Free Black Man in a White Coat by M.D. Damon Tweedy

treat substance abuse as a distinct entity from other mental illnesses, such as severe depression, bipolar disorder, or schizophrenia, although drug use frequently overlaps with these disorders.
    â€œSo what about a residential substance abuse program?” Dr. Raynor asked.
    â€œAs far as the twenty-eight-day private rehab kind, it’s the same problem of her being uninsured,” the psychiatrist said. “The state-run rehabs require her to get into outpatient counseling before they would authorize her treatment. That’s what we will set her up with.”
    â€œSo that’s the best she can get?” Dr. Raynor asked, incredulous.
    â€œSadly, yes,” he said, his exasperation indicating he felt the same frustration that we did. “The odds are stacked against people like her. We talked about her going to a women’s shelter, as those sometimes can provide the needed structure and support, but she wasn’t too keen on that. I talked with her uncle, who seems like a decent guy. He is willing to take her back, and she’s okay with that. We’ll get her an intake appointment set up. In the meantime, we recommend starting her on Prozac.”
    With that, Dr. Raynor began work on Leslie’s discharge papers. It was time for her to leave. Under the current system, the hospital had done all it could for her. As we tied together the final loose ends, I thought back to the heated exchange between Carla and Dr. Garner before we delivered Leslie’s stillborn infant. Much of Carla’s anger, and to a lesser extent Dr. Garner’s and my own, had been targeted at Leslie for selfishly taking a drug that she must have known could be harmful to her growing fetus. But learning her life story had made that judgment a little less fair. The world she grew up in had clearly not been on her side. Perhaps nature had not been either, given her mother’s heroin use and what is known about genetic predispositions to drug abuse.
    Still, Leslie had chosen poorly, and her baby had paid the ultimate price. She would have to face the emotional consequences of what had transpired. As far as I could tell, the health care system—where she was easily maligned—wasn’t prepared to provide her much help with that.
    Within a few hours, Leslie’s uncle and his wife came to pick her up. They both hugged her fiercely. One could hope that with their support, and with the mental health care we had initiated, this episode might trigger something within Leslie to steer her on a path toward a stable, drug-free life. But with the ashes of this trauma piled atop the many others she had endured in her short life, I wondered where she’d go from here. As a future physician, I was also beginning to think more about the limitations of medicine and where my responsibility to patients might begin and end.

 
    3
    Charity Care
    â€œThis is it?” I asked.
    â€œThat’s it,” Mike said. “It’s a far cry from Duke.”
    Sharon simply nodded. We stood beside a cotton field, one hour away from the high-tech hub of Research Triangle Park, which was anchored by Raleigh, Durham, and Chapel Hill. Despite our proximity to the major universities and cosmopolitan residents of these cities, it felt, from my lens as a black northerner, as if we’d been transported back into a black-and-white photograph from the Jim Crow era. A tiny white home, nestled within a group of dingy trailers and makeshift houses, served as the building where we would spend the day treating patients. A small graveled area served as the parking lot. Flowing cotton fields and decrepit buildings filled out the canvas. My mind couldn’t help but conjure up images of Ku Klux Klan rallies a half century earlier.
    Although the clinic would not open for twenty minutes, about a half-dozen people stood waiting on the dusty porch. They were all black. While African Americans made up about half the town’s