EP. 8: MAKING SENSE, SPACE, AND MEANING IN THE ICU

WITH ADJOA BOATENG

Apr 20

WITH ADJOA BOATENG, MD

An intensivist and poet discusses sacred spaces, medical miracles, and motherhood in medicine.

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Episode Summary

Dr. Adjoa Boateng has always felt drawn to helping those at the margins of society. An intensivist and physician-writer at Stanford, Dr. Boateng has found language to be a crucial part of not only her clinical work, but of her art as well. In a medical field that can often be mired in technical jargon and dehumanizing shorthand, she champions an even greater importance on the choice of words physicians use as a critical aspect of care.

Dr. Adjoa Boateng is an anesthesiologist and intensive care physician at Stanford. She graduated from Yale, received her medical degree from Rutgers Robert Wood Johnson Medical School, went back to Yale to complete anesthesiology training and undertook a critical care fellowship at Stanford. Prior to becoming an intensivist, Dr. Boateng worked in the realm of addiction medicine, performing research on hepatitis C among injection drug users, and working with programs that trained heroin users in the administration of naloxone to mitigate overdose. She also has a passion for serving those at the margins of society, including homeless and prison populations. Dr. Boateng marries her clinical focus with her interest in narrative medicine as a writer and poet. She's currently investigating racial and ethnic disparities in critical care medicine.
How a college music reviewer came to write for The New York Times - 1:41
• Dr. Boateng’s career in helping individuals from marginalized populations - 1:51
• How she maintains a connection to the spiritual dimensions of medicine despite working in what can often be the most impersonal of medical settings, the ICU - 4:45
• Her reflection on a particularly transcendent moment with a patient approaching death - 7:21
• Making space for the sacred, even in the antiseptic rooms of a hospital - 9:57
• How she discovered her passion for narrative medicine and writing poetry - 15:40
• The importance of humanizing language, especially when talking to patients - 17:37
• The concept of “miracles” in medicine - 22:26
• The difficulties Dr. Boateng experienced during the COVID-19 pandemic as a new attending and new mother - 26:17
• The intense scrutiny she has experienced as a black woman working in medicine - 30:39
• A poem Dr. Boateng has been writing for her son about his birth - 35:23
Henry Bair: [00:00:01] Hi. I'm Henry Bair.

Tyler Johnson: [00:00:03] And I'm Tyler Johnson.

Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?

Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are, by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.

Henry Bair: [00:01:03] Joining us in this episode is Dr. Adjoa Boateng, an anesthesiologist and intensive care physician at Stanford. She graduated from Yale, received her medical degree from Rutgers Robert Wood Johnson Medical School, went back to Yale to complete anesthesiology training and undertook a critical care fellowship at Stanford. Prior to becoming an intensivist, Adjoa worked in the realm of addiction medicine, performing research on hepatitis C among injection drug users, and working with programs that trained heroin users in the administration of naloxone to mitigate overdose. She also has a passion for serving those at the margins of society, including homeless and prison populations. Adjoa marries her clinical focus with her interest in narrative medicine as a writer and poet. She's currently investigating racial and ethnic disparities in critical care medicine.

Henry Bair: [00:01:51] So Adjoa, how do the different elements of your career, ranging from addiction medicine to health care inequities to critical care, thread together to bring you to where you are today?

Dr. Adjoa Boateng: [00:02:01] I've always been drawn to marginalized populations, to individuals who are often overlooked, often forgotten, don't have a voice, don't have anyone to speak for them. And one of the first jobs that I took was working in clinical research at Mount Sinai Hospital. And we're looking to enroll patients into treatment for hepatitis C, specifically a lot of Spanish speaking individuals. So we went to needle exchange programs. We went to many homeless shelters. We went to a lot of community based organizations. These were the individuals, especially in a place like New York City, that folks often would step over when they were walking down the street, would disregard and the train stations. And now I was having lunch with them or getting to know their families or looking through their shopping carts. And that was very pivotal. I grew up in a way that there was a lot of duality, so I grew up around people who had nothing. But I also grew up around folks who had two private jets, homes in the Hamptons, and a lot of resource. And so this path, this trajectory that I've taken has allowed me to try and reconcile those extreme differences through medicine.

Henry Bair: [00:03:20] And can you tell us a bit about what first drew you to medicine? Like, why anesthesiology and critical care, in particular?

