“Where do we go from here?” an assuasive classmate once asked me.
I didn’t answer because I was clueless as to the intent behind the question.
Dabbling in mind games with his peers gave him the sort of release he sought after a stressful, hectic day of an offsite clinical engagement.
This classmate relished the idea of throwing mischievous questions about just for the fun of it.
Except that he wasn’t!
Rather, he used his unrestrained fondness for one-upmanship to raise probing questions about characterological oddities in the turbulent vastness of the human experience. In point of fact, he and I usually used our post-clinical leisure hours to share anecdotes, experiences and stories about atypical happenings during our separate clinical rotations, mostly offsite clinical rotations. Some of these happenings came across as encouraging and even worthy of our time, others not so encouraging.
These varicolored happenings boiled down to the operational architectonic jungle of human nature. The tricky vicissitudes of human nature in all of its panoply of shady varicolored characters.
Human nature is variously complex and the idea that it appears in many confusing colors itself may not be surprising to the spiritually dead and the emotionally extinct, but the fact of the ontological scutoids of these dangerously contrasting colors of human nature manifesting themselves in an omniform of social, political and moral instantons that rather complicates or destroys human interactions and social institutions, than brings about a tactical humanism of differences in the seed oyster of an ecumenical revolution, is compelling in the abject rawness of the existential character of human nature.
These ontological scutoids are all to be found in the endarkened labyrinth of the cultural mind―in the cultural hearts of Howard Griffin’s Black Like Me, Harriet Beecher Stowe’s Uncle Tom’s Cabin, Richard Rothstein’s The Color of Law: A Forgotten History of How Our Government Segregated America, Molefi Kete Asante’s Lynching Barack Obama: How Whites Tried to String Up the President, Nelson Mandela’s Long Walk to Freedom and Conservations with Myself, and Toni Morrison’s The Origin of Others.
But the monogenesis of the human race!
“A river system I call human nature, a confluence of conflictual patterns embedded in the labyrinthine seafloor of the cultural mind,” said I, my deeply troubled soul.
“A confluence of antagonistic patterns in the scorched mind of cultural imperialism pollutes the river system,” said I, my deeply troubled spirit.
In this context, polygenesis does not meet the standard logic of the marketplace of scientific and philosophical ideas where human evolution is the only esoteric language of metaphysical communication.
Monogenesis, the protest novel!
Polygenesis, the propaganda novel!
“Nature is not a cartoon dork,” I told myself. “Ex Africa semper aliquid novi!”
There I go again!
I wonder, I always wonder, at which stage in the developmental psychology of a river system does cultural imperialism set in the tributary mind of a creature before it reaches its anthesis destination?
At what point does the flesh-eating canker of cultural imperialism invade and empoison a growing mind?
Perhaps the answers are housed in the escrow heads of Kenneth Clark’s and Mamie Clark’s experimental dolls.
The screaming ghosts and doppelgangers of these experimental dolls lingered everywhere.
What do you do in a hypothetical situation where a patient tells you, a nursing student, to the face that you are too black and that your blackness is embarrassing, where an elderly African-American patient genuinely expresses her deep fears of being hurt―for whatever reasons―in a nosocomial environment with a predominantly white healthcare staff, and where a preceptor insensitively and condescendingly dismisses the latter scenario complaint as a medication-induced anxiety disorder without making any serious effort to get to the root cause of this problematically self-serving, highly conjectural diagnosis?
An attempt to explain away an important situation that offers an opportunity for students and preceptors alike to learn from as part of a pressing need to asseverate their analytic and situational awareness, grasp and understanding of hypothetical, actual dramatization and conceptualization of clinical case studies, an opportunity that eventually goes down the drain anyway, can be emotionally painful, to say the least. Let's look at the following likely hypothetical scenarios:
“Look at him!” said a child patient. Four of us were with him in the room. I was the only other him in the entire room. The nurse and the patient’s sister turned to look at me with emotional depth, their self-conscious eyes striking me with piercing arrows of frightening suspicion. “Look at him!” he repeated with absolute confidence. “It’s so embarrassing!”
The room fell into a dead sleep.
What was the child patient talking about? Something was definitely amiss. I examined myself thoroughly, I mean, closely, in the mirror of my proactive self-image but failed to discover or sight any untoward airs about me. The once-intact river system was beginning to show signs of salient fracture in the sociology of race―of race relations. The false architecture of polygenesis was beginning to rear its ugly head in the sociology of race, fighting off the legitimacy of monogenesis. That was when the confluence of conflictual patterns usurped the fractural salience, forcing its insidious presence into the varicolored cracks of the spongy mind of cultural imperialism.
