Black Man in a White Coat

by Damon Tweedy, M. D.

  * * *

  In the final days of my internship, I had a chance to display my ever-increasing acceptance of gay people, but I almost blew it with one harmless-sounding question. On the medical ward one night, I admitted a young man named John. He’d developed sudden-onset chest pain at work, and within an hour, found himself in our emergency department where he was quickly diagnosed with a pulmonary embolus—a blood clot in his lungs. He was being admitted to the hospital to receive intravenous blood thinner and to search for any underlying cause of the clot. Before this, he’d been in great health. I stared at the age listed on his chart. We were both thirty. I wondered how I would have handled such a health scare. Would it have prompted me to quit the grueling life of medicine and find something else to do?

  After taking the usual medical history concerning his recent physical symptoms and past health problems, I turned to his social history. As the medical internship year went on, I often found myself more interested in patients’ social and emotional backgrounds than in their medical histories. A heart attack or stroke could only manifest itself and be treated in so many ways, but each person had the potential to teach me something about a particular part of the world or way of life that I’d never experienced, allowing me to grow both as a doctor and a person. For this reason, I’d found the field of psychiatry increasingly appealing.

  John had grown up an only child in Raleigh and played baseball in high school. His dad was a lawyer and had attended the University of North Carolina at Chapel Hill (UNC) in the early 1970s during the era when black student enrollment there climbed. His mom was a high school history teacher who had also graduated from UNC. John followed his parents’ path in going to UNC. After law school at Georgetown, he’d come back to North Carolina and become a junior associate at a law firm in Raleigh.

  He drank one or two beers on the weekend. He’d never smoked cigarettes. He tried marijuana once during his freshman year at UNC.

  “Do you have a wife or girlfriend?” I asked, as I continued the social history inventory.

  He looked at me uncomfortably. He stuttered. “No, I…”

  I knew I’d made a mistake. During my rotation through another medical service earlier that year, I’d been supervised by an openly gay doctor who corrected another intern during a presentation for addressing the patient and the woman beside her as sisters when in fact they were long-term partners. John rubbed his hands over his knees, his eyes darting away from my stare; he wanted to change the subject. As with George, it hadn’t even occurred to me that he might be gay. I tried to take my size-fifteen foot out of my mouth.

  “Are you involved with anyone seriously? A partner, a friend, or anything like that?”

  Beads of sweat sprang up along John’s hairline. “Yes. I have a partner.”

  Usually that was code for a same-sex companion, but I was done making assumptions. “How long have you two been together?”

  “About three years. He should be here any minute. He was in court today.”

  “Two lawyers,” I said. “That’s almost as bad as a doctor couple.”

  He nodded, smiled, and then told me a little more about their history together, which went back to their time as law students. I completed the rest of the medical interview and physical exam, just as I’d done hundreds of times before. We shook hands and I wished John the best. I hope I’d shown him that I was willing to discuss his personal relationships and treat them no differently from any other person. He’d just had a life-threatening episode and wasn’t yet in the clear. He deserved to be treated the same way as the next person facing these same fears.

  Although far from perfect, I’d come a long way from the teenager and young adult who’d been firmly homophobic. I deeply regretted the times I’d used gay slurs or laughed at demeaning jokes about gay people. As my pager beeped and I headed off to see the next patient, I thought about how society might be different if more people had experienced changes of attitudes the way that I had. Perhaps if George or Larry had been surrounded by acceptance rather than hate, maybe they wouldn’t have felt pressured to conceal their sexual identities. Maybe tolerance could have saved Monica’s life.

  PART III

  Perseverance

  8

  Matching

  Lonnie, a Durham native a few days shy of forty, decided one morning that he was going to celebrate this upcoming milestone by lighting birthday candles. But instead of setting them atop a cake, he tossed them onto the wooden porch of his neighbor’s apartment. When the police and fire trucks arrived on the scene, Lonnie ran back to his apartment and began hurling kitchen knives out of a window. Within an hour, he was brought to the Duke emergency department, where, just a few months after finishing my medical internship, I was now on duty as a psychiatry resident.

