June 30, 2011

Saturday Palpitations

Heart impulses represented in the cardiac cycle.

It was early Saturday morning, I was making my plans for the day, crossing-off a few items that seemed unreasonable with others that had been accomplished. As I moved toward the kitchen, a voice from the living room bellowed “the coffee is ready”  turning my head I could see bright rays of sunshine making a visible path through the open front door.  My morning greeting followed with “did you have breakfast?” she answered, “yes” so I grabbed a cup of yogurt, found a banana in the fruit basket and sat down with cinnamon coffee in my favorite cup. 
She came to the table, pulled up a chair up close and said with half-hearted laughter, “I keep having these fluttering feelings” and I asked,  “what have you been up to this morning?” She said, “well, I ate cereal for breakfast, took my medication then I rode my bike to the bank.  Now I’m getting ready to go grocery shopping, choir rehearsal and then to get my hair done, but I keep feeling these flutters.”  Her schedule made me uncomfortable, she had other unmentioned responsibilities like caring for my grandmother and cooking dinner but I wasn’t ready to stir up an argument. My response, “well, it’s been a busy morning so why don’t you go back to the sofa and rest for awhile”  from the other room we talked about a co-worker who’d died suddenly a few days ago. She took pause to admit her feelings of anguish.
My summertime stay made for an opportunity to talk about anxiety, stress and triggers. Learning to listen attentively and offering the power of presence to her narrative, I began to see her rage with the world of injustice, her strength to overcome, but more clearly, a shield entrapping her emotions as described in Paul Lawrence Dunbar’s poem “We Wear The Mask.”
“What Shapes Health?” a series of webinars held by Robert Wood Johnson Foundation with leading national experts presenting their research on the relationship between stress and health.  My talks with mom don’t afford the opportunity for statistics and analysis, but the current evidence does compel my passion to carry on with our dialogue.  She’s interested the simple facts. In response to the New York City Health Department’s no trans-fat public awareness campaign, her question “What’s the big deal?”  As I grinned through a a medical student biochemistry lesson on lipid metabolism she became irritated and puzzled. I made more progress when I went told story about french fries and  the hidden calories in partially-hydrogenated oils leading to weight gain, rising cholesterol levels, which may increase the risk of heart disease.  She got it, began reading food labels more carefully and switched out the oils in the pantry with healthier choices. Yet, our conversation about the relationship between stress and health continues to be challenging as her perceptions are not mine. I'm asking the upstream policy questions about the conditions in our lives that can help alleviate stress and make for healthier living. Mom's web of healthy choices are obvious from the breakfast table to the bike path, but there's also chronic stress embedded in tough daily decisions and the quest for life balance.
By late Saturday evening, I was sitting in front of the computer with the banter of young people outside my front bedroom window and a hint of barbeque in the air keeping me alert enough to move through the night’s reading.  I heard rushing foots steps coming down the stairs, she knocked on my door.  In a shaky voice she said “What did you tell me to do about these palpitations?”  My alarm-filled response, “have these continued from early this morning?” She nodded, exclaiming “I’m too uncomfortable to lie down or sleep like this.”  My response, “you have to go the hospital” reaching for the phone I dialed 911. She lamented that she didn’t think her situation was that serious. I did. She urged me to take her blood pressure.  I did not.
The prevalence of heart disease among black women is twice as high as for others.
The ambulance came in less than ten minutes. Her pulse was rapid, blood pressure was abnormally high and the portable heart monitor gave a picture of irregularities. She was rushed to the hospital while I stayed behind with my grandmother who was now awake, upset by the ordeal and demanding answers by asking the same few questions repeatedly. “Why did they have to take your mother to the hospital?  What’s wrong with her heart? How did that happen? She’s too young to have heart trouble? They took your mother to the hospital? For what?”  It was a long night. 
After an hour in the emergency room, mom was admitted to the hospital.  Her pulse, blood pressure and rhythms returned to normal with medication.  Further test results, proved puzzling to the doctors, but she was released from the hospital after a few days with instructions to follow up with her primary care physician and with a referral to see a cardiologist.
That summer, I also finished my first reading of our cardiovascular physiology packet with a more profound interest in the advances of science and medicine as well as the research related to health disparities.

