Tag Archives: stigma

Modern rural

–Tom Bibey

And yet before you misunderstand, let me reassure. We are modern. We use the same medicines as our city counterparts, and we are only a helicopter flight away from the latest technology, not that it solves all of our problems. We take the same competency tests as our colleagues, and I’ll bet we do just as well or better. (Maybe my old professors did a little better, but they got to write the questions.) We have access to the same information too. My computer is just as fast as the ones over in Raleigh.

(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Dr. Bibey addresses with humor the impression that rural means backward. It is easy to judge the choices another provider made when you aren’t in the trenches with him/her.  In other entries, we’ve examined the innovative efforts to adapt to the quickly changing world of modern medicine that have originated in some rural practices. Examine your setting. Who are the innovators? What are the qualities they have that keep them thinking and moving forward? Is it curiosity? Is it the desire to serve their patients well? Is it the need to keep learning and stay engaged?  


Sometimes patients repulse us…

— Lorence Gutterman

I knock, enter the room, and introduce myself. Carter rolls over to look at me, a grimace on his face. I step back as the musty air of his room reaches me, reminding me of my high school gym locker room. I brace myself and ask him why he became a rodeo rider.

“My uncle and older brother rode. I wanted to be like ’em. Doc, you want to try it?” He laughs through his obvious misery as he pushes himself into a sitting position, his reedy legs now dangling beneath the flimsy, gray-checkered hospital gown.

“I’m too chicken to sit on a bucking horse,” I say and place my chair a safe distance from him. Not so far away to be rude, but I need some space.

“Man, what are ya’ afraid of? Thought Docs could do everythin’.” His grin changes to a frown as he crosses his legs.

“Believe it or not, doctors get scared.” What would my colleagues think of me, admitting vulnerability?

Carter shuts his eyes and rubs them. He clenches his jaw. “Can you give me something for pain? I hurt like hell.”

“Of course. I’ll talk with your nurse.” I quickly leave the room to find his nurse who is counting tablets and putting them into a tiny paper cup. I ask her to increase Carter’s dose of morphine. I reenter Carter’s room. The odors have not changed. I return to my chair, the cracked vinyl squeaks.

“Hey Doc, ya gonna get me feelin’ better?” He has returned to lying down.

“I’ll try. Can’t promise you though. Could you control the bronco the first time you sat on it?”

He tries to prop himself up on his right elbow. “Doc, ya never can control that animal.”

“Kind of like your fever, until I know more about you,” I say fidgeting with his chart.

“Those shakes last night, damn! Bounced me around more than any bronc.”

“Fever caused your shakes.” I stare at the plastic bag filled with clear liquid hanging on a metal pole on the corner of his bed. Its slow drip is hypnotizing, calming. I decide to get to know him before I start quizzing him about risks for AIDS. Taking a sexual history has never been a comfortable task for me.

(Excerpted from Hanging on for Your Life and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

In this selection the author appears repulsed by this patient. It may be the patient’s profession, it may be the smells of illness, it may be the patient’s personality. We are human, we all have reactions to patients. My toughest patients are those who are morbidly obese and come in with complaints related to their excess weight. Obese patients are hard to examine. My feelings are real, I can’t get rid of them. The important thing to remember is that I cannot act on my feelings. I need to recognize them, then set them aside and figure out how to meet the patient where he or she is. Likely the obese patient is embarrased about their weight and has been the recipeint of cruel comments. I try to find some empathy for that patient.  Partnering with a patient demands figuring out what if feels like to walk in their shoes–that saying may be cliche, but its a good place to start. Empathy can help me put my repulsion aside. This is part of professionalism. We may have unsavory feelings, but we don’t act on them.

Sometimes to let off steam, we may joke with colleagues and co-workers about a patient or the situation. Be careful about this. You never want to do that in a location where the patient or his/her family/friends might over hear you. Humor helps us to cope, but eventually you need to set it aside and return to a position of empathy.

The author also talks about being scared. Feelings of fear are human too. Sometimes we are afraid and we need to ask for help. However, sometimes we need to set our fear aside and do what needs to be done.

