cultural competence – Stacie Walton MD

Accused of Attempted Murder

Posted on June 6, 2021June 5, 2021 by Stacie Walton in cultural competence, Humanity, Unconscious bias

Part Two

Please read Part One first!

We disembarked from the ski chair, and I led to the left. The gentle slope led me to a run I had skied multiple times in the past; simple and easy. I chose a beginner slope, or so I thought. I remembered an easy grade with minimum pitch and gorgeous terrain. In retrospect, I never saw a trail marker, probably because I didn’t look for one. Taking the lead and moving down the mountain, feeling the cold breeze against my face would offer me the chance to get my head together; I slowly moved forward. I thought I had chosen a simple run, as Marianne had only been skiing a couple of times before. Marianne followed close behind. As I skied over the first ridge, I immediately recognized the steep pitch of an advanced slope. I wondered, where am I. Skiing over the first ridge; I realized I had led both of us onto a double diamond run, difficult for me and impossible for Marianne.
As I coached her down the mountain, falling occasionally and watching her take spill after spill, I realized I had put us both in danger. She could be hurt. We focused on the job at hand. I had forgotten that minutes earlier, my friend had told me the most important fact about her life- who she chose to love.
One hour later, when the danger seemed to dissipate, with skis in hand, walking down in knee-deep snow and crawling over moguls the size of little hills, Marianne laughed at the top of her lungs, smiling at me, ” I’ve come out to a few people, but Stacie, no one else has tried to kill me!”
We tell this friendship story, entitled “When Stacie Tried To Kill Me” at gatherings and between ourselves. My love for her has never wavered, and I have no idea what happened on that ski slope some 30 years ago when I steered her onto a double diamond ski run. Could it have been unconscious biases guiding my actions? Could it have been my need to appear accepting, using up so much brain space, that I had blinders on for the reality surrounding me? I wonder…

The Precocious Child

Posted on September 25, 2019September 25, 2019 by Stacie Walton in connections, explicit bias, privileges

I had difficulty sitting quietly in my seat. Excited about new ideas, my hand shot up before the teachers asked their questions. I enjoyed sharing the correct answer and loved the classroom. Even as a kindegardner, I set my clothes out the night before to prevent any delays in the morning, and then I ran the three blocks to school. I was the “precocious kid” that drove the teacher crazy with my musings.

So it was no surprise that one day my teacher informed me that my mom was going to join me after school, and we were going to meet the headmaster of an elite school across town. I sat in front of the prim and properly dressed white woman and held my mother’s hand as they started their adult conversation about my joining her private college-prep school.

The headmaster explained the curriculum, the yellow bus that would pick me up daily, the full scholarship, the performing arts program, and the incredible opportunity. Their school would set me up for attending any one of the country’s best colleges.

Later that evening, my parents informed me that I would not be going to the private school, ride a yellow school bus, or learn how to ride horses. My parents reminded me that in the next school year, I would have Mrs. Edwards as my teacher. My distress about the affluent private school across town dissolved quickly. Mrs. Edwards, one of the only black teachers at my elementary school, was the smartest, most life-affirming teacher I would ever experience. She continues to be a legend.

I never asked my parents directly why they didn’t feel comfortable sending me across town into an unfamiliar community of white people and affluence. I reflect on the social and political backdrop of 1964. Poor people were screaming for equal opportunity by rioting in the streets across urban cities all over the country. We heard about black churches in southern towns being burned to the ground almost weekly, and civil rights workers killed by members of the Ku Klux Klan. I am sure that fear kept me close to home.

I completed my education in that segregated public elementary school; however, that would change. Mandatory busing integrated my junior and high school. I went on to graduate from Ivy League colleges and one of the top medical schools in the country. I am convinced that my success was directly related to my parent’s decision to keep me close to home, their unwavering belief in my abilities, and the brilliant educational foundation I received from the teaching of Mrs. Edwards.

Identifying my Superpower

Posted on August 14, 2019August 14, 2019 by Stacie Walton in healthcare, Leadership, Privileged Position in Society, Super power

I entertained the idea of quitting medicine after my first night on call during my internship year. On that night, I felt petrified assigned to the Neonatal Intensive Care Unit (NICU). Joe, the third-year resident camped out in his call room, gave clear instructions. He should only be disturbed if an infant deteriorated during the night. In the competitive culture of the residency program where I trained, the senior doctors, known as the “attendings,” supervised the interns and residents from the comfort of their homes. The unwritten rule stopped residents from consulting them in the middle of the night.

While I was hunched over a micro-preemie completing a procedure, a nurse asked if I wanted to give antacid to an infant who had acidic undigested formula in his stomach. Clueless, I breached protocol and interrupted Joe’s football game. Calmly, he approved of the plan to give the antacid. I researched the dose and wrote the order in the infant’s medical chart. The nurse informed me in the wee hours of the morning that the infant with the acid issue improved.

