Black Voices in Healthcare: 8. Touch
Synopsis
From the physical exams we conduct to diagnose disease to the reassuring handshakes before a surgical procedure, human touch is fundamental to the work we do in healthcare.
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FEATURING
Lori Edwards, MD; Ty S. Elliott, MD; Ajibike Lapite, MD, MPHTM; Stephen L. Noble, MD, FACS; and other healthcare workers who contributed their stories anonymously.
CREDITS
Hosted by Ashley McMullen, MD
Executive Produced by Kimberly Manning, MD
Produced by Emily Silverman, MD and Adelaide Papazoglou
Sound engineering by Jon Oliver
Medical student producing by Rafaela Posner
Original music by Janaé E.
Illustration by Ashley Floréal
Black Voices in Healthcare is sponsored by California Health Care Foundation and The California Wellness Foundation.
The Nocturnists is made possible by the California Medical Association and people like you who have donated through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Black Voices in Healthcare
Ep 8. “Touch”
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Ashley McMullen
You're listening to The Nocturnists: Black Voices in Healthcare. I'm Ashley McMullen.
So much has changed in the course of this pandemic. Systems that were once considered inflexible were suddenly transformed in a matter of days. And as we remain socially distant, technology has in some cases brought us closer to those who once seemed so far away.
This moment offers new perspectives and hope for better days to come. But also, a new appreciation for things we once took for granted, especially human touch. Now, my friends will tell you, I am not the most touchy feely person, but I am feeling this absence. I miss those good hugs from friends and family. And, more than anything, I miss that connection with my patients.
For many of us in healthcare, our hands are the tools that we use to understand what's going on–to receive new life on the L&D wards, or feel the pulse of someone who's slipping away, to cut, puncture, sew, and mend, to give reassurance, comfort and build trust. Human touch is fundamental to the work that we do in medicine. And these are your stories. Here's “Episode Eight: Touch."
Dr. B
I started working at a VA hospital in 1998. I was seeing patients there, and having great success in connecting with our veterans. They're awesome as a patient population, and just great people in general. For all the services and sacrifices that they made in their lives, I felt it was quite a honor to take care of them.
On one particular day, I was taking care of a brand new patient to me, and he was a Black male. And we went through the process of talking about his history and gathering the history and reviewing his chart. And at the end of which I said to him, "Hop up on the table so I can get a look at you. Take your shirt off, so I can examine you."
I turn my back to the patient to continue some charting and the patient didn't move. So I said, "Sir, would you mind taking your shirt off and hopping up on the table so that I can examine you?" And so, seemingly reluctantly, he got up out of the chair and took off his shirt and disrobed and sat on the table, and I proceeded to examine him. And as I was coming to the end of my examination of him, I noticed a tear was welling up in his eye. I said, "Sir, have I done something wrong to you? Is it my breath?"
And he shook his head and smiled and laughed and said, "No, no, no, Doc, it's, you're fine, you're fine, you're fine." And so I finished the exam. And he dressed and sat back down in the regular chair beside me. And as we started talking about what we were going to do for a plan, he stopped me and he said, "I need to tell you something." He said, "I've been coming to this hospital for over fifteen years. I've seen many providers in this hospital. And I want you to know that you're the first doctor who has ever touched me." He said, "Most of the time, the doctors come in, they sit down, they start either writing on paper or start writing on a computer, and they casually look over to me, I mean, while they're asking me questions. And after a few questions get answered they say, “Okay, I'ma write this prescription,” and they give it to me and I walk out the room." "So you mean," I asked, "They never touched you? They never did an exam on you?" He said, "That's what I'm trying to tell you. You're the first doctor that has ever touched me."
