M-80 Firecrackers & Garrison Keillor
In my internship many years ago I was working the ER in Bangor, Maine, and I get this fool who’s blown open his hand with an M-80 firecracker. His wounds are all skin lacerations, nothing deep is damaged. The guy has on steel-toed boots, grey uniform with dirt and oil smudges, dirt under his fingernails, needs a shave. We all know the type.
Or we think we do.
Hands heal up very well on their own if there’s no infection. So I sew what I can pull together, and clean and bandage the other wounds and leave them open. I ask him what he does for a living, in his Maine accent he says, “I’m ah fo’klift drivah.” I explain that I don’t want him driving for the next week or two, his hand needs to heal.
“Just as well, Ah can listen to tha radio.” Making small talk, I ask him what he likes to listen to.
“Bach,” he says.
I pause, and look at him anew. I comment, “You know, before I came to work I was listening to some Liszt.”
“Oh,” he says, “Liszt was a vereh contr’versial composah.”
I take that in, then ask him if he ever listens to Garrison Keillor’s A Prairie Home Companion on NPR. He responds excitedly, “Ev’r’ othah weekend! I have t’ work on the othah ones.” So I ask him if he’s read Keillor’s Lake Wobegone Days which had been recently published.
“No,” he says, “but Ah’m dyin’ to get m’hands on a copeh.”
The ER is a rare glimpse into humanity. For me, part of the fascination is that I run into people who upset my prejudices. Someone comes in who is ‘clearly’ of some socioeconomic category, and then in talking with them I discover that I was completely wrong. I think it’s a fun way to be wrong.
The word ‘prejudice’ is from the Latin pre (before) + iūdicō (to pass judgement) which means to ‘pre-judge.’ I am quite prejudiced in the ER; it’s my job. I’ve got to make quick decisions about your disease, which means I have to make quick decisions about you. Almost all of those things that are politically incorrect in normal conversation can be clues about what’s going on, about what questions to ask, and about how to treat you.
Prejudice in Medicine
In fact, all doctors are trained to be prejudiced. If you have high blood pressure, I need to consider whether you’re white or black, because the causes and therapeutic courses for the two tend to be different. White kids get lice, black kids don’t. Asians have different ear wax from Caucasians. Immigrants may carry exotic diseases, and I may need to hit the Internet before I make decision. And so on.
Sex, sexual activity, and sexual orientation are constant considerations. Diagnosing a heart attack is harder in women, because the symptoms are different and more subtle. If you have lower abdominal pain, a woman is more likely to have a bladder infection, but an older man, a prostate infection. If the abdominal pain is located in other places, I need to consider whether you’re male or female, young or old, skinny or fat. If you have arthritis in a single joint, it makes a different whether you’re 60 (probably degenerative, maybe rheumatoid arthritis) or 20 (gonorrhea until proven otherwise). And if you’re in between, I’m thinking gout.
Open-Mindedness in Medicine
The critical thing is to keep an open mind. In almost all of the malpractice lawsuits I have seen, the problem didn’t happen because the doctor or medical support staff didn’t know the underlying medicine, but because they wouldn’t listen. They made a quick decision, and then refused to take in more information.
Medicine, like all complex decision-making, is about having an understanding of the relative probabilities, and considering the most likely problems first. That prejudice can spill into social considerations. Sometimes that’s because the social aspect is important for medical decisions, but sometimes not. Doctors are people like everyone else, and we are constantly making assumptions about what’s going on around us.
Schizophrenia, Crime, and Punishment
I remember a psych patient at Charity-New Orleans, a schizophrenic woman who lived on the street. The attending psychiatrist interviewed her and noted afterward that he thought she was borderline mentally retarded. I had my doubts; the nurses had told me when we admitted her that she knew her hospital number. She knew her Social Security number, too, but she remembered her lengthy hospital number, from her previous admissions to Charity.
So the next day in evaluating her, I asked her if she ever read. She said she used to, but couldn’t concentrate anymore. I asked her what she used to read. She told me, “Everything.” I asked her to name an author she liked.
“Dostoevsky,” she said.
