I spent an hour yesterday with a new patient who has complex repaired congenital heart disease. In our initial conversation it became apparent she and I had differing agendas. I was on a mission to efficiently evaluate her heart, sort out any ongoing issues, document the visit and then move on to the next patient. Her desire was to tell her story and be listened to. So, in the moment and having the benefit of a little extra time, I chose to listen well. She shared how difficult it had been growing up with congenital heart disease, having suffered through many surgeries, being the slowest kid in the PE class and being teased about her scars. Her childhood was challenging in that she had to grow up fast, her parents divorced and family life fell apart. One current complaint was chronic joint and muscle pain that had been interpreted as drug-seeking behavior, biased by the fact she had recently been homeless. She shared how she has felt marginalized and judged by medical providers and how no one seems to have time to listen to her. When I examined her it became apparent she was extremely flexible, with findings to suggest an underlying connective tissue condition. She also described a history of joint subluxation, chronic fatigue, and pre-syncopal symptoms and easy bruising, other symptoms to suggest a hyper-mobility condition. I shared my suspicions about how her complaints may all be related. She then thanked me for listening to her story, for asking questions and for not judging her. For a long time she had not felt worthy of being listened to and believed her physical complaints had been ignored. Simply acknowledging her symptoms was a relief. I don’t share this story to blow my own horn, but to illustrate how listening is a huge part of what we do for our patients.
This encounter made me reflect on the current circumstances of our society. COVID-19 gave us a pause in life and offered us time to listen too. I have heard many friends and colleagues comment they were able to spend more time together with their children at home or with family or friends virtually, listening and talking to one another. This pause in our rat race allowed us time and opportunity to relearn the value and privilege of hearing one another.
Similarly, the social unrest and rioting triggered by George Floyd’s death, is prompting us to reflect on how we hear and see one another, how we hear and see marginalized communities, how our biases lead us to hear and see others. In an attempt to understand this issue of racism on a deeper level I watched Rachel Cargle’s TED talk about racial disparity and white privilege. She pleads for each of us to take a three-fold approach to racial disparity by gaining knowledge, practicing empathy and moving to action. Knowledge, Empathy, Action are the same steps we practice with our patients daily. These are steps I am already good at, but on a broader scope I needed to ask myself, “How often have I looked and not seen, listened and not heard? How often have I been color blind or even deaf? An anonymous quote I recently read hits home, “If you don’t see my color, you don’t see me and you certainly don’t see how I see you.”
The sentiment of hearing with new ears and seeing with new eyes also applies to how one can seek to understand racism from a white person’s perspective. Peggy McIntosh, in her 1989 article entitled, White Privilege: Unpacking the Invisible Knapsack, states, “I was taught to recognize racism only in individual acts of meanness by members of my group, never in invisible systems conferring unsought racial dominance on my group from birth.” Her profound self-reflection and realization that her schooling gave her no training in seeing herself as an oppressor, unfairly advantaged person or participant in a damaged culture was eye-opening to me.
Gaining knowledge and practicing empathy are key steps in how we must approach this new world. What action steps come next? I offer up that this starts with personal reflection, examination where our vision may be myopic, where we may not be listening because we are centered on ourselves. This process of self-examination, pause and reflection allows us an opportunity to thoughtfully respond rather than immediately react, to be intentional in our next steps in the same methodical way we assess our patients and seek to provide them with answers. For all of us, we are in the midst of uncertainty and insecurity and are seeking answers. Choose to practice knowledge, empathy and action as you find your way.