Tseganesh, Primary care physician
So I don't typically wear gloves unless I am examining a skin rash or doing more sensitive exams or, you know, it's a MRSA case or VREU where you need that extra additional protection. But I don't typically in my clinic, in my hospital practice, wear gloves, because I want to touch you, I want you to know that I see you in your humanity, and my hand on yours is an affirmation of it. In COVID, though, it's been very challenging and different, because all of a sudden it feels like we ought to be wearing gloves with all of our patients. We can't touch them in more of the casual ways, like a handshake, or–my patients like hugs, and so they would hug me, and none of that is allowed anymore. So we sort of stare at each other in this awkwardness. And then I usually, I put on gloves when I'm doing my physical exam, or I am very cautious and aware that I need to wash my hands right after having touched them. And it's so, ah, breaks my heart every single time I have to do that. I also wonder if we'll keep doing that after all of this is over. For me, gloves are so distancing and there's so, um, they just trigger all sorts of things in me.
My father had had a stroke several years before, and we were in the hospital with him. And it drove me crazy that every single time the neurologist came in to examine him, he put on gloves. And every part of me wanted to scream, “What do you think you're going to get from my father? Why can't you touch him?” It meant so much for me to have someone touch my father with their hands. And when he didn't it was so insulting. You know, as he's a Black man in the hospital, and it's already hard. And then to feel like he wasn't good enough to be touched, that he needed protection, that you needed to protect yourself from him before you touched him, was so deeply, deeply wounding.
Stephen Noble
A couple years ago, I was seeing a patient for coronary artery disease. A gentleman that was in his mid 60s, Black gentleman, who had pretty severe blockages in the arteries that go to his heart. Before I went in to see the patient, I was pulled aside by the nurse. She said, "This guy's a difficult patient. He's been pretty mean, pretty ornery." But as soon as I saw him, I could immediately tell that this was a guy that just really appeared to be anxious and somewhat scared and, and fearful. So I introduced myself. told him who I was, told him what the situation was, and asked if, if he would mind if I went out to the waiting room to get his wife.
So, his wife came back in and as I'm discussing with him his overall condition, as well as the, the treatment and recommendations, I told the patient that, based upon what I was seeing, you needed open heart surgery. I would be doing bypasses. And we would probably do it within the next one to two days, given how tight the blockages were.
He was admitted to the hospital, we got the preoperative studies. Things were going pretty much par for the course until, about nine or ten o'clock at night, I got a call from the nursing staff saying that the patient was being combative, not signing the consent form, and was threatening to leave. I recommended maybe give him some ativan or something of that nature to help him sleep. Fortunately, I was in the neighborhood, and so I decided that I would just swing by the hospital and talk to the patient. So I came in, I had a good discussion with him. Tried to explain to him as clearly as possible how bad his disease was and, really, how we need to get him fixed. And that after the surgery, he should be able to go back to doing some of his normal things.
During that conversation, he kind of alluded to me that he felt as if the nursing staff and that people around him just really weren't listening to him–that he was just, kind of, being put off or not being fully heard. I decided not to give him any sort of medication. It was clear to me that what he just really needed was someone to listen to him and someone to just, kind of, hold his hand and walk him through this experience. Me being Black, I think, was something that was really important to him–being able to see another brother come and be there with him. He stated that, you know, I kind of reminded him of his son who was, who was a lawyer.
The next day, we took him to the operating room. Fortunately, everything went well. And then his postoperative course was, was pretty unremarkable. There was one part that we always talk about to this day, as far as my partner having to come in and pull his chest tubes out, and how he didn't like how my partner did it because he did it without any sort of warning, he just kind of yanked them out. And that was really the only time that I've ever seen this gentleman very upset. My patient, when you really got to know him, he's a really warm and loving guy. And although he has his tough outer shell in which people look at him and just kind of immediately assume that he's going to be difficult, or a pain in the ass sort of patient, when you really got to know him, you realize that he's just a loving guy.