Suddenly the integrity of the structural engineering of professional relationships, the sociology of knowledge, was being tested.
The neutral face and body habitus of the nurse I’d both been shadowing and understudying that day showed symptoms of discomfort and situational confusion. Regardless, the nurse continued to conduct a physical examination on the child patient and to gather data for the patient’s health history―two useful clinical processes making up the patient’s health assessment. The professional conduct of the nurse generally, and the spectacular ease with which she went about her clinical assignments, particularly the way she conducted her clinical assignments by way of her empathic communication with the patient, were a familiar sight to behold. They pointed directly to an exciting anamnesis of clinical ritualism―at least of a deeply personalized nature―I’d witnessed on many a clinical rotation.
Anamnesis and physical examination had become second nature to me.
“He’s too black!” the child patient said to me with his angry, erect right index finger directly pointed at me. I froze. The nurse froze too. Since when did blackness become an embarrassment? Of course I stood out as the only black person in the room. I remained composed in the face of the embarrassing comment. Far from it, not that I was embarrassed being black, for, at least, I was black after all. I was more than conscious of my biological blackness and didn’t think a stark reminder of it in that questionable nosocomial context was appropriate. I did worry more about the probable scandalous intent of the comment―nevertheless.
Then, as if in a drunken trance, I recalled why he’d abruptly pulled his fingers from the cup of my hand as I tried to assess his capillary refill, following the nurse’s instructional example. Everything fell into place now. I couldn’t account for or take his capillary refill for this reason.
Sure, I was now Richard Wright’s Black Boy and Native Son, no longer one of Margot Lee Shetterly’s Hidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space Race.
Or no longer of Vivien Thomas’ Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock.
I smelled the incorrigible putridity of an impressionable and innocent mind, probably a mind unconsciously poisoned and held in dramatic, exhibitionist stasis by Amos Wilson’s The Falsification of Afrikan Consciousness: Eurocentric History, Psychiatry and the Politics of White Supremacy, in that charged nosocomial ambience.
In the end, I exercised professional judgment and refrained from advancing any pugnacious judgment that would have aggravated the already charged environment and probably called unnecessary attention to the institution under whose aegis I was training to become a professional nurse. I’d to protect myself and my school from any form of censorial attacks while professionally distancing myself from the patient’s insensitive comment. I also didn’t want to jeopardize the chances of other nursing students from my institution of learning―by not putting them in a situation where they couldn’t be able to advance their nursing education during their clinical rotations―to avail themselves of the same opportunities I enjoyed while being posted to the facility.
Add to this the fact that I wasn’t ready to put my nursing education and potential career as a professional nurse on the line.
Thus I refused to say a word in response to the patient’s shocking comment, instead remaining in a state of unruffled stolidity in spite of the obvious provocation. A snake-oil political salesman of our generation, Trump, a Freudian Edward Bernays in charge of the political soap opera and circus of America, was the elephant in the room of that impressionable mind, a child in an adult body. Trump himself, a political Pinocchio of the far-right and the far-right's chauvinistic patriotic organizations, was a shameless child sartorially clothed in an adult body, a spitting but exaggerated image of that child who, unlike the slippery Trump, exuded an air of benignity.
Trump, unlike the child patient, was the face of little emperor syndrome, of prince sickness.
Trump, a political scarecrow allergic to the so-called “empathy pill” as well as a metempsychosic expression of Vance Packard’s The Hidden Persuaders, was a mindless, ticking time-bomb political cartoon waiting in the wings to destroy the photomosaic integrity of his crumbling empire.
Trump, a political riptide, was perhaps the century’s most important spin doctor, the Edward Bernays of American politics, a spin doctor known for feeding his experient electorate pretending to be political neonates on a staple diet made up of Paul Weyrich, the Heritage Foundation, Nixonian Southern Strategy, white supremacy, and non-democratic mundialization ideas―ideologically dangerous pollutants of the river system.
What has my hypothetical preceptor got to say about this hypothetical child patient’s outrageous comment and behavior?
But the river system with its spongy tributary mind had long since been polluted by the flesh-eating canker of cultural imperialism, the false architecture of polygenesis having completely taken over the Golden Stool of monogenesis. Was this a Trumpian-driven symptomatology of racism, ethnocentrism, bigotry, and xenophobia? This was difficult to answer because the conduit of that jaw-dropping, sensational comment was merely an innocent-looking teenaged child, a precocious child nonetheless. There were obviously waves of mind transfer from Trump to an impressionable reservoir, a process that ended up in a quantum psychological murder of a developing soul.
