As a home visiting NP I make sure that I have on scrubs. We have the option of selecting a polo shirt with the company logo but I prefer the scrubs to add an additional layer of recognition to my appearance. I make sure my badge is up high and facing outwardly as soon as I get out of the car and make my approach to the front door. Now with COVID-19, I am wearing a face mask and face shield as a part of my daily get-up, which may protect me from COVID risks but makes me uneasy about how I may appear to my patients so I make sure I place my mask on after the patient sees me. I take a second to look around, and check my surroundings then placing one foot in front of the other I climb the stairs and reach out to ring the doorbell. I do one final body scan to make sure I “look” like a healthcare professional, with ID showing and put a smile on my face so that when the door opens I come across as non threatening as possible. This happens automatically with every encounter, every day.
I have been doing home visits for five years now and have been pregnant 2 times while out in the field. When I was pregnant that was the only time I didn't feel my skin color was the major thing making me vulnerable. I felt more exposed due to the fact I could not move as fast as I normally would if something should pop off and I had to hustle. But even then my brown skin and how I would be perceived when I came to the door of my mostly white, elderly, rural patients was in the background of my mind. I really enjoy being a caregiver and feel that I have a great opportunity to provide healthcare to patients in their homes, a place where they are most comfortable. The downside is oftentimes that comfort comes at the expense of mine and negotiating that can be exhausting mentally and physically.
I ring the doorbell. Wait 30 sec. No answer. The front door is open but the tinted glass storm door is closed and I'm unable to see anyone inside of the house from where I'm standing on the front porch. I had previously called to let this husband/wife duo know that I was coming. The wife answered and I let her know I was 5 minutes out so they were expecting me however there was no way I was going to attempt to open that door to announce myself, that is way too invasive. I ring it again and this time I see a hand wave for what I thought was for me to come in. I gently crack the screen door and announce myself and proceed to come in. The husband was sitting in his recliner and looked at me a little confused. I again introduced myself and asked if it was ok to come in just because he looked so apprehensive. He said yes, I could come in but stated he didn’t know who I was. I went to take a seat and continued telling him I was the Nurse Practitioner there to do a home visit. I took a seat and started taking out my equipment when I glanced in his direction and on the arm of his recliner his firearm was out and his arm was resting passively right next to it. I took a breath, startled at the site of this weapon. Here we go again, I thought. I should just walk out. Make up an excuse and walk out. This is too much. I proceeded to explain the purpose of the visit, told him my name for a third time and again asked if it was ok to check him out and review his medications. He said, Oh yes... We do this every year. My wife didn’t tell me you were coming. He pointed to a doorway where his wife was entering and put his firearm away. She came in with a tote bag full of prescribed medications and greeted me with one of the wittiest jokes I’ve heard from a patient. I barely laughed though, and even now I can hardly remember the nuances of the punchline because I was still so nervous from my initial encounter. I just couldn’t shake what had just happened. I shouldn’t have to deal with this, my mind kept saying. I felt my eyes welling up with tears knowing that I had so much fear in that short encounter and it seemed not to phase him at all, but in my mind I’m still rattled. I cannot concentrate on how often you take your blood pressure pills. I can not bring myself to care about your rash and bowel habits. Anger, resentment, fear, confusion all still swirling and I felt my body temperature rising. In that moment I was able to feel the warmth of my body and it was just the space I needed to become aware. So you made the decision to stay, I told myself now bring your awareness to your body and get out of your head. I could hear my patient in the background telling me about his heartburn and his latest episodes with spicy food while my heart still thumped forcefully with each beat. This is what fear feels like, I thought. I felt my palms sweaty and an innate urge to run, which I thought was weird because it was so strong. Fear makes you want to run and overriding that urge takes some intense presence of mind. The more I let all the feelings flow over me the more I was able to be fully there and not let these feelings define me. Similarly I was able to see past the actions of my patient and see his fear and anxiety and likewise chose not to define him by those same feelings. There was a light and energy behind all that. I got a glimpse of it as he began to talk to me about his time in armed forces and how tired and weak he felt on a daily basis from his chronic conditions. The more mindful I was in that moment the more barriers eroded and our sameness was reflected back onto each other.
The truth is I got through the visit and in the end was able to have a connection with them just as I try to have with all my patients. They even said they wanted me to come back next year. I don’t know about all that though. Once I was out of their home and walked to the car, the thought crossed my mind they probably don’t consider themselves racist. They may even insist that they would have had their firearm out no matter what the person looked like that came to the door. That surely doesn’t change the impact of the situation and the trauma I experienced initially upon our first meeting.
I told my husband about the whole situation of course being the loving husband he is never wants me to stay in a situation like that again and to call him immediately when it happens. I love the sentiment and maybe I’ll make a choice to remove myself from that type of situation next time. There will be plenty of opportunities unfortunately. There will be a next time for sure.
After leaving the patients’ home and talking with the hubby, I sat on the driveway and kept mowing it over and over in my head. What if I had made the wrong decision to stay?, what if he didn’t put away his firearm?, what if I had made the wrong moves. How can I continue with this day?, I’m so on edge right now. So in my car I again reminded myself that it was over, in the past and that the thoughts are just thoughts. I am not in danger and there was no longer any reason to be anxious. I focused on my breath and did a quick mantra meditation I've been using lately that has really helped me to bring my attention to the present moment. I breathe in "There is nothing else" and I breathe out "This is it". It totally helps me at this point in my life to relax my body and get out of my head. As I continued mindful breathing, thoughts about having to do mindful breathing for the rest of the day because I was so shook, started to get me worked up even more. I again reminded myself that I was focusing on a “future” that wasn’t even here. Breathe now, in this moment. Relax now in this moment. The next hour will take care of itself. I encouraged myself. I started to get sad and emotional thinking of how many black people deal with this specific type of trauma regularly and how it is taking a toll. Everyone has trauma and has to find ways to cope. For me it is through mindfulness and finding ways to be involved in social justice programs that focus on how race intersects the healthcare encounter among providers and patients. In that moment on the driveway I decided to put on my schedule for later that day some reflection time to see if there are better ways to respond to instances like the one I had just experienced. Once I placed it on the calendar and it had its own space,I could let go and cease from the perpetual analytics of the situation. I could dwell in the space beyond time for a few moments and just “be” before I headed off to the next patient. I could more freely go back to the breath and feel the freedom of connecting with my true self, the beautiful, godly essence that fear and hate can never touch.