply rooted that I couldn't go to the idea that I or others could somehow "make up" for the complex series of events (since the 1600s) that led us to today. And I couldn't accept the childhood classism: I saw it for what it was in that exam room, just a soft racism. I went home confused that day.

Mentality 5: Love
A week later, I was working in a community clinic and met a black woman who humbled me. At my age, she had four children under six and was pregnant again. She had just left the father of her children because she'd discovered he'd exposed himself and her to HIV, and that he'd had another wife and fathered three other children while he was fathering hers. But she was firm in her plans to raise her children well. Her two year old was with her and very well-behaved. Sitting across from her, I was impressed at how generous she could be in spite of all that had happened to her. And now I knew what to do with my confusion about race.

Her culture, I thought, is broken--it makes for some broken families and selfish, addicted people. So is my culture. Why can't I be mature enough to look at each person as they are without a) dissociating them from their color and culture but also without b) attributing all the negatives attached to that culture to them? Why can't I be prudent enough to combat objectively problematic elements of black culture while also calming down about others?

A classist will whisper "That woman's probably a welfare mom." Positive discriminators say, "We need to pour more funds into the programs that assist STD prevention." The color-blind protest, "I don't see how marital turmoil is relevant to the question of race," and a racist would say something not worth printing. None of those contain the full truth. The right answer is the simplest: love each person without ignoring the problems and the beauty in them and their world.

I'll end with an observation about the beauty of black culture. I'd never heard or seen an ice cream truck until I moved out of my white neighborhood and into the inner city. The first time I heard the truck go by, I was so shocked that I stood up and went to a window. Why hadn't I seen one before? There was more isolation and fewer children where I grew up. (We were one of four families on the whole street, the other three of which had six children combined). We never played with our neighbors and our extended family are all out of state. Last year, among the low-income apartments that I used to distrust, I saw parents (yes, mothers with fathers!) walking children in strollers and whole extended families partying on patios.

It still takes me effort to avoid falling into classism and color-blindness. It's worth the work, though: not only is it the right thing to do, but it's much more satisfying and fruitful to love.

St. Agnes. Credit: Mike Boening