Granted, could I’ve re-phrased the antecedent question in terms of the social, psychological, biological, or chronological age of the patient? That wasn’t necessary. I was immutably black and my blackness assigned my station in life a status of natural validation, of course of the kind not open to question. I wasn’t a chameleon or Michael Jackson, for I was comfortable in the empirical evidence of my biologic existence. I was rather a leopard that couldn’t change its spots.
To top it off, I was a humanist and a human being too, just like the child patient. The question is, if I were like the child patient on the level of the commonality of our human genome, on what basis then could anyone conclude that we were different? The mindless arbitrariness of blackness and whiteness don’t make biologic sense given that the two constructs are different sides of the same coin of our common humanity. The perceived idea of blackness and whiteness as marked differences, an idea mostly conceived through an emotive language of cultural juxtaposition probably makes sense only in another sense, of sociological comfort. That said, blackness and whiteness are nevertheless powerful constructs―both inventions embroiled in an epic battle informed by the culture wars of the last five centuries. These culture wars continue today.
Even though the child patient didn’t want any direct physical contact with me, I was still the same person who moved him around on the floor in a wheelchair in the company of his placid sister. The nurse took advantage of our absence to change his bed sheets. In fact, I’d helped out briefly with the linen change before stepping out with the patient and his sister. While wheeling him around on the floor, I made sure my hands never slipped beyond the push handles to touch any of the compartmentalized dermatomes of his person. I maintained my stoical front. The patient’s sister was so impressed by my sang-froid demeanor and professional approach to her brother’s disparaging comment that she initiated a conversation to defuse the charged atmosphere.
She asked specific questions about my educational background, employment history, how long I’d been in the United States, why I decided to go to nursing school, whether circumstances pushed me into nursing or whether I was passionate about the nursing profession itself. She then told me about her family, about her father particularly, and the kind of job her father did. After I’d told her about my educational background, she still wanted to know if I was interested in a professional job in statistical analysis or econometrics given that my formal education had included courses in optimization, statistics, and econometrics. The conversation was revealing in its edificatory character.
Her father, it turned out, had trained as a formal statistician who used statistics and statistical software to model scientific problems in the form of solutions, optimal solutions geared toward addressing agricultural problems either for the Colorado Department of Agriculture or the U.S. Department of Agriculture. She jotted down her father’s email address on a slip of paper and handed it to me with graceful tactfulness. “Send my father an email as soon as you get home,” she told me after she had a brief phone conversation with her father. She then initiated another conversation on inequality and race relations in America. I contributed very little to the conversation due to the oversight context of a profession that restrained the tongue from contributing to confabulations that did not directly hinge on patient care, advocacy, safety and satisfaction.
I continued to look at the slip of paper, sharply in awe of its career prospect. “Thank you.” I got home but the piece of paper was nowhere to be found, having disappeared into thin air. I had too much on my mind that day that I didn’t know where exactly I had kept the slip of paper for ease of retrieval.
How many rivers did I’ve to cross to get to a comfortable destination in life? I don’t think a dark skin color increases one’s susceptibility to death and sickness any more than a light skin color does. Black dies, white dies. Everyone dies! Cancer affects people of all races and ethnicities. Black gets sick, white gets sick. Everyone gets sick! Mental health illness isn’t restricted to any particular race or ethnicity either. Neither is psychological resilience a natural property of any race or ethnicity. Naturally, I can make the same sweeping generalizations about gender and different age groups. That is, neither death nor sickness is a respecter of skin color and age―although some diseases preponderantly affect certain age groups and “races” than others.
I must add that pharmacogenomics and pharmacogenetics reinforce some of our natural differences.
Race is a sham, a hoax. Thus I view blackness and whiteness essentially as sociological contrivances, convenient tools specifically designed for the social, political and psychological control and manipulation of people―social engineering. The concept of race is an important ideological contraption only in the pseudoscientific mind of social engineering. This is not to say I am grudgingly fixated on race, far from it. It’s just that America is intricately and inescapably defined by it.
Perhaps another example should suffice. I met this elderly African-American woman who exuded gracefulness, warmth, personableness and decorum, and yet she also exuded anxiety in certain situations. I realized that her anxiety intensified only when I entered her room with white nurses but, oddly enough, she appeared calmer and friendlier when I went to her room in the company of an Asian nurse I understudied and shadowed. She effortlessly smiled at me often with an edge of absolute sincerity, extending same to other non-whites. Obviously, she felt more comfortable in our company.
