Racist I have been

Damn it. I’ve thought, said, or done something racist again. Of course, we all have. When I was 13, I read an amazing article in Ms. Magazine that concluded, “We are all carriers of the disease called racism,” but I try to evolve. This one incident sticks in my mind because I didn’t even realize it until I kept a journal as part of the PHSA Indigenous Cultural Safety Training course in 2017. I was sewing up a nasty laceration on an Indigenous woman’s leg in the emergency department, which she’d gotten in her line of duty as a firefighter. Read: Racism: Call it by its name That gave us plenty of time to talk. I noticed a tattoo on her calf, and she explained that her tat combined the outline of a wolf for her clan, the wolf clan, but was done in red, white and blue for the New Zealand flag, to represent her husband’s heritage. Both their cultures came together on her skin. “Awww, that’s awesome!” I was so touched by her story that when an orderly came by with extra sponges, I explained the tattoo to her too. The orderly loved it too, but the patient changed the subject to laceration care. “When should I have my stitches taken out? How should I watch for infection?” I knew that the tone had changed, but I didn’t really understand why until I reflected on it later. This patient had trusted me, but she didn’t choose to share the story with someone else she hadn’t met. It wasn’t my story to tell. I felt so embarrassed. Like, why did I do that? Why didn’t I keep my mouth shut? Confidentiality isn’t only about diagnoses and treatments, but personal stories. Read: Making a difference: 10 physicians working to improve healthcare for racialized communities Why am I telling you and furthering my humiliation? Because we all do things like this. Some of it is unspoken, some of it is spoken, and some of it is action. For example, sickle cell patients are often under-treated for pain and told they’re drug-seeking. Since many sickle cell patients are Black, this means we’re under-treating Black people’s pain. Studies such as the one from Proceedings of the National Academy of Sciences of the United States of America (“Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites”) illustrate how medical people can actually believe that white vs. Black patients feel pain differently! I was taught to err on the side of giving pain medications because otherwise you’re fostering patient suffering. Have I given narcotics to drug seekers? Yes. Some of them may genuinely have had pain, and some of them may not. But I try not to send them home with a prescription. That’s my line in the sand. I see truly overt racism and lack of care. Once we had a difficult patient who was a person of colour. This was also my first patient who deliberately coughed on my face, said, “I’m going to give you COVID,” and threatened to spit on my face mask. That patient received Haldol and Ativan. When the paramedics came for transfer, the blood pressure had dropped to 70/30 (was originally a systolic of 113), and I said, “Whoa. Let me get some fluids." Read: Repair and connect: Focusing on constructive solutions to microagressions in healthcare “That patient is fine! That patient should just go!” the nurse argued. “No,” and ordered the fluids, secretly amazed. Can you imagine if I sent a vulnerable patient in an ambulance with a blood pressure that was half of normal just because it would have been more convenient to clean out the emergency department? ‘JOYRIDING’ Another time, a physician friend signed over an Indigenous pediatric patient who’d fallen off an ATV, “because you know how they all do that, joyriding.” “I don’t think that’s relevant to the case,” I said. “You could just have signed over that it was an ATV with a head injury, waiting for a CT scan.” My friend didn’t like that. “I’ve worked on the reserves, you know, and we saw this a lot.” “I’ve worked on reserves too. And I still don’t think it’s relevant.” Later, I learned that someone had given the child a ride home from school, and the fall was an accident. Not that it should matter, but these unconscious biases do affect care long before we run into cases like Joyce Echaquan, the 37-yearold Atikamekw woman and mother of seven who silently broadcast a Facebook Live of the “caregivers” who taunted her before she died at the Centre hospitalier régional de Lanaudière in Joliette, Que. I don’t pretend to be perfect, but racism is kind of like a foreign body that’s worked its way deep under our epidermis. Every one of us needs to recognize our prejudices, dig them out, wait for new ones to surface, and dig those out too, every day that we’re alive. If you pretend you have no biases, that you “treat everyone the same,” or that you “don’t see colour,” look again. Take the cultural sensitivity class. Read books. Watch videos. Ask others for feedback and listen to their answers without defending yourself. Watch your thoughts, deeds, and actions. Do your level best to fight for better care and for a better future. Dr. Melissa Yuan-Innes is an emergency physician in Alexandria, Ont. You can read more from her blog Life Support here.

Racist I have been

Register for free access or login.

Related Topics