I've seen this patient several times since then. Every time he comes into the hospital, I'd always make it a point to come by and see him. And every time he sees me, he gets the biggest grin and smile on his face and always says, "My man, that's my heart surgeon." And it's funny because every time he comes in, he always wants me to manage some of his other conditions: his gi reflux, he wants me to manage his diabetes medications. I try to tell him, (LAUGHS) "I don't do that, I'm not a primary care doctor."
Ajibike Lapite
September of last year, I walked into my third patient's room for the day–just a two-month-old little girl who presented with pretty concerning symptoms but no clear diagnosis as of yet. We didn't really understand why she had the constellation of symptoms that she had and her lab values were trending in the wrong direction. And it was her third day at the hospital. They had been at two hospitals already before and the word on the street was that the family was very frustrated with their care at the other institutions, not yet at ours. So I walked in. I did what I typically do when I meet a new family. "Hi, I'm Dr. Lapite and I'm one of the pediatric residents here. I'm on the team that will be taking care of your daughter." I took a couple of steps closer.
The father had his daughter cradled in his hands, and I got ready to take a listen to her. She was asleep, and it was the perfect time window to get a good listen to her heart and lungs. He stops me. "Wait, who are you?" And I repeated myself. "Hi, I'm Dr. Lapite. I'm one of the pediatric residents on the team." He's like, "So, what are you trying to do?" And I said, "I am her doctor today. I just want to get a good exam." He said, "Don't touch my baby." And I was startled. I don't think I've ever had a patient tell me not to touch them. And I've definitely never had a family tell me not to touch their child. So, I was startled. And I said, "Well, I really need to get a good sense of how she's doing. I'm worried about her."
And I was. I mean, she was definitely the sickest of the patients on our list. "You are not a doctor." I say, "Do you want to see my badge?" I show it to him. He looks at it, he disregards, and he follows with, "I have been to three hospitals, now, in the past week. I've seen a lot of doctors, and I have never seen a Black female doctor before. So, forgive me for not thinking that you are one." And, in the moment, I was stunned. I am a fairly talkative person. I didn't have a lot of words to say. Um. I placed my stethoscope on her chest, and I said, "I'm just going to take a quick listen, and then I'll see you on rounds." So I listened. I felt her abdomen. It was very distended, she was very jaundiced, she looked very sleepy. She didn't look well. And I mentally recorded all the things I saw.
I stepped outside of the room, and I bumped into my attending. And the first thing I said was, "That father hates me. He just told me I'm not a doctor, because I'm a Black woman." And my attending said, "Well, people sometimes think that I'm not an attending because I look so young, because I'm Asian. These are just the things that we deal with. These are just the things that we deal with.”
And, I mean, it's not as though this was the first time I'd had anyone say something offensive to me. I went to medical school in Louisiana, like, I've been offended. But it was the first time that someone so explicitly told me they didn't want me to be involved in the care of their child. And things escalated. Like, it's hard when things start off that rocky for things to get better. So day by day became more uncomfortable. Day by day, I struggled with trying to understand this diagnostic mystery, and also trying to protect my heart, while also trying to not be the weak link on a team of all white colleagues, but finding myself crying myself to sleep most nights on that service.
It was about 7:45 in the morning, was a Monday morning. I was leaving the hospital, and this father followed me. He followed me for about ten minutes and he yelled my name. It was almost ironic when he said "Doctor," because I had never heard him call me a physician before, and I've been taking care of his daughter for two weeks by that point. And he made a lot of comments. He said a lot of things. Some of them I can't really remember because so much time has passed between then and now. And I asked, “Why?” My parents, when I told them this story later, they were just like, "Why did you engage him?" "I just wanted to know, I just wanted to know." And I was–I kept trying to figure out the answers myself, but here was the source, so I asked him. And he said, "You just look like you should be doing something else. You're wasting your life being a physician. Medicine is not good for Black people."