  “We’ve got a live one,” the charge nurse said to me.

  I looked up from the computer screen, where I’d been checking basketball and football box scores. It had been a quiet Sunday morning in the psychiatric wing of the emergency department. One patient had gone upstairs to our inpatient psychiatric unit about an hour earlier. Another was calmly awaiting transfer to the state hospital following a serious suicide attempt. Both patients had been seen and treated overnight by one of my colleagues. I’d been on shift two hours without having to do much at all.

  “What’s the story?” I asked the charge nurse.

  “Schizophrenic. Tried to set his neighbor’s apartment on fire. He’s been rambling about Al Sharpton and Jesse Jackson. Real delusional. It’s probably safe to say that he’s off his meds.”

  “Or maybe he’s high on something else?” I countered.

  “I don’t think there’s a drug in the world that can make you this crazy,” he said.

  We shared a quick laugh. From a detached point of view, psychotic behavior was sometimes quite funny. But when you stopped and considered the person behind these symptoms, it was profoundly sad. And if you acknowledged that such illness could strike a friend or child and ruin his life, it was downright scary. It was easier to laugh than to cry or feel helpless.

  I opened the computer database and scanned for records. Lonnie had been here once before, about a year earlier. That time he’d come in believing that the FBI was sending him threatening messages through his cell phone, so he’d coated his phone in flour and cooking oil and set fire to it in the middle of a busy street. He received injections of antipsychotic medication and was shipped to the nearest state psychiatric hospital. As I always did, I checked his chart to see whether he’d had any alcohol or drugs in his system at that time that might have explained his behavior. He had none. The nurse was right; this guy was really sick.

  Hearing someone scream, I jogged to the rear area where the psychiatry patients were held. This space, like virtually all hospital psychiatric areas, was a locked wing, this one modernized in requiring a bar-coded ID badge rather than a clunky key to come and go. I pressed my badge against the sensor, turning the light from red to green. This allowed me five seconds to open the heavy wooden door before it automatically locked again.

  Inside, there were two small seclusion rooms to the left, where the most ill and dangerous patients were housed while recreational drugs cleared their systems or our tranquilizing ones took effect. To my right, a large open area was divided into several small cubicles, each consisting of a lounge chair bolted to the floor and a television secured to the adjacent wall.

  Lonnie was in the first seclusion room, screaming. He paced back and forth in the confined area with the urgency of a drug addict in need of a fix, but if his records were any indication, his problem had nothing to do with drugs. Over his thin frame he wore a T-shirt and sweatpants that had several holes of varying sizes and were blotched with paint stains. His thick hair and scraggly beard both looked uncombed and unwashed.

  “This is racist shit,” he yelled at the two police officers who stood outside the partially opened metal door. “That motherfucker tries to infect me with Ebola and
I get locked up? You gonna let him kill all the niggers in Durham, ain’t ya?”

  The older police officer, a gray-templed New York transplant with broad shoulders and thick biceps, stared at Lonnie blankly. His younger colleague shook his head in disgust. Everyone Lonnie had encountered thus far, from the police officers who’d brought him in to the nurses and emergency room doctor who’d seen him, was white. Even the on-duty nurse’s aide (most of whom were black) that day happened to be white. Like Chester, the racist white patient who encountered one black staff member after another, Lonnie picked the wrong day to get sick.

  “I’m gonna sue all you crackers for this,” he screamed, as spittle sprayed in several directions. “You just wait. I’m gonna get Johnnie Cochran and Al Sharpton and Jessie Jackson to come down here and put your white asses out of business.”

  “I can’t wait,” the older officer said sarcastically. “I need a new job anyway.”