The next day as morning rounds began, I reflected on how all the infants and I had survived the night. Because of exhaustion, I barely noticed the blinking lights of the breathing machines and the beeping sounds of the IV poles. Before me in one large room stood twelve tiny babies in their respective incubators with their nurses hustling around them, inserting IVs, changing diapers, and dispensing medications. I began my discussion of each infant’s events during the night to the senior physician, the two other residents, and several medical students. The attending physician, Dr. T, asked questions, and I answered moving from one crib to the next. When we reached the infant I’d written the order for the antacid, Dr. T stared at the crib. Suddenly, without warning, he grabbed the bottle of antacid sitting prominently on the shelf just above the infant’s bed. While hurling the bottle towards me, he yelled an expletive and followed with the question that haunted me for many months, “What are you doing, trying to kill this infant?” He followed the outburst with a quote from a research journal about the potentially fatal adverse effects of using antacids in premature infants. Luckily, my years as an athlete helped me dodge the bottle which settled near my feet. The room seemed to disappear. The infant’s incubator crib appeared to leap into my vision inches from my face. I felt hot all-over and my palms felt wet. No one said anything to diffuse the situation. Not one nurse revealed that ordering antacid had been a common practice. Dr. Joe, the supporting resident, had already left the NICU. Nothing could have insulated me from the humiliation. I quickly scribbled an order in the patient’s chart to discontinue the antacid and jotted a note on my clipboard to find the research article to read later that day.

As the morning rounds continued, the bottle of antacid rested in the middle of the floor. Did anyone, fellow intern or senior resident, or one of the nurses have the courage to support me that morning? Did anyone else see the hurled bottle as an assault? Maybe not. After rounds, in the privacy of the bathroom, along with my tears and simmering anger, I reflected on the dynamics that would allow one person to treat a team member with such unfiltered anger and disrespect. What did the Attending physician possess that the rest of the team lacked? He could claim seniority. He possessed seniority in a rigidly hierarchical system. He occupied a position of privilege in relation to everyone else. In the privacy of the bathroom stall, I identified a future superpower. I promised myself that when I had the responsibility of being the senior physician in a teaching hospital, I would never shame an intern or a resident on rounds. I’d always use my superpower of seniority for good.

Can you remember an experience that revealed a superpower or encouraged you to develop one? Share below.

Privilege is Your Superpower

Posted on August 7, 2019August 8, 2019 by Stacie Walton in Privileged Position in Society, privileges

The medical team stood around the older woman’s bedside. As one of the students, I prepared to meet my assigned patient. While being assigned to me, Mrs. R. yelled, “I’m not letting that N*** take care of me!” As the only Black person in the room, her words meant for me hung in the air. Frozen in place with my heart racing, I fantasized walking out of the room. Without a break in the conversation, my third-year resident, the most senior person on the team, used his superpowers of whiteness, maleness, and seniority to inform Mrs. R. that her bigoted behavior distressed the team. He granted her a choice. She could change her attitude, or we would help her find another hospital. Forty-eight hours later when I arrived at the ward, I learned that she transferred to another hospital in the middle of the night. My third-year resident chose to be my ally. He set a tone for the team and reminded everyone my skin color didn’t allow anyone, including a patient, the right to disrespect and degrade me. He used his superpowers for good.

There are three prominent aspects of our superpowers. One, we all have privileges afforded to us in society. You may be male or tall. You achieved a high level of education or inherited lots of money. You may be socially agile or recognized as being pretty. You may be white. You may be able-bodied or straight. You may have been born in the United States or be a Christian.

The second often frustrating aspect about superpowers is they sometimes allude you. When you hold a privileged position in society, that privilege offers a buffer to the effects of that social condition. The advantage becomes the “norm” for you. One strategy for identifying your privileges is to listen to the stories of those who are at a disadvantage. Don’t be quick to discount the stories about patients refusing care from the colleague with the foreign accent or sexual harassment continually occurring in the hospital. Just because it has never happened to you, doesn’t mean it never happens. These stories are the key to stepping into and owning your privileges and your superpowers!

The third aspect of superpowers is having the discernment for how and when to use your superpower. The most important thing to realize is when you decide to embark on a courageous act or conversation, you need to understand your role, to act from conviction, not emotion, and to understand the ramifications.

I encourage you to identify your superpower! Imagine you could become the superhero that saves the day on hospital rounds, helps boost team morale, or secures the opportunity to strengthen a special relationship. Remember, everyone has one or more superpowers. Identify your privileges and commit to using them for good. Advocate for others in situations where their social position, medical condition, race, country of origin, LBGTQ status, disability, size, gender, or rank in a medical setting sets them up for discrimination or harm. I guarantee your life in medicine will be more vibrant with friendships and collegial relationships developing and flourishing for a lifetime. Teams have the opportunity to thrive and do great things for patients and their families. Take some time to reflect on your superpowers, your privileges. Have you used them for good?