Pales in Comparison: Cause of Death, Medical Errors and Limited Thinking

“Don’t go dancing on any tables.” My friend Barb would say that to me in college if she left a bar before I did. Over the years, it’s a phrase I’d use. “I have to go now, don’t go dancing on any tables.” I was on the phone with my dad, we were about to hang up after the I love yous, and I said, “Hey old man, I have to go now, don’t go dancing on any tables.” I hesitated a moment and then laughed and said, ” No wait, at your age and with your health, if you can get on a table and dance, well boogie on.” At 5’ 8” and 150 pounds, he’d refer to himself as a little old man; he’d survived two bouts of tuberculosis, WW II, a few heart attacks, Parkinson’s disease, a quadruple bypass, a month in a coma and a stroke.  Less than 24 hours later, he was dead at 78, due to a medical error.

In 2013, a study that showed medical error is the third cause of death in the US. The definition of “death” was later debated; but medical errors remain an issue. My doctor stopped mid exam and went to get another doctor in the practice. The doctors, both women, palpitated what they described as a hard mass on my abdomen. Looking more alarmed than I felt, my doctor wrote an order for a CT scan. Two days later, I was in the scanner, barely breathing when the whirring finally stopped.  Taking a deep breath believing I was done, I heard the voice, “we need to do another pass.” no need to tell me to be still, I froze. My mind spiraled. I did not notice the second whirring had stopped and that I was out of the scanner until I heard the technician. She was standing beside me and as looked up, she was laughing and shaking her head. “Look, I know I said we can’t tell you anything and the doctor makes the diagnosis, but let’s just say, you have the cleanest scans we have ever seen.” She started laughing again; the next sentence she said was inaudible and all I heard was “…she felt your spine.” After getting herself together, she reassured me with, “You just looked terrified and you’re by yourself, we don’t want you to worry. Your doctors felt your spine.” As she left the room, I could hear more laughter coming from the technicians looking at my scans.

Another misdiagnoses of many. There was an ugly mono episode. I had headaches, a sore throat, swollen lymph glands and fatigue. The doctor lectured, you have headaches because you are stressed from studying, get some rest. He said, what I called swollen lymph nodes in the back of my head cysts sent me to a dermatologist. The dermatologist looked at me said no, those are lymph nodes, you have mono and sent me back. By then, the fatigue was worse and I a consistent fever. So, there I was again back to the same doctor who insisted he didn’t think I was sick. In his words, I did not look pale and weak. However, since his colleague requested it, he’d belligerently agreed to test for mono. I tested positive three weeks after my first visit. In the meantime, I was walking around contagious. I was out of commission for 6 weeks after that.

I have an alarming list of being misdiagnosed. The case of the missing tumor the surgeon could not find during a pre-op exam. Or maybe it vanished with the power of prayer? There was the iron incident, I had severe anemia with an iron level of 3.8g/dl, far below the 12g/dl – 15g/dl. Only after 4 visits and 3 months of displaying classic symptoms, and at risk of a heart attack for low oxygen, the doctor’s response was “…but you don’t look pale.”

Funny, the definition of pale – light in color or having little color makes no medical sense. Yet search pale skin and you get a myriad of causes.That’s my constant balance with medical care; treatment versus misdiagnosis. Over the years, studies have shown that medical text books used in the US, Canada and Europe use young white men as a universal model. This did not go unnoticed by Malone Mukwende.

Malone Mukwende was in his first day of medical school when he noticed something odd. As he learned about diseases of the body, all of the diagnostics were grounded in white skin. Red bumps from rashes. Blue lips from oxygen deprivation. Such colors are masked by melanin, meaning these diagnostics don’t work for much, even most, of the world’s population.

Mukwende points out that doctors are trained to spot diseases through just one racial lens. Textbooks are racially biased, sometimes to the point of flagrant racism, and as a result, the medical community is beginning to realize that Black people tend to get diagnosed and treated later for the same disease white people might have, at which point, the disease is harder to treat and often more deadly.

Mukwende gives examples of how bad training leads to poor health outcomes. With the rise of COVID-19, which has disproportionately killed Black people, doctors have seen an increase of Kawasaki disease, which is an inflammatory condition that involves swelling across parts of the body. One of its telltale signs on white skin is a bright red rash. But on Black skin this same rash appears without a clear color signifier; to the untrained eye, it might look like goosebumps. ¹

My dad bled to death after being hospitalized for three days with severe stomach pain. He was on a blood thinner, coumadin and the blood was collecting is his stomach. I reckon he didn’t appear “pale” to his doctors. My dad died 22 years ago today. Sometimes, we fail to realize we’re looking at a problem through the wrong lens. This week, consider, do you discount the obvious because of the framework you’ve been taught?

¹ https://www.washingtonpost.com/lifestyle/2020/07/22/malone-mukwende-medical-handbook/

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