As you spend time in clinic and the hospital you will see health professionals who are empathetic and kind to some of the most difficult and repulsive patients. Watch them, ask them how they do it.

Mississippi Mayhem

Hinds County,MS 2001

–C.D. Bradley-Jennett

“Remember you’re just an observer”

The ID doctor with the long gray hair and tortoise shell rimmed glasses reminds me

I don’t need reminding.

I know this is her clinic

I know she is trying to help

I am just an observer here

I am just a resident

Just a witness


Jesse James is black

Really beautiful

Dark like mahogany

Cheek bones angled just so…like a model really

But he is dying

“Got that AIDS,” he says, matter-of-factly

He is 26

The medicines might’ve worked if he’d taken them right

Not “every now and then” as his mother divulges


Now he sits on the examining table, bones jutting out everywhere

“What hurts you” the doctor says

“Everything” he replies

“And I just keep runnin’ to the bathroom…

Won’t stop no matter what I do…”


“Jesse we need to think about hospice”

“Remember we talked about that…”

“I’m having a hard time remembering anything lately. Mrs.…I mean Dr. Lee…

just tell my mama…she remembers everything”


And she does…the positive test…pregnancy test…27 years ago…how they had to “remove her womb and everything else ” because she wouldn’t stop bleeding… ensuring Jesse would be an only child. 

She remembered everything…the first step, the first word, the first day of school…the first clue…that something just wasn’t right…

he was 19 and losing weight and kept getting rashes on his face that just looked funny and then pneumonia and almost dying like that in Jackson Memorial Hospital…

They drove 40 miles to get there…he needed to see the specialist.  She needed her baby to live. 

The other positive test…

”Yes, it was for sure”   “No. they couldn’t tell how long he had it”  “Maybe she should talk to him about it”


She had warned him about so much:

“Be careful crossing Fitzgerald road ‘less you get hit by a tractor or somethin’ “

“Don’t swim in Hinds county creek the waters too dirty ‘bound to get all kinds of germs…”

“Pleeeeze, don’t get that fast girl pregnant now…you know I don’t need a baby around here…with me working all day”

“Baby I know it’s the 20th century, but please don’t sass them white folks…Mississippi ain’t changed that much”


Hadn’t warned him about this.  This disease that would kill him.

He was disappearing right before her eyes.  

Shrinking…folding in upon himself. 

Graying…his skin and even patchy areas of his once thick and lush hair. 

She remembered everything, but she kept quiet.

And even after she lost her only child she found it hard to say it aloud.

Everyone knew what Dr. Lee’s clinic was for, but it was still a secret in this small Mississippi town where separate and unequal still reigned supreme.

And everyone said “Mrs. James, I’m so sorry about your loss”, and the deaconesses from the church baked cakes and the supervisor from her job made her famous deviled eggs and the pastor’s wife fried chicken and people whispered laughter…as was appropriate for a repass, and everyone was so polite…

But, I wanted to shout because Jesse was younger than me and quite possibly brighter than me…

and now he was dead and that was not OK with me…

And I wanted to scream…and I wanted to sound the alarm…and I wanted to rally…and I wanted to educate about how it’s done up North

…but mostly I wanted to scream…

but I was just an observer.

(used with permission and published in The Country Doctor Revisited, KSU, 2010)

Dr. Bradley-Jennett reflects on her experience in the rural south as a medical student. In small towns all over the US, everyone knows everybody’s business. Sometimes that business includes health problems with a stigma like AIDS (Dr. Bradley-Jennett’s patient), sexually passed infections, or an unplanned pregnancy. Even today depression, substance abuse or the need for Viagra can be embarrassing. Recently, I had a patient ask me to write out her husband’s prescription for Viagra so she could hand carry it to the pharmacy in another town. She didn’t want the local pharmacy assistant, who she’d known forever, to know that my patient and her husband needed it. Sometimes what is known is not discussed, like in Bradley-Jennett’s poem. As a result neighbors can have a passivity about what is: Mr. Jones is an alcoholic and he beats his wife. It’s a given, no one asks if she needs help, or they are tired of her denying that it happens. As a result the alarm and rallying never happens to change the status quo. What have you noticed on your rural rotation about small town nosiness and privacy/confidentiality?