Sunday, December 09, 2007
I was recently informed by an ER patient that I need to take sensitivity training.
The patient was educated, articulate, dignified, and clearly suffering from a mental illness. The mental illness wasn't the presenting complaint, though; a small physical injury was. When I stopped by, as part of my routine rounds, and identified myself as the chaplain, the patient requested prayer, but didn't give me the chance to offer it. Instead, I became the audience for a long, winding, alternately convincing and bizarre narrative about family history, the injustices this person had suffered at the hands of police and paramedics, and the events leading to the ER visit.
The patient wasn't white. This is important.
I sat and listened; that was clearly my job in this situation. When the medical staff entered the room, I left. When I went back in, the patient was ranting to a nurse about how the doctor had been racist. The doctor had called the patient by first name; the patient found this disrespectful.
Trying to help, I said, "That's how we do it here; he'd call any patient by first name. I'm sure he didn't mean to offend you." But the patient was on a roll. The doctor was racist; police were racist; paramedics were racist; the nurses were racist.
The nurse gave me an imploring look and said, "I'll go find the doctor." I followed her out of the room and asked if she wanted me to talk to the doctor too; she said, "No, that's okay. He just has to go back in there and make nice."
I went back into the room. The patient was talking to someone on a cellphone. I left, and wound up in the middle of a cluster of nurses who were muttering about the patient.
"You know, that makes me angry, being called racist."
"It's a symptom of mental illness," I said. "Has to be. Something's wrong there."
Everyone agreed, but the staff was still angry about the accusations. This was all complicated by the fact that the patient had been discharged, but showed no signs of leaving. The doctor had evidently suggested a security escort, which wasn't going to make the patient feel better about anything.
I went back into the room. The patient, off the phone now, had spread a bewildering collection of personal items out on the countertop and was arranging them haphazardly into small piles. Things kept falling onto the floor. "I need to get all of this organized so I can go get my money." I offered to help pick up the things on the floor, but the patient said, "Oh, no, my lawyer's going to fly in and lift all the fingerprints from that. We can't touch it."
"How about if we wear gloves?" I asked, but the patient -- while moving things back and forth on the counter -- said that we had to leave everything where it was. The nurse came back and started explaining discharge instructions.
"You're standing up! You're talking down to me!" the patient said. "You're racist!"
I'd been standing the whole time. "I've been standing; I'm sorry if that bothered you -- "
Whereupon the patient whirled to face me and said, very calmly, "What you need is, what do you call it? Sensitivity training. That's it. You don't know what it's like to be black."
"That's true," I said, "I don't," whereupon the patient treated me to a long lecture about racism.
The nurse left. The patient calmed down. Through the open door, I could see three security guards (two of them white), and my heart sank. But the patient had evidently forgotten about lawyers and fingerprints, and gave me permission to pick up the things on the floor. "Oh, it's fine if you do that. I don't have a problem with you. Have you seen my driver's license? I think the ambulance people stole it."
I was trying to lift a very large plastic bag of personal belongings. Was this well-dressed, well-groomed person homeless? "I can't pick this up," I said.
"Neither can I. I can't lift anything."
So a helpful, smiling security guard stepped in to give us a hand. Perfect! Exit patient, with a helpful, smiling security escort. An audible sigh of relief went up from the nursing station, and the nurses started teasing me. "Hey, Susan, so you need sensitivity training, huh? Yeah, of course you do, because you're so insensitive."
"Well, I've had that training through church, but I guess it didn't take."
"Yeah, you must've flunked."
"Hey!" a tech called. "I found the driver's license! It was on the floor!"
"I'll take it out there," I said.
"No," said the tech, "I'll do it," and did. But a few minutes later he came back, fuming. "So I hand over the driver's license, and then I say, 'You can't smoke in here because it's a hospital,' and what response do I get? 'You're racist!' So I say, 'It has nothing to do with race! You couldn't smoke in here if you were purple or yellow or green!'"
"It's a symptom of mental illness," I said again, weakly.
"Yeah, I know, but it still makes me angry. One of the admitting clerks came up to me when I was out there and said, 'You know, I've been called everything, but being called racist really made me angry!' And I said, 'I know! Me too!'"
Later, I talked to a nurse, who observed ruefully, "When people say things like that, nobody's as nice to them, and then of course they think it's because of racial issues."
"It's a self-fulfilling prophecy," I said.
Meanwhile, I was frustrated by our complete inability to address the psychiatric issues. This patient lives out of the area and hadn't come in because of psych issues, which made them off-limits. And it would only have made things worse to tell the patient, "No, we aren't racist; you're mentally ill."
I'm sure the patient's encountered genuine racism in the past, and now sees it everywhere. Something -- personal history, the psych issues, a combination -- has left that patient oversensitized to the possibility of prejudice. The medical staff, meanwhile, were reacting far more defensively than they usually do to insults, insisting to me and to each other that they aren't racist. The patient's obsession had sparked some collective psychodrama, some group wrestling with anger and guilt, in the nurses and techs.
And I was in the middle, having very little luck communicating with either side. The patient's accusations didn't worry me, because I really did see them as symptoms; but precisely because I viewed them that way, I had trouble empathizing with the reactions of the medical providers, who were taking this symptom far more personally than they take most others.
Which means, I guess, that I really do need sensitivity training.