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On Being a Doctor |

Mattie's Visit

W. Roy Smythe, MD
[+] Article, Author, and Disclosure Information

From Scott & White Healthcare Temple Clinic, Temple, TX 76508.

Requests for Single Reprints: W. Roy Smythe, MD, Scott & White Healthcare Temple Clinic, Department of Surgery, 2401 South 31st Street, Temple, TX 76508; e-mail, rsmythe@swmail.sw.org.

Ann Intern Med. 2010;152(7):470-471. doi:10.7326/0003-4819-152-7-201004060-00014
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In my role as chair of a department of surgery, I occasionally work fairly late in the office, especially on days when Hercules shoots the administrative eagle, releasing me like Prometheus from the bondage of paperwork and meetings. This eagle may not eat at my liver, but it certainly devours a portion of my spirit each day. It is during these periods of liberation that I actually get to practice medicine and perform surgery. However, my much-anticipated time in the operating room is a double-edged sword or, perhaps more accurately, scalpel, as the other work associated with my job does not magically dematerialize during my 8 to 10 hours in the operating room—it's just stacked up on my desk like cordwood for burning later, often with midnight oil as the only available fuel.





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Be careful to avoid sterotypes
Posted on April 21, 2010
Janice M. Scully
No Affiliation
Conflict of Interest: None Declared

Dear Editor,

I am writing in response to Dr. Smythe's recent essay about the interaction between himself, the chair of a department of surgery, and a black cleaning lady who is grieving the lose of her husband. I have no doubt that his efforts in writing this story were well intended. Dr. Smythe mostly likely wanted to increase awareness that we, as doctors, must show compassion both inside and outside the office.

I am an internist and a writer, my focus currently is writing for children and young adults. I was uncomfortable with what, in my opinoin, was stereotyping in Smythe's essay, both of the woman name Mattie and of himself. This is all too common, in my opinion.

Smythe begins: "In my role as chair of department of surgery, I occasionally work fairly late in the office, especially on days when Hercules shoots the administrative eage, releasing me like Prometheus from the bondage of paperwork and meetings." I think his placing himself in the realm of the gods is not helpful in this particular article. It is during one of these evening that he encounters Mattie, the black cleaning ladey.

We aren't given Mattie's last name. What does she look like? She is overweight with "ample arms." Her form is a "backlit silhouette filling the lower two thirds" of his office doorway. He imagines this hospital scrub-attired woman, "for a moment...weating a Sunday dress and hat," which is a common sterotype of older black women. Mattie also speaks throughout in a heavily overdone and, yes, sterotypic, black dialect (Twain gets away with sriting dialect, yes, but it is appropriate and well done in his work).

The following is an example: One evening, weeks after Dr. Smythe first met Mattie, she takes a break from her work and comes into his office and sits, telling him about the vision she has had of her deceased husband: "[My husband] look so handsome to me. I gets up out of bed and stand up, my eyes still closed and we start to dancin'. I dancin' with him right there, in my bedroom!" As she tells him this, the doctor notes the following: "[Mattie] shuts her eyes and starts to move rhythmically in her seat, open hands lifted up in the air, moving as if dancing to some slow jazz beat."

Is there anything about the portrayal of this black woman that is not a sterotype in this essay?

Did Mattie look, dance, and talk as he presents her? I'm sure there was some truth in the description, there always is. But I am just as sure there is probably much about the real Mattie not described, individual, specific to her. And Dr. Smythe isn't a god, even if he uses godlike images to describe himself. Sometimes however, doctors think they have those powers.

The essay is about a doctor imparting wisdom to help an older, relatively poor, black woman, deal with her grief. But I found the essay paternalistic. In reality, this woman would have, at her age and station, just as much, if not more, to teach him about loss and suffering. That might have been an interesting topic. Instead he has made her a character who is innocent about grief and in need of a "god's" help.

We all have to be careful to avoid sterotypes in our thinking and our writing in a distinguished journal such as the Annals.

Conflict of Interest:

None declared

Response to reader's comments regarding stereotypes
Posted on April 24, 2010
W. Roy Smythe
The Scott & White Healthcare System, The Texas A&M HSC College of Medicine
Conflict of Interest: None Declared

I thank the reader for her comments, and her expression of concern regarding stereotyping in "Mattie's Visit".

The supposed reference to the surgeon as a God in this piece, and its relation to the interaction with this grieving woman requires a great deal of imagination - perhaps the reader is promoting a stereotypical depiction of a surgeon?

The opening paragraph was simply an effort to describe the conflict that many have when administrative life takes them away from patients. We miss them not for what we can "pass down from Mount Olympia", but for what they teach us, and reward us with in the process. I am not speaking of praise, money or "Godly" fame, but rather intimacy and trust, exemplified by the gift of this woman's touching story, and her coming to terms with her loss. If nothing else, as a hubristic surgeon playing God, one meaning to make the correlation that she describes, I would have chosen a more successful deity. Poseidon, the God of the Sea, and Earthquakes (literally, "Earth Shaker") comes to mind?

My interaction with this woman, and her language and appearance were as depicted, rather than stereotypical reconstruction. Her first name was changed slightly and her last name omitted to protect her privacy.

I write other essays about interactions with patients and family members of all races, religious backgrounds and ethnicities. If this had been a rural white farmer from, or a migrant worker from another country, I would have depicted these dialects and appearances as accurately as possible as well.

I wonder if the authors of "The Color Purple", or perhaps "Push", the novel that the recent acclaimed movie "Precious" was based upon, would be willing to take this reader's advice? If they did, would these works be as meaningful to us? Like the characters in these books, Mattie is not ashamed of her language or appearance.

If we would take the time to listen to our patients and families more closely, regardless of how they look or sound, or where they or we feel any of us exist in the artificial continuums of society, socioeconomic status and race, we might be enriched.

Thanks to this reader's critique, I have "revisited" this essay, and have found that that rather than the husband "visiting" her, from my perspective, Mattie "visited" me, and reminded me of the importance of engagement and listening.

Conflict of Interest:


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