  Medication is the staple treatment for acutely psychotic behavior. In the emergency room and psychiatric hospital, it often comes in the form of a needle in the rear end. The psych nurse, Suzanne, a brunette in her mid-forties, had already drawn up the tranquilizers—a mixture of Haldol and Ativan—into a syringe. In these settings, this combination was to agitated psychotic patients what insulin was to diabetic patients. Even the proportions were standard. Haldol was given in a dose of 5 milligrams, while Ativan was given in 2-milligram doses. So common was this cocktail at the places I worked that doctors and nurses simply referred to it as “five and two”—shorthand that communicates as quickly in a hospital as “I’ll have a Number two” does at the fast-food restaurant drive-thru window when a customer orders a burger and fries.

  Unless patients were trying to escape, or presented an active threat to hurt someone (including themselves) or to destroy hospital property, I liked to at least make an attempt to talk to them before they were held down by police and stabbed with a needle. Despite all of his paranoia and aggressive words, my instincts told me that Lonnie understood he had no chance of getting past the burly officers. Whether that meant he would agree to take medications on his own, however, was another story. But I thought it was at least worth a try.

  When I came into his line of sight, Lonnie, who’d been cursing at Suzanne about how she was trying to poison him, stopped talking. His eyes lit up. He smiled the ragged smile of someone with several missing teeth. “Michael Jordan,” he said.

  Lots of people had said that I resembled Jordan through the years. A dollar for every time I heard this comparison would have financed a short trip to Jamaica, dining and hotel included. But maybe Lonnie, with his delusional mind, thought I was Michael Jordan.

  I stood hesitantly at the entrance to the seclusion room. “My name is actually Damon.”

  He studied my face closely. I wondered what sort of bizarre and disconnected thoughts were dashing around in his fragmented mind. Should I have just played along?

  “But you related to him, right, man?” he asked.

  “Not that I know. But a lot of people have said that I favor him.”

  “You play ball too,” he said, more a statement than a question, while excitedly mimicking the motion of a jump shot. He stuck out his tongue like Jordan did so many times, only Lonnie’s was covered with a scaly, thick white film that looked like part of an ongoing infection.

  I would have much preferred people to think that I looked like Jordan on the basketball court rather than in street clothes, but that never happened. Not even once. “I used to play a bit,” I said. “But I don’t have much time anymore.”

  Lonnie’s jagged smile faded. I had dampened his fantasy. He glanced over at the two police officers who stood behind me.

  “So, can you tell me why they brought you here, to the hospital?” I asked.

  Lonnie looked at the officers again. I turned around. Both had their arms folded, which accentuated their biceps. Both wore latex gloves, something police often did around psychiatric patients in the emergency room, on the chance that they might have to grab and restrain the patient at a moment’s notice. The psychiatrists and nurses usually didn’t get their hands dirty.

  “Can you give us a little bit of privacy?” I asked.

  The older cop gave me an “Are you sure about this?” look. When I nodded, he shrugged and motioned to his partner. Both of them stepped back about twenty feet toward the center of the room. Suzanne went with them. It was more symbolic privacy than anything real.

  Lonnie started a loud, rambling story about his neighbor trying to infect him with Ebola. Apparently this neighbor was in cahoots with the property manager to make all of the black people at the apartment complex deathly ill, as if a virus like Ebola could somehow be confined in such a way that it would only make the black residents sick. There had been news reports at the time about poorer blacks in the area getting displaced by affluent whites through urban renewal projects, or gentrification. So there was a kernel of truth to Lonnie’s paranoia. However, his schizophrenic brain had distorted that reality into a delusion.

  Although I’d been training in psychiatry for just a few months, this was sufficient time for me to know that there was no point in trying to use reason to convince him of what was real. That approach usually made things worse. He couldn’t go back home, so I had to figure out how to get him calm while we processed his transfer to the state hospital, where the severely ill and aggressive patients went. The only other option would have been to have the police take him to jail for setting fires and throwing knives at people. But once he got there, from what I’d seen done before, they would simply have sent him back to us. He needed medication.

