You’re a stickler for acting on the basis of scientific evidence. Where does that come from?
I grew up in the inner city of Detroit with people who were not formally educated but who were wise. My father was also very inquisitive. I was influenced heavily by this and by the Jesuits in my high school, who taught me about the scientific process. They taught me there are three things: things that are known, things that are not known, and things that are believed. Very frequently doctors think of things they believe as things that are known. When you talk about cancer screening, many doctors of my generation and older never took a course that covered screening and don’t understand the basic principles.You write some harsh things about doctors in private practice, including some here in Atlanta. Will you ever be able to eat lunch in this town again?
] There are a group of doctors, certainly not all doctors, who have lost the meaning of the word "profession." Everything is about business, and it’s not about putting the welfare of patients first. And some of these guys, due to laziness or a focus on money, have failed to evolve. So they practice the best medicine of thirty years ago, which was when they graduated from medical school. Some of the docs who read the book may very well say, “Is he talking about me?”
She walks through the emergency-room doors sometime in the early morning. In a plastic bag, she carries an object wrapped in a moist towel.
She is not bleeding. She is not in shock. Her vital signs are okay. There is no reason to think that she will collapse on the spot. Since she is not truly an emergency patient, she is triaged to the back of the line, and other folks, those in immediate distress, get in for treatment ahead of her. She waits on a gurney in a cavernous green hallway.
The “chief complaint” on her chart at Grady Memorial Hospital, in Downtown Atlanta, might have set off a wave of nausea in a hospital at a white suburb or almost any place in the civilized world. It reads, “My breast has fallen off. Can you reattach it?”
She waits for at least four hours—likely, five or six. The triage nurse doesn’t seek to determine the whereabouts of the breast.
Obviously, the breast is in the bag.
I am making rounds on the tenth floor when I get a page from Tammie Quest in the Emergency Department.
At Grady, we take care of patients who can’t pay, patients no one wants. They come to us with their bleeding wounds, their run-amok diabetes, their end-stage tumors, their drama. You deal with this wreckage for a while and you develop a coping mechanism. You detach. That’s why many doctors, nurses, and social workers here can come off as if they have departed for a less turbulent planet.
Tammie is not like that. She emotes, and I like having her as the queen of ER—an experienced black woman who gives a shit. When Dr. Quest pages me, I know it isn’t because she needs a social interaction. It has to be something serious.