I was at the nurses’ station with the Asian nurse going over our paperwork when the elderly woman’s call light beckoned for help, shattering the stilted monotony of the art of official documentation. I wasn’t the only affected by this shattering sound. “Francis could you check on her?” the Asian nurse politely asked of me, “to see if she needs anything. Let me know if I should lend a hand.”
“Don’t mention it!”
The call light completely dissolved my ennui, causing me to quickly rush to the patient’s room. “How can I help you ma’am?” I asked respectfully of her upon reaching her room. She wanted a table in her room bearing her tray of food, cutlery set, dessert, and cups of fluids repositioned closest to her bed, that is to say within arm’s reach. I did that for her. “Is there anything else I can do for you ma’am?” I asked as a matter of professional courtesy. She seemed a nice woman, a woman I saw as my own grandmother. As a matter of fact I saw every human being including patients as relatives, as extensions of my own accommodating and progressive humanity. Fact is, I saw the tenets of humanistic and biopsychosocial medicine playing out in the philosophical extensions of my professional relationships with the community of patients, of the families of patients, and of my healthcare colleagues. I however realized that she didn’t want me to leave her room for whatever reasons, and so I politely repeated the question, “Is there anything else I can do for you ma’am?”
“That’s fine grandson. Thank you.”
“I think the table is exactly where I want it to be. Thank you again.”
I was about to leave her room when a statement she made caught me off guard. I stopped dead in my tracks. She wanted to know why I was leaving. “There are other patients waiting for us ma’am, the nurse and I,” I tried to explain. “I can hear many call lights sounding out in the hallway. These patients are calling for help. Some of these are my patients. Is there anything else I can do for you ma’am? Are you comfortable ma’am?”
The room seemed to fall into a deep hole of dead silence, but then she spoke up finally: “Yes…but.”
“Is there anything else I need to know, anything I can do for you?”
She let out a muffled cry. I fell into a manhole of paralyzing confusion. Should I leave the room and fetch the nurse knowing fully well that stepping out of the room could deprive her of my company and cause her further anguish? I was about to ask her to give me just a second to go out and call the nurse when, out of the blue, she said in a quavering voice, “I am scared, scared of this place.” I got more confused than ever. “You are black,” she continued. “I am also black. You and I are of the same race. I don’t want anyone to hurt me here. Please stay with me. Please stay with me my grandson.”
“You are safe here ma’am,” I told her assuredly. “No one will harm you ma’am. Those of us who work here care about your safety. We go to any extent to make sure you and everyone else here are safe. As you may know, patient safety is one of the bedrocks of quality care.”
She shook her head in agreement as I held her hands and rubbed them lightly to comfort her. Her muffled cry continued unabated. She no doubt found safety in racial solidarity, hence her insistence that I should stay and give her protective cover against any perceived threats to her person.
Eventually she let me go.
Her muffled cry trailed me as I quietly walked out of her room into the deserted hallway, and there in the hallway, I stumbled upon my hypothetical chatty preceptor. I told him about the incident with the elderly patient and sought from him how best such a difficult situation should have been handled. To this day, I can’t tell with any degree of certainty if his brusque answer was one that I should categorize as forthrightly dismissive or evasive, or one that directly pointed to his outright disinterest in a taboo subject, for he merely ascribed her racially motivated apprehension to medication side effects. And that was the end of the conversation. I became more confused than ever.
What if he was wrong? Besides, I wasn’t sure whether my approach to the situation was even professionally or clinically appropriate in the circumstances since his answer didn’t give me an opportunity to learn anything new from the experience by way of professionally, clinically acceptable solutions. He didn’t even bother to ask me how I handled the situation. In spite of the preceptor’s characteristically unengaging evasiveness and open display of extravagant nonchalance toward a situation with serious clinical implications for my intellectual and professional development, he and I did eventually check on her. I did notice an elevated calibration of anxiety in the whiteness of her mature, intelligent and perceptive eyes, however. We made sure that she was safe and all her needs attended to before leaving her room. She wasn’t happy!
It wasn’t long before one of her sons paid her a visit. She was back to her natural or spontaneous self.
Just as Sankofa, I took a long look back on the panoramic vista of my professional training up until that point for any practical clues about what to do in such trying circumstances. Absolutely none whatsoever! Race is a thorny or touchy subject and many people avoid it if they can. But Cornel West forcefully demonstrates in Race Matters this issue is just as important, even inescapable in public discourse and policy, and race relations. Regardless of its topical touchiness, race has been part and parcel of the institutional character of many an American higher institution of learning. I don’t think anyone can convince me otherwise that demographics don’t matter in admissions processes as far as selecting applicants for particular academic programs is concerned, noting that intersectionality sheds light on the complex dynamics that underpins the institutional character of American higher institutions of learning.