Dr. Adjoa Boateng: [00:03:29] So I've always seen medicine as the great equalizer. You know, this idea of duality. Seeing that when someone comes into the hospital, irrespective of you're homeless, if you are a CEO, if you're a child, if you are an octogenarian, everyone gets the same gown. Everyone goes into the same stretcher. And more or less, you know, with my idyllic rose colored lens as a teenager, I thought, you know, most people will get the same sorts of treatment. And I had never really experienced any other setting socially, professionally, that despite your walk in life, you will be allotted the same sort of opportunity to beat your disease, conquer your illness. And that was very, very attractive to me. Anesthesiology and critical care I have gravitated toward, probably because those are the times at which I feel closest to my faith. I mean, I find them obviously very intellectually stimulating and professionally fulfilling. But I think being in a place where you literally are moments and seconds away from, quite frankly, like the brink of death is a place where you have to relinquish some of yourself and sort of give it over to a higher power.

Tyler Johnson: [00:04:45] I'm curious. Adjoa, you know, one of the things that we have talked about before actually on this show is that the ICU almost by definition, is a dehumanizing place. Many of the patients are not even conscious. Many of them either can't communicate with you or can communicate in very limited ways. Hand gestures, thumbs, blinks, whatever. And as a patient, it's horribly traumatic, right? It's a tube in every orifice. And people doing things to you that in any other context, as one of our other guest said, would be torture. It's a striking juxtaposition, I guess to me, that in the midst of this place that is definitionally dehumanizing, that you felt drawn to it partly as an almost a spiritual calling. Or, you said because of your faith. So I'm curious, though, in the... In the day to day working with patients in the ICU, how do you practically maintain a connection to that deeper spiritual reason for being there when so many of the things that you're doing in an attempt to care for patients are so difficult, and in a way, even traumatic?

Dr. Adjoa Boateng: [00:05:55] It's a great question. I think it does go back to the story and to the human experience, and many other facets of medicine, the social history, the sort of psychology of the patient. The way that the patient and the family might view their illness or understand what's going on is sort of pushed to the side, right? Even in the operating room. I'm very keen to the language that we use and we'll say, oh, you know, in room 12 it's the liver, and room 14 is the heart, in room four is the lung. And we've whittled many of our patients down to their disease state. You know, someone who has an interest in language and linguistics, and that is my own personal Pet peeve... But what I love about the ICU is we don't really do that, or we try not to do that. And the patients are Mr. So-and-so in this room. And we know that person's mother, we know that person's sister, we know where they live. And I don't know that that's necessarily the case in other settings. And so you're absolutely right. When patients... If patients survive their critical illness and when they reflect and talk about it, they feel that they have been battered. But as a practitioner of critical care, I think I find some solace and some light in the fact that we can really elevate and bring to the forefront that part of their human experience.

Henry Bair: [00:07:21] Is there a story of a patient that you can share that really exemplifies this perspective? This approach to medicine and that which demonstrates this is the most meaningful work that you can do?

Dr. Adjoa Boateng: [00:07:35] Oh, so many. I remember telling a student recently who I worked with about a year and a half ago, like, 'remember, patient so-and-so?' They're like, 'Dr. Boateng, you remember him?' Like, I remember a lot of the intricacies of our patients. But in specific, there was a patient that passed away in our ICU about eight months ago who was quite young. And I think when you see yourself by virtue of your age or your race or your gender or, you know, the psychosocial situations of patients, it makes their care much more impactful. It makes it a lot more challenging to sort of distance and compartmentalize their treatment. And so I did see myself to some degree in this patient, and I could see the inner battle, the inner turmoil of him having to say goodbye to his young children and his family, but also knowing and having full awareness that his disease state was not going to be survivable.

Dr. Adjoa Boateng: [00:08:36] And when he did transition to comfort care, the room was... It felt like... Like a church. It felt like a spiritual setting, almost. He asked us to play music that he likes, so we put music on. His wife asked us to light candles. The chaplain was there. He had photos. He'd been in the ICU for many, many weeks, so he had photos all around. And we all kind of gathered around him, and I sort of silently cried in the background because it was so touching. And I just will never forget what his wife kept saying to him as he really sort of gasped in his final breaths and she said, 'I'll see you on the other side. I'll see you on the other side. I'll see you on the other side.' But, you know, the opposite part of that is that this was in the throes of COVID. So she was the only one who could be there. She was fully masked. We all were fully masked. You know, she wanted to kiss him on the cheek. And before he took his final breath, she turned to me and said, 'Can I take down my mask?' And I'm like, 'Absolutely.' But I think that whole experience - the optics, the emotion, the words that were spoken... Just really, really struck me. And it's one that though I've ushered many patients and families through death at this point, that was one that I'll always remember.