  I glanced back at the police officers and Suzanne, who awaited my direction. I told them that I needed a few more minutes, then turned again to Lonnie. Leaning down slightly to minimize our height difference, I spoke slowly and softly, hoping my voice and mannerisms might help calm him. I tried to put myself in his place and imagine where his mind might be traveling. The first feeling that came to me, surprisingly, was power: “It sounds like these white people around here are a bit scared of you,” I ventured.

  “Yeah,” he said, smiling again. “I want to make them all shit on themselves like babies.”

  I laughed—because of the absurdity of his words, but also because Lonnie was tapping into a familiar sentiment I’d heard so often. I used that familiarity to dig into what I’d long thought was a source of that attitude: “You also seem a little scared too. I get it, man.”

  Lonnie broke eye contact, bowing his head so that his chin almost touched his clavicle. His hands quivered slightly. For a second or two, I worried that I might have said the wrong thing, something that could make me the target of his racial delusions. I took a step back. But he had no more fight left. He looked defeated, embarrassed, and ashamed.

  “Yeah,” he said. “I need to get some sleep, man. I’ll take those pills. They ain’t so bad. You don’t need to give me no shot.”

  I spun around to see if Suzanne had heard Lonnie, as he’d never lowered his voice enough to keep her and the officers out of earshot. Her jaw dropped ever so slightly. She looked at the capped needle and syringe in her right hand before her eyes darted back up to meet mine. “So, you don’t want to give him the shot?”

  “It sounds like he’ll take the pills,” I said, turning back to Lonnie. “Is that right, sir?”

  Lonnie nodded. Suzanne scurried toward the locked door and used her ID badge to get back to the nurse’s area where the medications were stocked. She returned moments later with two small individually sealed tablets in one hand and a tiny cup of water in the other. She popped the foil and plunked them into his hand. Lonnie swallowed the pills. He even allowed Suzanne to observe him for “cheeking,” where patients pretend to take a medication only to spit it out moments later. Lonnie then stretched out on the slab that functioned as a bed. Within half an hour, he had fallen asleep.

  “Good work,” the senior officer said to me. “The last
thing I wanted was to throw my back out wrestling with him.”

  “Same here,” his younger colleague chimed in. “It looks like you’re in the right field.”

  Suzanne smiled. She asked me if I’d thought about working in the psych ED as a career. By meeting Lonnie on his level, I’d saved everyone a lot of trouble. The police and Suzanne didn’t have to deal with the inherent risks of an uncapped needle and an agitated psychotic patient. More important, I’d helped Lonnie. The senior doctor—in charge of the entire ED—had already ordered Haldol and Ativan; Lonnie was going to get the “five and two” cocktail regardless of what I did. What I’d done was save him the discomfort and humiliation of being forcibly restrained like an animal.

  During medical internship, I’d drawn blood from veins and arteries all over the body, inserted needles into abdominal and chest cavities to drain away excess fluid, placed central catheter lines, and performed CPR. I conducted hundreds and hundreds of physical exams. Rarely did anyone compliment me, even as I became increasingly proficient with these various procedures. With Lonnie, I hadn’t raised a hand. Nor had I suggested a drug that worked better than the standard ones any ED doctor could order. All I had done was talk to him. Yet this had made a clear difference in his willingness to accept treatment. Never had I felt like I’d done so little while those around me thought I’d accomplished so much.

  “I think it’s great for the patients here to see a black male like yourself,” Suzanne said. “You know, someone they can look up to. It would have been a mess here otherwise. Thanks.”

  I wasn’t sure if she was thanking me for being black, for being calm, or for both. In the short time I’d worked in the psych ED, two-thirds of the patients who came through had been black. On the inpatient psychiatric unit, about half of the patients were black. During medical school and my internship year, I’d certainly had black patients respond favorably to me, but no scenario had ever been quite this dramatic.