Words Between Worlds: Improving Cross-class Communication in Medical Spaces

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by Kate Delany |

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Recently, while I was in the political organizing world where I spend so much of my time, a random hospital memory popped into my head. It was of a routine experience from the days when my younger sister, Mary, a cystic fibrosis patient, was in respiratory failure. She was on vast quantities of pain meds, and the nightmare of complications felt endless.

While visiting her inpatient daily, I’d keep an eye on the doctors moving down the hallway, doing their morning rounds. When they stopped in front of my sister’s hospital door, ready to discuss her status, I’d step into the hallway to join them.

These sessions were intense, with an assemblage of pulmonary doctors, transplant doctors, infectious disease doctors, surgeons, pharmacists, anesthesiologists, physical therapists, nurses, and residents, all huddled around laptops, swapping reports and analyzing data.

The first time I stepped into their circle, introducing myself as the friendly older sister with some questions and concerns to voice on behalf of my family, I might as well have introduced myself as a being from outer space. I felt out of place. But I kept at it, and it got easier — not just asking questions, but also interjecting when things didn’t sound right, like when one doctor decided it was time to take my sister off all antidepressant and anti-anxiety meds stat, for seemingly no reason. They were the ones with knowledge in spades, of course, but I had some knowledge, too, from lived experience, and I was determined to share it.

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In my political organizing life, I work on the grassroots level in the southern part of my state where the population is far more working-class than up north. In conversations with statewide organizers, I’ve struggled to find my footing, sometimes feeling like I am back with the rounding doctors.

Some of the northern organizers are volunteers like me. Some are professionals. Some are academics. They swap intel from meetings with insiders and legislators. Senate bill numbers roll off their tongues. But the patient in the bed is democracy, and again, I have lived knowledge to share from working in the community, getting my hands dirty daily.

In both of these worlds — political and medical — I can see how what I say and how I say it, as well as how I relate to others, is shaped by my class origins. Sociologist Betsy Leondar-Wright puts it this way: “[A]s we move through our lifetimes, we innovate, we make strategic choices, and we change, but always from the starting place of our class origins, and we are always influenced by the predispositions inculcated in us by our childhood social position …”

I am what psychologist Barbara Jensen calls “a straddler,” meaning I grew up in a working-class world and now live in a professional white-collar world. My parents have expressed appreciation for my interfacing with doctors, especially my father, who is skeptical of physicians but jovial and garrulous around hospital janitors and orderlies. Most of his adult life, my father worked Monday to Saturday, from 8:30 a.m. to 6:30 p.m., at the inner-city home improvement store where he was the longtime manager and eventually owner. The hospital manual laborers are people he understands.

In her book “Reading Classes: On Culture and Classism in America,” Jensen describes the working-class priority of belonging, which focuses more on the communal than the individual, more on character and less on achievement. Jensen notes that, “… part of belonging, as a central feature of [working-class] culture, is a tendency toward peer relationships (where power is equal) and a tendency to shy away from hierarchical relationships.”

In hospital settings, my family seeks out people they feel are most like them, and that’s usually predicated on class. I see myself doing this in my organizing work, too, looking toward people I feel have similar lived experience and thus are unlikely to talk down to me.

Conversations are shaped by class, too. Studying different language use between middle- and working-class groups, sociologist Basil Bernstein noted that while white-collar professionals use language to debate, to display individual ability and uncover differences, working-class people use language to connect emotionally and find commonality. I have seen my family do this time and time again — try to share emotional issues with physicians who often ignore it. As a straddler organizer, I use unifying emotive language, which likely sounds sappy or odd to white-collar professional types.

Not all caregivers or grassroots organizers are working-class or straddlers. But regardless of their class background or level of education, patients and caregivers who have dealt with the complexities of chronic illness for a lifetime have intimate lived knowledge to share. Those truths matter. To connect well — in medical spaces and all spaces — the working class needs to feel seen and heard.


Note: Cystic Fibrosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cystic Fibrosis News Today, or its parent company, BioNews, and are intended to spark discussion about issues pertaining to cystic fibrosis.


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