Tyler Johnson: [00:09:57] I'm really struck. That's a poignant and really beautiful story. Thank you for sharing it. I'm struck because one of the themes that is starting to emerge as we talk with doctors in many different niches within medicine is this idea that within medicine there are sacred spaces, whether that sacred space is welcoming a baby into the world, or paradoxically, whether the sacred space is being there as a man dies. And I guess I'm curious, and I'm not trying to demean critical care in any way, but I just I know from my own training and my own time spent in ICUs, they can be such tough places. Right? And I guess that I'm... I'm just trying to think, how do you as a practitioner try to strike a balance between allowing all of the medical things that need to be done be done, while still holding place for a patient and his family to create a sacred space like that?

Dr. Adjoa Boateng: [00:11:06] It's hard. You know, it is... It is very challenging and sometimes involves a lot of conversation, a lot of meetings with families. It involves a lot of consultants to help usher families through those meetings. You know, it's not infrequent that we consult ethics, palliative care, spiritual care, because despite our best intentions, sometimes we still wear the hat of the doctor. And, you know, our language kind of gets in the way of what we're really trying to do for the patient. And these consultants are able to convey our intentions, I think, in a way that is sometimes more digestible for patients and their families. So, to reconcile those two things, it certainly is difficult. But many of us who enjoy critical care enjoy it for that reason, because at any point we can pivot our treatment plan. There are numerous instances where we're moving, moving, moving. We're going to do this procedure, this invasive test, you know, plan for intubation if all else goes awry. And then the patient or a family member will essentially say, enough, you know, I think we've had enough, and that's fine. When I was younger in my career, I felt defeated by those sorts of instances. I felt like maybe if I was more persuasive, this person would survive. Maybe if they had better understanding of what was going on, this person would survive. Now, even as a junior faculty, those things are not true. Patients and their families sort of understand their disease states and what their wishes and goals are much better than anything that we can interpret. So it is very challenging, but I think the assistance of the many people who work together in the ICU, because it's certainly not a solo sport, really help us achieve that end.

Tyler Johnson: [00:12:59] I'm actually glad you took your answer there because that was the follow up question that I was hoping to get to. I'm struck that in medicine we default to talking about successes and failures, right? And so under that rubric, success in the ICU is a person who comes in very sick and then you make them better and they walk out and then they go on to live a long life. Which makes it striking that when Henry asks you to talk about a really meaningful instance, instead of talking about that, quote, success, unquote, you talk about a patient who died there. How do you think about that? Like, what does success look like in the ICU? Or how have you come to peace? You mentioned that you've sort of had a change of heart about this, even as a young attending. But how has your view on the... On what defines 'success' evolved as a young attending?

Dr. Adjoa Boateng: [00:13:55] At this point it is really, really important to me that the patients and their families understand what is happening. There are so many tools that we can use in the ICU and it is in large part what attracted me to critical care medicine. I think that to be able to bring someone from the brink of death certainly is entirely impactful. And I've seen some really dramatic turnarounds in our patients. But if at the end of the day, when I'm driving home or driving in because, of course, we go to sleep and ruminate about our patients all the time, and I feel like we are doing things or saying things to patients and their families that they don't really have a good grasp on or maybe don't fully agree with. But they are deferring to us as the treatment team. Those sorts of things really don't sit well with me. So when we think about success, I don't have any stake about feeling like the patient absolutely has to live, or this patient should absolutely pass away. It can be a challenge to sort of depersonalize those things. But I think above all, as the attending as the ICU physician, I'm going to have more patients come in. Right? But as the families, this is going to be usually one of the most pivotal and or challenging moments of their lives. And I tell my trainees all the time that what we say to them, they will carry with them for weeks, months and sometimes years. You know, you might forget about the patient next week, but they certainly will not forget about you and what you said to them and how you treated them. And so, above all, you know, I want to really ensure that they understand what's happening and that they agree with what we are doing and that at any point we can change our direction.