And I guess I should mention that this man is Black. I don't know, I don't know. It was a heavy conversation. He went into a diatribe about how transfusions are a way for white people to give diseases to Black individuals, specifically Black children. And did I see on the news that there are people here in America that are killing Black children just for the sake of getting their organs, so that they can save white children that are prioritized. And I heard the hurt in his voice, and the distrust of the medical system, and also just the very real distrust of this country. It was hard for me, as someone who went into this field hoping to take care of people that look like me, to be not enough to a patient's family that looked like me.
Ty Elliott
Every sixteen to twenty-one days, for the last five years, I have gone to get my nails done. I get a manicure religiously, faithfully. I've perused through different nail salons in the neighborhood but I've settled on one. Actually, I've had about three in the past five or six years. The first one, well, my lady wasn't available enough. She worked, like, Tuesdays and Wednesdays and that was just not enough for me. The second lady, it was more of a nail station. So she wanted her appointments to be, you know, very, very timely. And sometimes I would show up ten minutes late, fifteen minutes late. Her name was Lynn. Lynn was really quite excellent. Always did the shape just perfect. The shellac that I, that I got, she never made it too thick or too thin. It was always very even. Her top coats were amazing. I had a nice little shine at the end. But Lynn and I, we divorced after about two years because I couldn't keep up with the punctuality that she required.
So my current shop, love my nail shop, my lady is Lisa. Tammy does my toes. I mean, I know my nail girls. And so I think to myself and I and I say, ”Why do I, why do I value this so much? The importance of this ritual?” And I think about why I value this time at the nail salon. And it's because my hands are my tools. My hands touch my patients. My hands heal, my hands provide reassurance. My hands provide care and service. And they communicate with people. So my hands represent a large part of who I am as a physician. My hands represent my profession. My hands represent what I value. There's a lot of healing power in touch. So my tools have to be sharp and my tools have to look good. Not just my stethoscope, but my hands.
Lori Edwards
It takes a specific, I would say, je ne sais quoi, to, to provide services on a labor and delivery floor. It's a very overwhelming experience for, for these patients. It's absolutely amazing to see what the body can really go through, like what we can actually handle. And as a resident, we do offer epidurals for labor for these patients. So, I remember a specific situation where they were in significant pain, and they wanted an epidural to give them some sort of relief. I walked into the room and immediately I could feel the nervous energy–”I do want relief from this but I am absolutely afraid of what you're about to do.” She sits up in bed. makes effort to push out her lower back. I say to her very calmly, "Okay, I'm going to clean your back now. It's going to be very cold." I clean her back. And I think to myself, “Okay, this is going to be extremely difficult.” I can see the hesitation, just in her body, I can see the hesitation, and then just a slow relaxation of her shoulders.
I use a small needle to numb an area over her back. I then settled my own mind because doing an epidural does require focus. It's all about feel, touch. I felt the spinous processes of the vertebrae in her back and located the middle. I pressed the epidural needle up to her skin. I could feel the popping and gritty sensation as I passed through the skin, the subcutaneous tissue, the ligaments in between the vertebrae. I could feel it underneath my fingertips. Then there was just this increased resistance and then a pop, this sudden loss of resistance in epidural space. I was relieved. I took the catheter, put it into the needle, and I said, "Try not to move…. Okay, we're almost done. The needle is out, you can relax."
And I could see just the tension, the fear, the anxiety that was pent up in her body just slowly melt away. And as I injected the medication, the local anesthetics that we use to test the catheter, I could see that she was welcoming that cool sensation in her back. And with the next contraction, she was a little calmer. With the next contraction, she was even more calm. And by the time I left the room, she was asleep. I really love what I do.
Jennifer Berrian
For me, my memories of my childhood and my memories of my maternal grandmother are inextricable. They're memories of waking up to the smells of her salmon croquettes and grits and biscuits. Her soft touch on my head as she tells me to get up, brush my teeth and come eat breakfast. They are her holding my hand as we crossed the street, the feeling of the back of her hand on my forehead when I have a cold, her garden, that perfume that she wore that would just waft through the house and that would just completely encompass you when you hug her–not in an overwhelming sense, just letting you know, like, “Hello. It's me, your grandmother. I'm here.” It would always comfort me, It always soothed me.