In other words, race is an important ingredient in the demographics of students who are selected for particular programs of study.
That’s to say, the fact that standardized considerations for racial representation in admissions selection of students for their preferred programs of study is inevitable itself calls attention to why we can’t and shouldn’t avoid honest discussions of race in formal class-based settings, particularly where race and implicit bias compromise quality care and patient safety and increase health care costs for patients, much the same way we can’t and shouldn’t avoid honest discussions of gendered, economic, cultural, health literary, and religious implications for delivering quality care to patients. Nurses must be trained to raise the cost consciousness of patients by resisting those institutional practices and ideas that directly or indirectly translate to increased costs for patients and rising ethnic and racial disparities in the distribution of care strategies. Literacy in health economics constitutes one of the most effective tools nurses can use to fight rising health care costs. My personal position is that nurses should be taught health economics.
What am I driving at? I’m pointing to the fact that implicit or unconscious biases are real, real in the American healthcare industry and in the administering of care to patients. This is important because implicit bias contaminates quality patient care, contributes to patient mortality and loss of life expectancy, and leads to increased disease burden generally. Implicit bias is one of the major reasons women in America―particularly black women―die at an alarming rate from childbirth- and pregnancy-related complications―compared to white women―even after researchers control for subjects’ education and income. This controversial matter made a passing appearance in a class I took, Nursing Care of Childbearing Families. The professor who taught this class and I would go on to share some important ideas about this very matter and related others via private correspondences.
Finally, I should like to advance the argument that race, racism and ethnocentrism, and implicit bias should be openly discussed in nursing classrooms in a way that fully equips prospective nurses with requisite knowledge to fight implicit bias in institutional settings.
That is, we should muster up courage to pry into these taboo subjects and discuss them openly with a sense of intimate phronesis and professional urgency. This open discussion should be an integral part of Interprofessional Education and Development (IPED) classes. I think these formal discussions are appropriate for the IPED classroom. It’s best that nursing students join their colleagues from the School of Dental Medicine, the School of Medicine, the School of Pharmacy and Pharmaceutical Sciences, the School of Social Work, and the School of Public Health in these formal discussions. It’s also my personal position that colleges of nursing should require students to compose reflection papers after each of their clinical rotations in which they openly discuss, among others, clinical and professional experiences that aren’t explicitly or directly traceable to nursing curricula. Students should also propose solutions in these reflection papers and make a case for the workability of these solutions. And finally, how they intend to measure the effectiveness of these solutions and cost estimates of their speculative solutions.
Course professors can then collate the quiddities of these ideas and then advance them to the faculty of the IPED Center for open deliberations.
Where do we go from here? Isn’t race a sham, a Trumpian hoax? If race is indeed a product of pseudoscience, why do some people still cling to it? Why should nursing or providing care to another human being be about color? Why should the color of a nursing student who cares so much about his or her patients be embarrassing? What on earth could cause an elderly patient to be afraid of her nosocomial environment? Why is America so obsessed with race, racialism, and colorism? Doesn’t culture explain our differences better than race, a non-existent fabrication by sick minds?
Again, how many more rivers do I have left to cross before I get to a destination of institutional, psycho-emotional and ontological equilibrium?
Misdirected questions, whose answers I do not know anyway!
The river system is probably contaminated beyond decontamination. And the confluence of conflictual patterns now has more interlocking layers of confusion than was previously the case.
Yet nurses do have a role to play in reversing the tide of institutional contamination. The fact that medical doctors wield more institutional power than nurses doesn’t, in and of itself, mean nurses can’t mobilize the juggernaut of their collective voice and chalices of clinical judgment in defense of their consciences and patient advocacy, for it just isn’t doctors alone who are tied to the bottom lines of employers. Janitors, nurses, pharmacists, physical and occupational and respiratory therapists, accountants, speech therapists, students, preceptors/clinical scholars, radiologic technologists, certified nursing assistants, cooks, maintenance and emergency medical technicians, social workers, laundrymen and laundrywomen, and so on are tied to employers’ bottom lines as well.
Even patients generate money for hospitals, clinics, laboratories, and healthcare professionals.
After all, each member of the baobab tree is just as important as the baobab tree itself.
Aren’t both doctors and nurses repository of medical knowledge? What does a nurse do in the case where a doctor is wrong?
Perhaps we all need to go back and read Theresa Brown’s The Shift: One Nurse, Twelve Hours, Four Patients' Lives again!