“Ms. Bailey,” I look up to see the patient’s mother look at me with a subtle smile while the hiss of her words lingers in the air and buzz into my brain without fanfare.  This is the shellacking of the layers of submission and derision that I have become so used to in the name of grand old Southern tradition.  Like the hot air that permeates my skin, it radiates on me, seemingly taking notice of my presence and casting me aside at the same time.

I decided almost a decade ago to make this place my home, largely because of the close-knit feel that I felt almost immediately upon coming here. A “faux familiarity” that I believed substituted the brusque and dismissive tones of the North.  I remember my first encounter was at a Publix as I stood looking admiringly at the morning sun.  An elderly woman smiled and said “good morning” in a way that stated more fact than whimsy.  I was easily swept up in the aura of the natural landscape, pillowed trees draped with lacy curtained vines, sun that declared itself present and did not have to beg to be noticed with the constant sear of it on the skin, blue skies so vast and deep in their color that one had to plant their feet firmly on the ground or else they may be sucked into its eternity, this was a place to behold.

So, I packed up my things and made the long and winding trek. Starting by train, I marveled how the landscapes changed from a dense populist contraction to a slow and easy separated one.  I marveled at the space of the trees, how the grass seemed to rise up to meet the horizon and the people seemed to get to know each-other a little better.   I had envisioned myself, along with my family as becoming part of this. I had answered a call larger than myself to do the work of healing and inspiring children.  I imagined that my role would be intertwined with the larger fate of some of the community that I would in time be part of.  But, these thoughts I came to quickly realize were imaginings.

I have been in private practice for over five years now and still marvel at the beauty of the day-to-day routine.  I imagine it as inviting dear friends to a party day after day where I am able to listen to them, inspire them, hopefully add an air of delight to their days and offer an example to live by.  These are no simple tasks.  I purchase toys to line our treasure chests and stickers and decorations to capture the frivolity of life.  This is all in part to provide spiritual nourishment to my patients, young and old. I desire for them to step in our office every day whether sick or well, feeling the rich of the calm and celebration of life envelope them in this dance.

Regardless of what I am feeling that day, I do my best to enter a room with an air of playfulness, kindness, and humility.  I believe some may be in awe, while others in complete annoyance with my countenance, they may perceive my face to have a bubbly “clown sprinkler” smile that seemingly portrays an innocent emptiness or maybe they assume that life for me is easy.  Sometimes, I encounter the patient who does their best to pick at me, demean me, and challenge the medical plan laid out before them.  Now, I take no offense to my patients and their families questioning the plan— it is the other thing that I take some issue with. 

Though I had been running businesses for over 26 years, I am always astounded at how some of my patients assume otherwise.  I am one of the few Black women who owns her practice outright (most work for larger companies and conglomerates) yet, the patients who offer advice start out generally like “ I know that your new to business, but _” or they may doubt my Ivy League education,  however, I am most commonly undermined with the “Miss Bailey” or even “Aisha” instead of “Doctor”.

But, we have seen the statistics, even in my current home state, the most recent studies have shown that Black newborns are 50% less likely to die if they have a black doctor[1].In recent new cycles, we have seen the topics and the effects of health equity and health disparities shape the outcomes of African Americans and their plight. Other studies have shown that when Black doctors treat Black patients, the patients have better health outcomes and lower mortality in their community[2].   And yet, the cycle of bias continues in medicine, and in my community to perpetuate these same results.

We were recently named the second best pediatric office in my city. This was an especially greater honor given that I am currently practicing alone and have worked diligently to help and care for my patients, yet I am astounded again when some of my patients “get good insurance” and decide that they need to go to a “better office.” The outright assumption even in their minds are that my office is in some way inferior based on the color of my skin, since it is certainly not in the content of my character.

My staff and I are all of color at this time.  We make a concerted effort to treat all of our patients with respect, regardless of insurance type in an age where health celebrity status can reign supreme based on reimbursement rates.  We welcome all families, all family types, religions, creeds, and nationalities to our office and focus on the healing of the work. 

There is nothing as fulfilling and as powerful than to sit with my patients and talk to them.  As I listen to their hearts and lungs, I cannot help but feel a force working through me to inspire and uplift.  Rather than talk a lot, I like to listen for the thing that needs remedy during the day.  I deal with food insecurity, medical misinformation, physical and sexual abuse, depression and anxiety that may be intertwined into the everyday pediatric conditions that I regularly see.  But, it is by listening patiently that I can hear the pattern, see the bigger picture of what a patient is telling me and wait for the implementation of change to begin. 

There is no question that this is a gift and a power that is much bigger than me.  It is beyond humbling to have such a connection with people and then have them tell you in their appreciation how surprised they are by the care that they received based on what I look like, as though having an African American physician would be to their detriment though the statistics and the data tell a much different story from their own limited perceptions.

