Fifty Shades of Patients

Lately, my mind has been reflecting on the works of the artist Mark Rothko, especially his Black Paintings inside the aptly named Rothko Chapel in Houston, TX. It started happening on a post-call day when I was hastily explaining to my sickle cell patient that the pain pump that we ordered for her will be the best solution to her pain crisis without thinking about the inherent bias with which I walked in the room.

Dealing with sickle cell patients can be difficult as not only they are medically complex, but during an episode of pain crisis, management of pain can be downright challenging. Pain is a very subjective measure, and in a field which is very objectively driven, comprehending and treating pain adequately is an extremely demanding part of our jobs. I share this to provide an insight into how physicians can develop a bias towards patients in sickle cell pain crisis. Our bias is that the patients are demanding when it comes to analgesia and our best efforts are met with inadequate relief, causing frustration in this patient-physician relationship.

Reflecting on my patient, I have been thinking about the first time I visited Rothko Chapel. Rothko was a big pioneer of Color Field paintings under the umbrella of a movement called Abstract Expressionism; however he would have preferred to exist outside the label. Son of Russian immigrants, Rothko spent the early part of his life in Portland, Oregon before moving to New York in 1923 to pursue a career in art. As part of Abstract Expressionism, Rothko removed the subject from the canvas and focused on the relationship of color and form, painting canvases with bright contrasting colors now adorning most modern art museums and private collections.

The color appears to be absent from the massive black canvases that hang inside the Chapel. A departure from the past, the canvases sing a song of longing and deep rooted melancholy. I wanted to experience this so I visited the Chapel on a hot summer day. Taking cues from other visitors, I sat on a cushion facing a triptych black canvas. As my eyes began to focus on the art work, time became irrelevant and heat gave way to revelation. The canvas opened up to reveal that black was just the beginning and I began to perceive the subtle shades ranging from dark purple to deep red. Deceiving the eyes at the first glance, the canvases were anything but monochrome and they slowly revealed their secret if you chose to pay close attention.

As I stood in my patient’s room talking about how we are going to treat the pain with the pain pump, I saw the hint of bubbling frustration on my patient’s face. She opened up to me about how she is afraid of giving herself opioids and dying from an overdose. She has been tolerating severe pain and holding off from pressing the pain pump as in her mind, dying from an overdose was worse than suffering due to excruciating pain.

In that moment, I was ashamed of my preconceived bias and I apologized to her for not digging deeper. Just as the black canvases opened up to show me a new meaning to color, listening to my patient’s concerns opened to show me a new meaning for pain. As physicians, we should check our bias, but it is easier said than done. There is always a lot to learn in medicine but some of the most valuable lessons that I have learned are from my patients. If I can afford to look past the label of black canvases being “just black”, I can definitely look past the label of patients being “just their illness”.

Next time I see a sickle cell patient (or any patient), I have to stop and check my bias at the door. It does not help me be a better doctor and it certainly does no good to my patients. Rothko hated being defined by a category and I am beginning to understand why.

By: Mir Ali, DO