Otis Webb Brawley - How We Do Harm: A Doctor Breaks Ranks About Being Sick in America

Chapter 1

Chief Complaint

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 at a hospital in 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 hourslikely, five or six. The triage nurse doesnt 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 cant 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. Thats why many doctors, nurses, and social workers here 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 ERan experienced black woman who gives a shit. When Dr. Quest pages me, I know it isnt because she needs a social interaction. It has to be something serious.

We are wanted in the ER, I tell my team.

The cancer team today consists of a fellow, a resident, two medical students, and yours truly, in a flowing white coat, as the attending physician. I lead the way down the hall. Having grown up Catholic, I cant help thinking of the med students and young doctors as altar boys following a priest.

I am a medical oncologist, the kind of doctor who gives chemotherapy. My other interests are epidemiology and biostatistics. I am someone you might ask whether a drug works, whether you should get a cancer screening test, and whether a white mans cancer differs from a black mans cancer. You can also ask me if we are winning the war on the cluster of diseases we call cancer. As chief medical officer of the American Cancer Societya position I have held since 2007I often end up quoted in the newspapers, and I am on television a lot. In addition to my academic, journalistic, and public-policy roles, I have been taking care of cancer patients at Grady for nearly a decade, first as the founding director of the cancer center, and now as chief doctor at the ACS.

My retinue behind me, I keep up a fast pace, this side of a jog. Bill Bernstein, the fellow, is the most senior of the group. Bill is a Newton, Massachusetts, suburbanite, still boyish. He is having trouble adjusting to the South, to Atlanta, to its inner city. He is trying, but its hard to miss that black people and poor people perplex him. Contact with so much despair makes him awkward. But he has a good heart, a surfeit of common senseand he is smart. Whatever we teach him at Grady will make him a better doctor wherever he ends up.