Friday, September 22, 2006

Caught in the Struggle

I've been pretty busy in the hospital for the past month, and have seen very little of Jamal as a result. Thankfully, my current rotation ends in a week followed by a three day weekend. Typically, I'd rather discuss my dealings with Jamal and the lessons learned in my attempts to be the best mentor possible to him, but in light of my recent experiences, I will diverge just a bit.
For the past month I have been doing an internal medicine infectious disease rotation. In Baltimore, that translates to seeing HIV patients in various states of disrepair all day every day. Most of our cases are further complicated drug use, other STDs, and completely dysfunctional living arrangements. As my preceptor so eloquently put it, "To be seen on this service, you have to be a loser at life." So basically, the only patients that I have seen for the past three weeks are HIV positive, non-compliant, IV drug abusers. And of course 100% of them have been Black. Researching the topic of inner-city black poverty through books, blogs, etc. opened my eyes quite a bit. But joining the team that attempts to treat the most severely diseased, addicted, and desperate of the ghetto's casualties has been far more educational and painful. The patients that I have cared for over the past month embody the self-destructive tendencies that permeate and diminish Black American culture and I can hardly stand to watch any more.
In the course of caring for them, I often become curious about the indivual and what sent them so far in the wrong direction. The physician role allows for, and even encourages a high degree of privilege into the private lives of these patients. "How did you get HIV?" "How often do you use drugs?" "Which ones do you use?" "How many children do you have?" Of course, it's the response to that last question that weighs most heavily on me. I have come to believe that the greatest obstacles to success among poor blacks are parents who pass their failures onto the next generation, legacies of addiction, lawlessness, and miseducation where true success is a rare exception. I am skeptical about the chances of there ever being widespread reversal of these kinds of legacies, but I still believe individuals can make a difference. The past three weeks have been difficult, but I am strengthened in my resolve to make sure that Jamal and all the young men that I will mentor in the future are equipped with the knowledge and understanding to escape their parents' mistakes.