My grandmother, my maternal grandmother, was big on physical touch. She in fact was the first, the first head nurse of African American descent in her South Georgia hospital, back in the sixties. She was the head nurse on her floor. There is this picture I've seen of her, this black and white picture, of her with that beautiful smile on her face, her stethoscope in her ears, and she's leaning down to take the blood pressure. One of her patients, her hand lying gently on their shoulder in comforting touch, closeness, proximity.
One time, in, I was in sixth grade, so I was maybe eleven. My grandmother had come to stay with us because my dad and my mom needed to go on a trip. And so my grandmother was with us for that week. And talking later on with my mom, she said she knew something was wrong, because usually when she left my grandmother at the house with us, she would come back to a house that had been cleaned from stem to stern. My grandmother would inevitably find some way to plant a new flower or something in our small garden out front. And there would be food in the fridge. But this time when she came there was none of that.
In the months that followed, my only memories, it's memories of my mother talking to her sister, my aunt, saying, "What do you mean, mom just fell off the porch? How did she fall? Did she trip? She just fell? Have you taken her to the hospital? Has she been complaining of headaches?” Like, “I think this is a stroke." Memories, glimpses of this beautiful woman lying in a hospital bed. But me not being able to smell that signature smell of hers. Instead, I smell bleach and ammonia or whatever they use to clean the rooms. Fast forward an unknown number of weeks, months, diagnosed with a stage four glioblastoma. Fast forward a decade and some change, I'm a med student. And my second year, they're calling the glioblastoma the butterfly tumor, because it is so malignant, and so fast-growing, that it usually tends to grow from one hemisphere into the other and appears to be a butterfly. And I'm sitting in that class trying not to be sick at the characterization of something so beautiful and simple as a butterfly to the tumor that took away the touch that is my childhood.
I have one distinct memory, and I think, I think it might have been the last time that I touched her. It was some time after the surgery, because she couldn't walk anymore. She couldn't speak. And they were trying to transfer her into my mother's van to get her to an appointment. And I'm holding her and I know it's her. The smell isn't right. And she's not holding me back. But we managed to get her in the car. My mom fixed her clothes because they'd become disheveled in the move. Sometime after that, I'm not sure how soon, my grandmother died. Nothing can replace her touch or smell. That perfume, I never got the name. It smelled like flowers and….
Fast forward to 2018 and I'm sitting in this large auditorium filled with my new classmates as I prepare to get my white coat. I remember I was so nervous I was shaking, and felt like I was gonna throw up. And just as they called my name I stood up and felt pretty sure I was gonna faint. I feel her when I'm standing over my cadaver noting that this person also had glioblastoma and also had a radical lobectomy, and I feel her now, as I prepare to start in the clinical environment and this COVID era with so many unknowns. I feel her holding me, hugging me, kissing me, the top of my head, blessing me.
(MUSIC)
Ashley McMullen
This has been The Nocturnists: Black Voices in Healthcare. I want to thank our core team, executive producer Kimberly Manning, The Nocturnists founder Emily Silverman, podcast producer, Adelaide Papazoglou, sound engineer Jon Oliver, and medical student Rafaela Posner.
Thanks also to executive producer Ali Block, and program manager Rebecca Groves, and communications manager corps backers. Our illustrations are by Ashley Floréal and our theme song is by Janaé E.
Black Voices in Healthcare is made possible by the California Medical Association, the California Health Care Foundation, and people like you who've donated through our website and patreon page. Thank you for supporting our work and storytelling. If you'd like to add your voice to our project, visit our website at thenocturnists.com We'll be back next week.
Until then, remember: Black lives matter. Black health matters and Black stories matter.