Henry Bair: [00:15:40] When I asked you earlier to share a patient story, you immediately responded, I have many. You remember all of your patients.

Dr. Adjoa Boateng: [00:15:46] Yes.

Henry Bair: [00:15:46] And I think that's wonderful because that speaks to how you have a narrative mindset when it comes to taking care of patients. And I know that as a writer, surely this storytelling is very important to you. So when did you discover your passion for narrative medicine, writing and poetry?

Dr. Adjoa Boateng: [00:16:05] Oh, well, it's interesting. I never thought of myself as a writer until very, very recently. By that I mean the past probably 6 to 12 months, despite having written for probably the past 10 to 15 years. If someone said, 'Are you a writer?' I would say, 'No, I'm not a writer. I just write.' Writing was a way for me to kind of quiet the noise and the cacophony of both personal challenges, and being privy to the challenges of patients that I was taking care of through my training, through fellowship, through attending HUD. I found it a bit cathartic to be able to put words on paper and therefore sort of like set it aside and say, 'Okay, now I have peace with whatever the issue at hand was.' And then when I got to Stanford and discovered this community of other physicians and health care workers who also write, it was like, you know, in the zombie movies when you end up at the the place where everyone is a survivor, you're like, 'Hey, here, all my people.' You know? I just was really, really in shock that there were others who kind of shared the same passion and also had a similar lived experience. And so now this group is called Writing Medicine, this group has been like an extended family, artistic family here for me at Stanford. We had an in-person writing retreat earlier this year where we all met for the first time because we've been, you know, convening via Zoom. And that, too, was was really, really powerful. And I'm really grateful for that group.

Henry Bair: [00:17:37] One of the the word choices that you used earlier when describing your work with marginalized communities is how often they are forgotten. And there you go. I mean, that brings us back to the theme of storytelling again. How do you strive to tell their stories? And in what ways do you feel like narrative medicine or a narrative approach to medicine can help us address those needs?

Dr. Adjoa Boateng: [00:18:03] Yeah, I actually think a lot of it starts with language, you know? Although my trainees might not like it, I'm very particular about the language that we use when we describe patients. When we talk to one another, you know, other health care workers about our patients and making sure that we still remember the person behind the gown, the person in the room by themselves, again, on the... On the brink of death. I think that narrative medicine is so powerful because, you know, there are so many impactful things that can happen very quickly, particularly in the ICU, but just in general in health care. And it gives space to really sort of digest and unpack those moments. Again, that can be kind of overlooked or forgotten. And in this era that people are really struggling with things like burnout and trying to reconcile whether they still are in love with medicine. I think those moments bring value to the care that we give. That can sometimes be challenging to go back into every day.

Tyler Johnson: [00:19:10] On this podcast, I feel like we're sort of operating on two planes all the time. So there's the metaphysical plane where we're talking about big philosophical questions, and then there's the nitty gritty day to day plane. And that's purposeful because I think that as doctors, one of the challenges is connecting what's happening up here on the metaphysical plane to what is happening down here when we're writing orders and placing lines and doing whatever we're doing. So all that is to say, could you be a little more concrete, like when you talk about the importance of language? And of course, the podcast listeners may be attendings or they may be an undergrad in medieval studies thinking about going into medicine one day. Right? So they may not really have much of a sense of sort of even what you're talking about. So can you talk a little bit about what dehumanizing language might look like, and what humanizing language might look like?

Dr. Adjoa Boateng: [00:20:07] Oh, absolutely. So, for example, I think that to navigate through medicine and particularly critical care, we use sometimes comedy a bit. And so we are signing out to one another. Someone will say, 'Well, there was this disaster that came in overnight,' or 'there's that disaster patient in room 12,' or what have you. You know, when I hear that, I cringe, right? Because first of all, the patient usually doesn't have a lot of control as to what's happening to them, you know, pathophysiologically. And so that's something that I would literally pause, you know, if I hear someone signing out that way and ask for 'why do you call it a disaster?' 'Well, Doctor Boateng, they have all these things going on' and like. Yeah, but that implies that A: it's something inherent to them that they have sort of chosen this route and again, B: or dehumanizing them, right? This person is here entrusting their entire self to our care and we're whittling them down to a series of challenges. That is something that I really don't care for.

