2019 marked twenty years that Dr. Denise Johnson had now been practicing. In her mind, the years she’d walked the halls of Princeton, labored at Harvard Medical School, and completed her years of residency all seemed so long ago, that she could barely recall them. Instead, her everyday routine for the last twenty years consumed her. Awake at five-thirty. Shower. Eat breakfast. Arrive to the hospital by seven-thirty. Change into her scrubs. Greet the nurses at the nurse station. Check her clipboard that contained her appointments for the day. Nothing new.
However, what seemed to still shock others (including her colleagues) was the large number of patient transfers that she received each year. Seeing “Transfer” at the top of her clipboard, no longer surprised her. In fact, she glanced past the names of the patients and instead, focused on the answer listed for “race/ethnicity.” As usually was the case, her transfer patients were predominantly African American mothers. She knew that the reason why she looked at this piece of information, differed from the reasoning her white colleagues used when they viewed it. Some would argue that it was wrong for her to view this information first. To use it to make a judgment. But she knew the data. She understood the stats. She knew that regarding this information a certain way could save this mother’s life…and therefore, even the life of her child. So, when each transfer patient walked into the room, she was ready. Ready to listen. She already knew what to expect.
And yet, the expressions on each mother’s faces revealed that she did not. Dr. Johnson could see the dejection on each mother’s face, already debating on whether or not to bring up her list of concerns this time. What would make this doctor listen? After all, this was her first child. She didn’t know what to expect. Of course, the doctor must know better. She just needed to rest more. But, why was her pain still here? And the swelling? Some days, she could barely move. Her blood pressure was constantly up and down. But, at each visit to the ER, they condescendingly looked down at her over their clipboards. Was she eating unhealthy? Maybe try eating healthier, drinking water, and resting. And follow up with your primary doctor/ OBGYN, they said in an exasperated, irritated voice.
And so she did…again. Her white doctor, who spent ten quick minutes running off a list of questions, barely noting her responses before moving on to the next one. And she left…with all of the same concerns. So what to do? When your insurance only covered certain providers? Providers who didn’t listen. Who made you feel uneducated and wrong for asking questions? A few looked for one last hope, which is how they ended up in her office. Not really expecting much different. But then, they took in her hair. Her skin tone. Similar to theirs. And the relief appeared. They related all of their previous concerns, previous trips to the hospitals, etc. She listened as they spilled out every complication, every concern, and she took every precaution. She ordered tests. She analyzed the risks. And she knew what to look out for. She imagined that this patient was at least one new mother saved. At least, one other family intact.
Writer’s Notes: The issue that I’ve chosen to focus on is the disparity that exists for African American mothers who die at greater rates due to complications for childbirth in comparison to their white counterparts. I found a few articles giving a brief history of the issue, but one that I found most interesting was “America is Failing Its Black Mothers” published by Harvard Public Health. One of the social determinants that is influencing the disparity found is African American mothers’ concerns about their pregnancies and complications experienced afterwards not being taken as seriously as white mothers. Their symptoms and concerns are disregarded. Although this article explores many different elements of the issue, the voice of African American doctors and their experiences with patients seems to be missing. Therefore, I chose to write from the perspective of an African American OBGYN. Specifically, I wanted to give a brief history of her experience over twenty years since the maternal mortality rate has been increasing for the United States since at least the 1990s. I wanted to highlight that not much has changed in regards to listening to black mothers over the decades. I tried to implement this by mirroring it with her simple routine. I imagined that African American doctors are more attuned to certain needs of their African American patients. Where does the obligation come in then? How does race begin to influence their judgments? How should that influence future changes in the health system/ training? I struggled with finding a tone that I was satisfied with.