There I was lying on my bathroom floor: semi-conscious, teeth-chattering; relieved my fever-sweat was plastering my back to the cold tile. I was weak, trying my best to will my body to the warmth of an elusive ray of light bouncing off the floor, playing hide-and-seek behind a transient cloud. Whenever the light flickered across my face, it seared straight through my squinted eyelids and settled on top of the eyes of a mind-splintering headache. For a brief moment, I regretted the chase (OK, that’s enough, move on light), then instantly regretted the regret (no, no, come back), my cold body at war with my hot head which felt as if it was about to explode. It was a futile fight, all of us losing. I remember thinking what a beautiful day. Sun splashed across the blue, poking its fingers through a billowy cloud toward me. The day was perfect; an exhilaration of spring, a new birth.
I am dying, I thought. In less than twelve hours, I had consumed twenty-four bottles of water, desperately trying to hydrate with no voiding for my efforts. I lay on the floor motionless, heavy with water; my fever-induced delirium levitating me in and out of a cartoonish liminality: from eavesdropping on two frenetic swallows bird-gossiping outside of my window to worrying about my tomorrow.
That was Day Three.
The day before, when my fever-headache-nausea did not abate with meds, I summoned enough strength to leave several messages of vivid description for my doctor, not aware at the time that she was away, and that her patient load was covered by a colleague. My messages were not returned.
Day Four.
One-sided phone tag yielded an end-of-day response instructing me to stay hydrated. “It’s just the flu,” the nurse said, he said, “no need to come in.” My fever spoke different.
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Day Five.
Another excruciating twenty-four hours. I was depreciating fast. I left a final message to inform my doctor, hoping she had returned (she had not), that I was headed to emergency. Ten quick minutes later, a return call from the nurse. She was talking fast, apologetically translating for him. I heard him in the background, triggered (the noise decay hollow against the tiles). On the floor, I imagined him gesticulating wildly to the angry cadence of his words, the swallows outside joining in, circling his head. He was a verbal sniper: questioning my symptoms, mocking my descriptives as clinical incoherence, declaring my disobedience to his instruction as hyperbole. Distorted, careless words reached their target.
Later, as I waded through the waiting room of a crowded ED, I told the triage nurse in a moment of inappropriate levity that I was dead and needed resuscitating. My feeble joke did not land as I had hoped. “Uh-huh,” he said before cuffing my arm. He paused at the reading, tried again, paused. Then he looked at me (really looked at me ashen and dry), then panicked. I nodded, told you. He rushed back. I heard him yell, “I can’t get a read on her.” Before I floated away, I was thankful for the cool drip coursing through my vein. Finally.
I awakened to several hovering over me in intervals, calm and nervous: attending physicians, nurses, an infectious disease specialist (wait, infectious disease?), all speaking in rushed, urgent tones. I was on fire with a fever of 103. It was beyond the flu. I was septic. I was in the hospital for three weeks.
For some of us, recurrent experiences of inherent biases-racism and medical gaslighting that support the dehumanization of Black women in a clinical setting are as pervasive as they are normalized, predictable even. More than 20 percent of Black women report experiencing mistreatment and care disparities from a health care provider due to race. In my experience, these repetitive microaggressions intensify a state of constant anticipation of the next indignity. I am not alone. Over 60 percent of Black women surveyed prepare for potential negative words when addressing health concerns in a health care setting.
As a Black woman with unique intersectionality, there is an exhausting familiarity with the chronic repetition of clinical racism and microaggressions: the judgment, the feeling of being viewed through a lens distorted by stereotype. For some reason, questions and self-advocacy offend. I have had staff ignore my clinical presentation, redirecting focus to how I express myself in sentence structure and diction: “You are so articulate. Did you go to school?”; derisive language: “Just what medical school did you go to? Someone should stay off the internet”; and, registered surprise and disbelief: “Why do you live in New England?”
This emotional devaluation forces me to tread lightly through a minefield of implicit biases, constantly editing myself so as not to offend, as I am often offended by the inaccuracy of a skewed perspective. It is an awkward dance with an indifferent partner. A dance without grace. In my case, the doctor replaced my desperate need for help with a comfortable narrative of what he assumed I should be. The reflection through his distorted lens.
Our stories are many, and they echo my own. Clinical inertia from implicit bias is a barrier to equitable medical decision-making and treatment for Black women. Negative interactions between Black women and dismissive medical staff who fail to listen, challenge credibility or rely on their own intransigent racial perspective as the prevailing narrative have a profound effect on our health, especially in the absence of care. It shapes critical thinking and effective decision-making. It erodes trust and distills the unspoken: the thoughts before the words before the actions. It harms us. From my experience, the sustained practice of patient self-advocacy challenges implicit bias, thereby weakening clinical inertia, all to ensure we receive the care we deserve. Speaking up and often.
Genené D. Prince-Walker is a patient advocate.