Dr. Adjoa Boateng: [00:21:12] The other thing I think that people struggle with is the conversations around end of life. And that is something that is beyond obviously critical care, beyond Stanford. It's the way that we have chosen to talk about and navigate death, I think, as a society, at least as an American society. But anyway, a lot of times when we're talking about end of life, it can be challenging. And so people will say, well, you know, the feeling over there, they're... They're in denial. They're just not ready. Or they're... They're waiting for a miracle, which I'm trying to, like, put together a lecture on miracles. But again, I think it just like steals these patients and families of why they're here. If they were sitting beside you and they heard you talking about them like this, they would be absolutely appalled. You know, they're waiting for a miracle because they have hope that their loved one is going to get better. There's nothing wrong with that. You know, we can usher them through that process and explain maybe why medically that might be impossible. But we're not the ones to crack down on them and say there's no reason for you to have hope. You know, I don't know that that's appropriate.

Henry Bair: [00:22:26] I am very curious. So if it's not too early to share, would you mind telling us what some of the highlights of your talk on Miracles would be?

Dr. Adjoa Boateng: [00:22:37] Oh, well, I'm still putting it together, but I want to invite our chaplains and our colleagues from palliative care to talk about, you know, how we navigate the conversation around miracles. First of all, why? Why do people believe in miracles? Some people might believe in miracles because they've experienced it. When people ask me why I've gone into medicine I sort of do talk about the extremes of life. Like, I do believe it is a miracle when I see babies born, you know? I don't work on labor and delivery or do obstetric anesthesia anymore. But when I did as a resident, I would cry. When I saw, I was like, you know, this is just inspiring. We are all here because someone birthed us. Like, I can't think of a more pervasive experience, right? Like how did we each get to this Earth? Because someone gave birth to us. And so to be privy to that, you know, I really do think is a miracle. And we are sort of agents to help facilitate that.

Dr. Adjoa Boateng: [00:23:32] And similarly, you know, on the opposite spectrum, when someone is before you pulseless, literally dead and you, me, our team with our medication, gifts, talents, ultrasound skills, lines, you know, sort of jump to this choreography and get life back into this individual. That, too, is nearly a miracle, right? We don't necessarily call it that. We say, oh, we did great CPR, right? It was a great code. We got OSC, but there is something miraculous about that. So I want to sort of reframe how we think about that and understand the word itself, that a miracle doesn't mean that it's something like celestial or something that is like very esoteric and going to come down from the sky to resurrect someone. I think it just means that there's hope, right? There's something that happened that is beyond the explanation of a lot of our medical understanding. And I think that happens a lot, but we just don't call it a miracle. So I want to sort of rephrase how we think about it, because I think it'll be helpful for a lot of us to navigate that conversation. It always feels like a hard stop when patients and families use the word miracle, and I don't think that it has to be.

Tyler Johnson: [00:24:50] I'm really struck listening to you. One of the things that I know is always challenging for me as a doctor is finding a way to always remain in a place of empathy, a stance of empathy towards my patients. Because as I'm listening to you, what I see in myself is that when I talk about patients or their families who are hoping for a miracle, the way that I talk about it is often fundamentally unempathetic, right? Like, we as a medical community, I think, have a way of talking about the very idea of miracles dismissively as a way to say... It's almost as if the way that we talk about it suggests that it's a thing that only a person who doesn't understand what we understand could ever think about something like that happening. Right? Which, as you point out, is especially ironic because a lot of the things that happen in medicine, except for the fact that we see them so routinely, are pretty miraculous. Right? And so it creates this sort of a paradox. But I think it's a... It's a good reminder to me that so much of that returning humanity to the practice of medicine has to do with always staying in a frame of mind and a frame of heart, where I stay far away from dismissing patients, right where I instead try to understand where they're coming from and try to sort of work with them, rather than pitting myself against them.

Henry Bair: [00:26:17] Yeah. So thank you very much for sharing that. I think over the course of this conversation you've shared a lot of beautiful moments in your practice. On the other side, though, I was wondering if you could share a moment when things were not so easy, when things were challenging, either in the professional context, or perhaps even balancing the professional with your personal life?