Cross-posted at www.KevinMD.com

June 23, 2011

Matters of the heart

My sketch of the human heart during first year anatomy.
She whispered to me with bulging eyes of urgency, “something is not right, I’ve been in pain all night.” Her chief complaint was chest pain.  She had a routine work-up and some care with little relief.  The news came that all of her test results were normal.  Her body appeared tense, she looked panicked and afraid.  At bedside, the attending suggested endoscopy offering that her pain may be related to a gastrointestinal condition.  I introduced myself immediately as a medical student and quickly advocated for a cardiologist consultation. I mentioned that a few months prior she had been rushed to this hospital by ambulance with what had been determined as idiopathic ventricular fibrillation. The attending shook his head, he started moving toward the nurse’s station and I followed behind.  He reviewed her case with me again and then he shouted, “endoscopy” then I said “cardiology consult.” I left quickly without waiting for a response because I was trembling with fear.
As I sat outside trying to figure what my next steps would be, my phone rang and it was the nurse, she said that the attending had agreed to the cardiology consult. I returned to our house to care for my grandmother, in the absence of my mom she had no caregiver.  In the afternoon the cardiologist called me to express his concern with mom’s condition. He recommended, pending insurance approval that she be transferred to another hospital (the one that I had told her to go in the first place) for more tests and further observation.  This hospital did not have a full cardiology service and would be closing for good within next 72 hours.
Mom was transferred that night, additional test results showed significantly block coronary arteries. Early the next morning she had cardiac catheterization to open her blocked blood vessels. After a short hospital stay in she returned home. 
For a medical student learning to observe in clinical settings is a skill that comes with practice, time as well as teaching.  Furthermore, bearing witness involves seeing the whole patient taking aim at focus beyond the chart to examine the situation. The recently released book by Dr. Augustus White, Seeing Patients: Unconscious Bias in Health Care (Harvard University Press, 2011) offers the following:
“...the race and sex of patients [influences] physicians’ decisions about whether to refer patients for catheterization...If you were black, the report (Schulman et.al) concluded, you were less likely to be referred.  If you were a woman, you were also less likely to be referred.  And if you were a black woman, you were especially less likely to be referred.”
While some have criticized Dr. Schulman’s research as “exaggerating the disparities” inequalities in treatment and care are demonstrated in his efforts providing evidence for the need to improve health care as discussed in the report  Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare by Brian Smedley et. al.  As an African American woman who is a physician-in-training, I’m glad to witness good medicine as well as mom’s progress.

Cross-posted  at KevinMD.com

June 18, 2011

A beautiful story for all of us

I could not believe my eyes when a recent online Psychology Today blog post made claims about beauty and Black women.  As I moved through the article, the charts and read on, skewed “data” to malign in the name of science and research was clear.  I could not bear the sight of this without reaching out to a few friends and colleagues.  We agreed that this was egregious and something had to me done.  A few hours after the actual blog post there was so much internet traffic the article web page was shut down due to technical difficulties, then it was removed completely. Outrage and responses continued on other blogs, FB and Twitter. 

The story grew beyond the article into a pursuit of justice as young black women scholars organized with thecolorofchange.org petition to challenge the racist and sexist assertions regarding Black women. Over 100,000 people responded from across around the globe. The result: Professor Satoshi Kanazawa of The London School of Economics is no longer a contributing blogger for Psychology Today! Furthermore, the publication is revising their editorial process for reviewing blog posts.  The Color of Change group also urges editors "to take more proactive and transparent steps in exploring the role of racism and sexism in scientific research and analysis."  

Dr. Thema Bryant, psychologist, professor and President of the Society for the Psychology of Women states, “the media and television in particular has the ability to promote stereotypes or shatter them.  Negative stereotypes are often used to justify discrimination.  Stereotypes of African American women are rooted in the intersection of racial and gender oppression." 

Notes to consider
  • The leadership of a few can galvanize the support of many others who see injustice
  • Web 2.0 and social media empower “the people formerly known as the audience” to read and respond 
  • Moves against wrong can be swift because of the work already done and the progress made, this effort has been just a few weeks in the making
  • Research and data offer powerful tools for storytelling
Together, we can make a difference.

"Our lives begin to end the day we become silent about things that matter."   Martin Luther King, Jr.