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Community & Behavioral Health | Recovery | Social Change


Changing the Conversation

Looking for the "Borderline Patient"

10/30/14 01:55 PM | Gloria Dickerson | Health Care, Trauma, Race

In the ER… again! For weeks my chest pain kept coming on strong. Just when it appears to subside, it gets going again. Usually, after I get injections of Lasix and Lovenox, the treatment winds down with oxygen or breathing treatments that alleviate my symptoms. When I ask what is wrong with me, I usually get, “Wait, the doctor will come back to see you.” Then the next thing I know, I am discharged and told the doctor left for the day or is too busy.

This time as I am waiting, I start to think of the past, and it hurts over and over again. I think about how my doctors respond; they seem to think my intentions are to overuse services and burden them.

There is a knock. A young man comes in. I wonder, is this the doctor? No such luck— he introduces himself as, “Jess, a physician assistant.” Wow! I warn myself not to jump to conclusions— maybe this will be different.

I greet him with my hand extended and recount my history. When silence falls I ask him, “What is wrong with my heart?” He tells me, “We are not sure it is your heart. Your blood pressure is high, but we have to do some tests before we know. You know the routine.”

His tone is clear and hurtful. He continues, “No, it is not the Atrial Fibrillation, and it’s not the congestive heart failure!” His phone rings… he tells me he will be right back. I start to feel hopeless. I try not to think the worst. But, I believe I will probably get the run around again. Usually even though I get admitted there will be no diagnosis or any justification for the extensive treatment they propose.

The patient in the other bed alongside of me has been waiting, too. A doctor comes in and says, “Hello Mrs.________ , I am doctor______. I will be taking care of you.” The patient says, “This is my husband." The doctor nods and continues, “We see you have a history of blood clots. We did some blood work. Your levels of Coumadin are low. You also have some abnormal EKG’s, so we are going to keep you. We will run some more tests, and I will come by and give you some more information and answer any questions you may have.”

I was angry. What a difference. She is receiving “care” and I am receiving... the business. You know, it is like when kids say, “We gave him or her the business.” I have had several admissions for chest pain over the last year. My health is worse… and no answers, ever. My first thoughts are… "They are giving me the business because I have been in this ER so many times." But, I always have to come back because my condition goes undiagnosed and they treat only the symptoms. No doctor ever came in and sat down to talk to me and asked me if I have any questions. I remain invisible in this land of care because of the extraordinary assumptions and myths about me.

What could be the cause of the difference in the “care” that I receive and the “care” this other person received?

I am an African American woman, consciously wearing natural hair, overweight, smart, and piles of my medical records can be pulled up by a single click on a computer. My attributes hold meanings for people and perhaps trigger negative judgments about me. The problem is that imaginations about me do not reflect my character, qualities and humanity. Instead, they turn me into a caricature of myself, making me an easy target. [pullquote]imaginations about me do not reflect my character, qualities and humanity. Instead, they turn me into a caricature of myself, making me an easy target.[/pullquote]

The dismissive attitudes leave me feeling like an alien devoid of any ability to make human contact. When I have given voice to my need to be respected, it has only fueled the fire. There is never any pretense of caring for me in this hospital. All the appropriate words like “patient-centered care” and ‘individualized-treatment” waft like flimsy bubbles through the air. There is no substance, no actions, and no kindness to transform these words into reality.

I sought the help of a psychiatrist. He listened and then remarked, “Well, in the ER they see a lot of ‘borderline patients.’” Maybe my problem is that doctors and staff are “looking for the borderline patient.” I have no credibility with these otherwise good, intelligent and good-intentioned people. Everything about me, everything I say, or ask, only confirms their vision. If I am compliant I am seen as manipulative. If I am hurt or angry, I am deemed over-emotional. My surviving multiple traumas and even my fierce commitment to seeking help easily facilitates my transformation into… a borderline patient—a pejorative label at best and one that doesn’t belong to me. [pullquote]a borderline patient—a pejorative label at best and one that doesn’t belong to me.[/pullquote]

This flawed vision of me is never questioned and is repeatedly transmitted to other staff. If I dare to react to their humiliating treatment, the negative assumptions are confirmed. I am in a catch-22. Maybe a person the doctors deemed credible will be able to verify for them that I am a person of value. It is true, I have had to overcome a lot and I can experience great distress that sends me to seek help. However, using humiliation and shame to shut down my distress is never a helpful intervention.

Within medical settings the promise of Care for all is often unfulfilled. In these environments, hurried actions, chaos, and trauma occur frequently. And even good people can be lured into resting on their good intentions. The unchecked anger and mean responses doled out to quell the neediness of “a borderline patient” are in reality more consistent with predatory behaviors than caring ones.

Maybe no one should be treated like a “borderline” patient! Maybe we should all be treated like women, men, and children and allow our common humanity to move Care from a possibility to a reality for all of us. And maybe the doctors can learn from my painful experiences in the ER.

Image via Jorge Gobbi

Gloria Dickerson

Written by Gloria Dickerson

Gloria Dickerson is a Recovery Specialist at the Center for Social Innovation. Her expertise in recovery derives from academic training and lived experience of recovery from trauma, mental illness, and homelessness. Gloria received a B.S. from Tufts University and has completed master’s level studies in Instructional Design and Psychiatric Rehabilitation.