Dr. Adjoa Boateng: [00:26:41] Oh, yes. The most challenging part of my life, like let alone medicine, just my life thus far, was definitely sort of the end of of 2020. Going into 2021, I felt like if my life were a movie up until this point, that was definitely the climax. That's definitely the part where everyone's going to be like, 'Well, how is she going to get through that?' So, you know, 2020 was a challenge for many of us, but for me, I was pregnant with my first child throughout pretty much all of 2020. I was a pregnant ICU worker battling the pandemic pre vaccine. We were having this racial awakening right as we saw someone be sort of asphyxiated on the ground. And I just was overall in, I think, a mental and emotional state of survival, like let me just keep swimming, stay afloat. And I had my first child in September. I had just started as an attending a few weeks prior to that in August. And I was isolated. You know, I'm here in California with my husband and my baby, but all of our families back on the East Coast and we didn't really have anyone here. And when I did go back to work from maternity leave, that was when we had our surge in early 2021 and our ICUs were booming. I was trying to figure out how to take care of a newborn child, breastfeed, go to work, write notes, teach. And my mom was here helping out. Finally, she was safe to come out and she'll tell you I literally would open the door to come into our home after work from the garage and I would burst into tears. And it happens every day for at least a couple of weeks. And looking back, I can't pinpoint and say exactly it was because of this, you know, that I was so emotional, but I really think it was the constellation of all of those things. And I really questioned whether I should continue in medicine. I wasn't sure at that time, but that... That was definitely a very, very challenging time for me.

Henry Bair: [00:28:57] That really does sound like a difficult period. I was wondering if you could tell us about some of the lessons you've learned about thriving in medicine, either when the work itself isn't going so smoothly or when the situation such as COVID is making medicine very difficult. Or perhaps a lesson about parenthood in medicine?

Dr. Adjoa Boateng: [00:29:24] Yeah, I think I come from a lot of institutions and settings where there was very, very little room for error - from Yale to the practice of anesthesiology to the practice of critical care. Like, you know, small mistakes can have big impacts. And so it was very, very hard for me to let go of the ideology and the philosophy of true perfectionism. But as many parents, moms, especially sort of Dr. Moms will know, we have a child that kind of has to go out of the window a little bit and not to the demise of patient care, obviously, but just understanding that at any moment you're sort of juggling multiple balls and something may fall a little bit shorter than the other. So, you know, maybe you wanted to pump four times a day and it only happened three times. That's okay. You know, everything will be okay ultimately. And so I think really relinquishing some of that ethos and, you know, asking for help, quite frankly, not carrying this title of the superwoman and asking my mom to help, asking my husband to step in, asking others around me to cover my shift if my child was sick, whereas before I'd sort of grin and bear it. I think those things are okay.

Tyler Johnson: [00:30:49] If this question is appropriate... You mentioned that part of the difficulty when you were working through this very, very hard time was the national and then international awakening that was happening with regards to race relations and the aftermath of the murder of George Floyd. And can you talk a little bit about the unique burdens of coming up through medical training as a black woman? And whether those particular difficulties have had any special lessons to teach you or have shaped your practice in a way that you think is maybe different than if you had not been through that?

Dr. Adjoa Boateng: [00:31:32] Certainly. So essentially my entire life I've been either the only or one of very few black people in these spheres. And as many of my colleagues would echo who have a similar experience and similar trajectory, when that is the case, you are inevitably put under a lens, sort of put under a microscope. You know, as I was mentioning earlier, this sort of gift and curse of perfectionism is sort of exacerbated by that experience. So even now, you know, as an attending, when I introduced myself to my patients in the morning, say, 'Hi, I'm Dr. Boateng. I'll be your anesthesiologist today.' I can see the very quick processing that often happens in their eyes about who is this black woman who I'm sort of bestowing my life to in the next 10 minutes. Right? Anesthesiology in particular is unique because we don't have that rapport or sort of long term relationship with patients that other medical professionals have. We have only five, ten, 15 minutes to really establish that relationship. And so oftentimes I'm met with questions like, 'Wow, you look young. How long have you been working here? Where did you go to school? Where did you go to medical school? How long have you been doing anesthesiology?' And I don't know if, you know, this line of questioning is given to my colleagues who are not black. I would venture to say probably not. You know, thankfully or really by the grace of God, you know, I have answers that are palatable for these patients. But what if I didn't? You know, what if I couldn't say that I trained at Yale or, you know, I look younger than I really am. You know what? If that wasn't the case, then what? And so it is a little demeaning, you know, for that to happen over and over and over again. And so the way that I try to counter that or balance that is really with the black medical students and black residents who are coming behind me and letting them know that, you know, you are enough. Because time after time, because there are so few black physicians, I think it's still very hard for people, particularly those who grew up in an era where there were zero black physicians, to understand that someone who looks like me can actually do this job. So that that is very, very challenging.