  The patients who venture off to doctors who don’t look like me to “check my work” often recount tales of medical bias, unbeknownst to them, with these doctors who do not follow evidence-based medicine, a specific recipe for medical interactions that has been scientifically proven over time.  Yet, these people will repeat the other doctor’s findings with conviction and…pride.  As though they are standing on top of a solidly built brick wall and feel as though they can climb to the stars with the information given them.

  I am stupefied by the realization that they are in fact standing on hodgepodge medical knowledge that may not be solid in some way, like a loosely boarded up sinkhole. I also realize that getting this patient to realize this will take a feat greater than climbing Mt. Kilimanjaro, and I ofttimes try to do so, but there is one thing that my patients hold tight in their heads, the recollections of Ages past and the importance given to those who use the color of their skin as all the education and experience that they need.  How do you shout across dimensions to their reasoning?  How can you effectively permeate their consciousness otherwise when the ticker tape parade of bias strolls the pathways of their mind?  I generally take a seat afterwards and sigh with the weight of the task.

Evidence Based care is exactly what it is at this time.  This means that I have listened to my patient’s history (what brings them into the the office, how long they have had the issue), their symptoms, and created a differential diagnosis- a list of issues that could be wrong with my patient.  Then taking the most recent medical knowledge that has been proven via thousands of hours of research and patients for its effectiveness, I come up with a treatment plan that I know to be most effective.

   I am flabbergasted by those who smile with pride and recount the older doctor who gave them Mountain Dew to treat their asthma or told them to put bleach on their skin to treat rashes and skin conditions.  I realize that those patients look at me as though I am the problem, not adhering to some twisted tradition of ignorance laced with racial bias that runs counter to the medical “culture” and the time-honored roles of the Haves and Have Nots.

This is not to say that there aren’t beautiful traditions here. There are many rituals and practices that are laced with beauty and exquisite in their own right. However, there are many of those same practices that are based in subjugation and humiliation that continue to permeate, alienate, and dehumanize people on a constant basis.  As an outsider, I appreciate what I see.  I have found through time that one of my singular roles is to distinguish what can potentially be harmful to my patient population after viewing the effects over time.

 

I am generally exhausted when leaving my office at the end of the day, having expended almost every ounce of grace, enlightenment, and inspiration that I can muster.  Many times, when attending meetings in other respects, I still wear my scrubs laden with the “magic of a concocted medicine of the spirit” though my dress code often clashes with my counterparts at the same time.

Even in these small social circles, I am routinely “forgotten” with people who I have known for years mispronouncing my name or making it a point to start with my title and switch mid way through to the “Miss”.  In those situations, I have become used to this.  I have begun to understand that I am a single Black woman business owner in the South.  There are deeper caste systems that structure this current place and though I may break ground in other ways, this is an elegant crown-molded box for me to be dropped into.

I remember the first time that I tried for connection.  I would speak with other women my age or older, we would exchange polite conversation about our professions, trade stories, and even hug in these settings.  However, each time that I saw them again and again, I realized that I was living my own Groundhog’s Day.  Furthermore, the things that the women would say would move me to silence.  I had offers for me to come to people’s houses and sit on their couch as I would a therapist, offers of life-coaching, offers of babysitting.  There was never any mention or reflection of my accolades, only my supposed needs.

Though the wall of connection seemed lined with metal spikes, I realized that I was seen as a chimeric adolescent girl and invalid and always expected to throw myself upon the mercy of the married woman for acceptance and validation.   In social settings, I am often objectified by men who compliment me and then make offers to me, regardless of whether I am wearing my scrubs or not.  The key assumption is that I am unmarried and requiring a man in both respects- either as husband or Sugar Daddy.

But, this is not necessarily the case.  And as I grow older, I am beginning to realize the power that I wield.  It is not a simple task to do what I do every day and put myself last in a majority of instances.  To sit with the light and heal.  To create a safe space for the soul to align and bring the body into a whole, synergistic unit.  Most days, I simply reassure myself of this, though the overriding community still calls me by my first name with an appalling familiarity that is glaringly contradicted by the lack of our social interaction.  So, I humor myself to say that in order to know me, they have to know my true work and (in doing so) my worth.  I shall continue to endeavor that this will one day be the case for all.

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References:

[1] Greenwood, et al. Physician-patient racial concordance and disparities in birthing mortality for newborns, Economic Sciences, August 17, 2020.

[2] Snyder, et al. Black Representation in the Primary Care Physician Workforce and Its Association with Population Life Expectancy and Mortality Rates in the US, JAMA Network Open, April 14, 2023.