The Gangsta’s Kids
Recently I had a couple in, both very large African Americans, him in unlaced sneakers, low-rider pants with a plumber’s crack, her in a tube top with hoochie-mama shorts and stiletto heels. We all know the type.
No, we don’t.
They were there because their kids had the sniffles. The kids? Both dressed in neat school uniforms, polite to a fault, and avid readers. While I chatted with the kids about their favorite books, the parents beamed at them.
The Real Problem with Prejudice
Some people say they are not prejudiced. I always doubt that. I think that, rather than deny our prejudices, we should be aware of them. Rather than take an inflexible position about prejudice, we need to understand it, and decide when it is helpful, and when it is not. And with that, we should learn to be amused by how wrong we can be.
Because the real problem isn’t the prejudice. The problem is, What are you going to do with your prejudices? Will you use them to help people?
And even more important, Do your prejudices stop you from looking further? My black friends often talk about getting pulled over for ‘DWB’, Driving While Black. I remember a pre-med student some years back, a young black man whose father was a surgeon. His dad had given him his second-hand Mercedes convertible two-seater.
The local cops pulled him over constantly. Young black man + expensive car = drug dealer.
Looking Beyond Prejudice
The police who stopped him were racially profiling. But if they had just looked and thought about what they were seeing, they would have recognized what was really there: a clean-cut young man, dressed in a polo or button-down Oxford shirt, driving a conservatively appointed 10 year-old Mercedes. Highly unlikely drug dealer.
If you look at the people complaining about racial profiling, they’re not worried about the police pulling over the guy in the tricked-out lowrider. They don’t want him around either. They’re complaining because of cops who see nothing beyond race.
Looking at skin color, and missing the whole picture is not only unfair, it’s bad investigative work. It’s bad in medicine, it’s bad in law enforcement, it’s bad everywhere.
Knowledge as Prejudice
I can take the position that everything we ‘know’ is a type of prejudice. Experience and research teaches us that doing a will produce b. But it’s not always true; quite often a does not produce b. The doctor, the entrepreneur, and the lawyer cannot promise an outcome, we cannot guarantee that a decision will succeed; what we have is knowledge of what worked in the past, and therefore what the future is likely to look like. This accumulated experience comprises many jots of knowledge, each of which is a kind of prejudice, something we expect in certain situations.
We get into trouble when we look at only one or two factors, rather than the larger picture. It gets worse when we choose to focus on less important variables rather than the biggest ones, and finally it becomes toxic when we refuse to look further, when we do not consider new information that should change our decisions.
Prejudice vs Closed-Mindedness
Prejudice is not a problem, and in fact is essential. The problem is when the prejudgement, the judging before, becomes the final judgement. The problem, as always, is closed-mindedness.
The closed mindset is currently a major problem on the national stage. We, as a nation, are talking about using racial and religious profiling in our immigration practices. It does no good to point out to people that most acts of US terrorism, and most criminals and welfare recipients, are white, and were born right here.
Some people look at large social and political problems in the same way they look at minorities. They don’t know the facts, and they make it clear they don’t care to learn about the facts.
They aren’t interested in the larger picture. The problem is always closed-mindedness.
When we look at situations, and people, with a closed mind, our pre-judging becomes toti-judging; our first impression is our only impression. That is what creates injustice. When used with an open mind, our prejudices can help people. With a closed mind, they become harmful.
Which is the point here. If we look closely at injustice, the deep problem isn’t prejudice.
It’s closed mindedness.
Addendum: Brussels Bombings of March 2016
This was published the day before the Brussels Zaventem Airport and metro bombings. The goal of terrorists is terror, and that is how many people will respond. Terror produces almost impenetrably closed minds. The terrorists are certainly closed minded, believing that their actions will somehow cause their enemies to give up, even though the evidence is clear the opposite will happen: the enemy will dig in, and react more aggressively. Meanwhile the terrorists’ other enemies – including us – will overreact with a different kind of closed-mindedness.
Few people will look at the problem holistically and dispassionately, and respond in a rational way.
Bronze cast of Franz Liszt’s hands courtesy of ChopinLiszt on Tumblr.