Dr. Adjoa Boateng: [00:34:01] I've had some... I won't even call them micro... I've had many microaggressions, but I've also had some macro aggressions by patients. When I was pregnant, I was working in the CVICU and was getting ready to do a procedure on a patient while he was awake and talking to me. So we're gathering the supplies and he started asking me about my pregnancy and how everything was going and if it was a boy or a girl. And I told him and he said, 'Oh, well, you know, if it's a girl, I think a nice name would be something like Shaniqua or Lashonda.' And again, I thought to myself, 'he would not say this if I was not black,' you know, and I could see the sheer look of shock, terror, fear by the nurses who were in the room, kind of helping me get set up. And yet, you know, you still have to take care of these patients who say these sorts of things. Like, I often wonder what would happen if, you know, you undergown a patient to do chest compressions and you see a racist sign or symbol or phrase on their chest. Right? Like you're still hurt. You've taken a Hippocratic oath to save this person's life. You still have to do that job. But it is very challenging to do so.

Tyler Johnson: [00:35:23] Thank you. We're running short on time. I know that, if you'll grace us with it, we asked you to bring a poem so that we can hear the real deal. And we would love to just have you as we're wrapping up, sort of tell us maybe the genesis of the poem. Give us a little bit of context, and then if you would read it for us, that would be really lovely.

Dr. Adjoa Boateng: [00:35:45] Sure. So as I mentioned, you know, 2020 was was a challenge for me, like many others. But a lot of what I was thinking about in the setting of this kind of racial awakening was trying to understand why black women are more likely to die in the Peripartum space. And it's actually black women like me. You know, college educated black women are about five times more likely to die giving birth. And, you know, I'm a healthy person. I had an uneventful pregnancy, but objectively, I had no risk factors. But all data pointed to an outcome that could have been otherwise. And so I wasn't fearful, per se. And I think that goes back to my faith. But I think I wasn't completely unafraid either walking into the obstetric suite. So I've been trying to write this poem to my son for almost two years now. That is not done. But the first part of it, I talk about that experience of giving birth, essentially, so I'll read it.

Dr. Adjoa Boateng: [00:36:50] Dear son, if this moment had color, she appears cotton candy, sunrise across valley plain her texture soft, billowy, a sound of intermittent harp punctuated by jazz saxophone, then crescendo of violins. My stomach, devoid of solid food, sustained only on liquid apple juice. Soulful spirit erupting. We had gracefully arrived to this moment, a ten month cascade of wonder care, prenatal vitamins, worry, exhilaration, ultrasounds, invasion of privacy in the most fabulous epidural. She said gently to me, It's time to push Adjoa. For this. The heightened pinnacle of life that forefathers and for mothers have gone before us. There was actually very minimal fanfare. We elegantly donned our positions, placed our regalia, and the choreography began. Have you ever felt such emotional release? Have you ever held on to hope and love simultaneously relinquishing control for the life of another? Have you dropped to your knees and prayed to the Lord, begging to keep life in His divine hands? Have you ever indulged the fragrant bliss of answered prayer as they lay him across your chest? This new life, fresh anointing. As Miles Davis said, someday your prince will come. Welcome, son.

Dr. Adjoa Boateng: [00:38:12] That's all I have so far.

Tyler Johnson: [00:38:15] Well, it's hard to imagine a better note than that to end on. So we we really appreciate you being here with us. We appreciate you talking about topics joyful and sad and sensitive. And we wish you all the best. And thanks again for being here.

Dr. Adjoa Boateng: [00:38:30] Thank you. This is great.

Henry Bair: [00:38:31] Thank you for joining our conversation. On this week's episode of The Doctors Art, you can find program notes and transcripts of all episodes at theDoctorsArt.com. If you enjoyed that episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.

Tyler Johnson: [00:38:50] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.

Henry Bair: [00:39:04] I'm Henry Bair.

Tyler Johnson: [00:39:05] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.