Submitted by Dr.Kattlove’s Cancer Blog

The controversy that the Reverend Wright is stirring up reminds me of an incident in my practice that remains with me 20 years later. Wright’s outrageous and perhaps paranoiac statements about the United States are especially telling when he questions whether the HIV virus, the cause of AIDS, is a man-made virus, perhaps created by the U.S. Government. Nuts, right? Well, a large number of African-Americans believe this according to a study published by Rand Corporation in 2005.

Many African-Americans just don’t trust white doctors. This was brought home to me in that incident 20 year ago. I was treating a middle aged black woman for breast cancer. She came to me with advanced disease and no matter which drugs I used to treat her, the cancer kept growing. Finally, we ran out of drugs and it was clear that her time was limited. Her lungs were especially affected. They contained multiple cancer deposits.

Finally, she became very short of breath and her family brought her to the hospital where we admitted her for her final days. At that point, my only goal was to keep her comfortable and I told her family that we would give her morphine to relieve her feeling of breathlessness and not do any heroic measures when her heart stopped or she stopped breathing.

I totally expected them to go along with this. We had always had a good relationship, so I was completely taken aback when they insisted that we do everything possible to keep her alive. Off she went to the ICU where a breathing tube was inserted and mechanical ventilation begun to provide her with enough oxygen. Because of the tube, she needed to be sedated. I could then give her enough morphine to keep her comfortable.

This situation lasted only a few days. As her lungs filled with cancer, even the mechanical ventilation wasn’t able to provide enough oxygen for her body. Eventually her heart gave out. At this point there was no further “heroism” like cardiac resuscitation. The family was convinced at this point that everything had been done and she died peacefully.

When I reviewed all this in my mind, it became clear that the reason her family wanted aggressive support was they didn’t trust the white medical establishment that I represented. It wasn’t personal, I think. They just weren’t sure we were treating my patient the same way we might have treated her if she were white. The Reverend Wright and the Rand study confirm this deep suspicion.

Still, my patient had a good death. She was sedated during all this time and didn’t suffer. Because of the morphine, she didn’t feel or know about the breathing tube. Perhaps the only downside to her family’s distrust was that because of the breathing tube and need for extra-heavy sedation, she and her family didn’t get to say goodbye.