A Story from the Inside

A Practitioner’s Hidden Pathology

After twenty years of clinical practice, I have learned to trust the quality of information that arrives not through analysis but through contact and context. As an example, when taking the pulse, I am not simply counting beats. I am listening. I am attending to depth, to rhythm, to the quality of the pulse’s arrival and departure, to what the body is willing to say when a skilled hand is quiet enough to hear it. This is one diagnostic art of East Asian Medicine (EAM). It illuminates what moves beneath the surface of the presenting complaint, beneath the patient’s own narration of their condition, and actively senses, through the quality of the pulse, what the body itself is trying to communicate. It is, at its core, an act of radical attention.

For most of my clinical life, I turned that attention outward. Toward my patients. That is, after all, what practitioners do.

It took me longer than I would like to admit to understand that the same diagnostic gaze — the same willingness to move past the presenting symptom, past the story a system tells about itself, toward the root — was precisely what I needed to turn on myself. And that when I finally did, what I found was not a comfortable diagnosis.

It was a Tuesday afternoon, early in what I thought of as my social justice years, early in my clinical days — a period when I had begun to take the work of antiracism seriously as an intellectual and professional project. I had been to trainings, workshops, conferences. I had read widely. I had restructured my clinic’s intake forms, website, language to be more inclusive. I believed, with some confidence, that I was the kind of practitioner who did not carry bias into the treatment room.

A new patient arrived – a Black woman in her mid-forties – referred by a colleague. She presented with chronic fatigue, disrupted sleep, and a constellation of symptoms that pointed clearly, to my experienced eyes, toward Kidney deficiency with elements of Liver Qi stagnation. A pattern I had treated hundreds of times. I knew it the way I know my own kitchen — by feel, by instinct, without needing to think.

But underneath that clinical ease, something else was operating. I noticed it only later, sitting with my notes after she left.

I had rushed her intake. Not egregiously — not in any way she would necessarily have named. But I had moved through her history more quickly than I typically did. I had asked fewer exploratory questions. When she began to describe the social context of her fatigue — the weight of her work environment, the particular exhaustion of being one of few Black women in a leadership position, the way that stress had a texture different from other kinds of stress — I had nodded, acknowledged it briefly, and redirected toward her physical symptoms. The clinical presenting complaint. The measurable. The treatable, by my reckoning.

I had, in the language of EAM, examined the branch and left the root undiscovered.

What was the root? I had not asked. Not because I lacked the skill to ask. I ask those questions with every other patient. I ask about grief, about loneliness, about the accumulation of unlived life in the chest and belly. I ask because I understand, from two decades of practice, that these are not peripheral details — they are the terrain in which illness takes root. I know how to follow a patient’s narrative toward the places where the body’s story and the life’s story converge.

With her, I had not followed. I had steered.

This is what I mean when I say that Embodied Racial Tension (ERT) operates underneath awareness. I did not sit in my clinic and consciously decide to give a Black woman a shorter, less exploratory intake. That thought never formed. What formed instead was something quieter — a barely perceptible quickening, a subtle sense of navigating unfamiliar ground, an unconscious inclination to stay within the clinical container I knew how to manage rather than venture into the territory her words were opening. I steered toward what felt safe and efficient. And what felt safe and efficient was, in that moment, trying to avoid anything that would require me to look at the tension that was being activated within me.

When I noticed this — really sat with it, the way I would sit with a patient’s chart before the next session, following the threads — I felt the diagnostic recognition that Internal Social Justice moves to address. Not shame first. Not defensiveness. Something that preceded both of those: a clear, uncomfortable seeing. I had not been neutral. I had been influenced. And the influence had not come from my medical training, which told me to follow the root wherever it led. It had come from something deeper and less examined — the accumulated conditioning of a lifetime of moving through a world that treats Black women’s experience as supplementary context rather than central data.

Much like the contextual intelligence and mindfulness necessary to read a pulse, this moment was asking that of me. But there was a deceptive tension within my own being, my own practitioner body, that got in the way.

In EAM, we have a phrase for the moment a diagnosis becomes clear. We say the pattern reveals itself. It does not announce itself with certainty all at once — it emerges through the gathering of signs, through the practitioner’s sustained and open attention, through the willingness to not know until the picture has fully formed. What revealed itself to me that Tuesday afternoon, in the quiet of my clinic, was not a picture of my patient’s condition. It was a picture of my own.

I saw the root. And the root was mine to tend.

Internal Social Justice™ as a body or work and practice was seeded in these moments of reckoning. Honed over the last 20 years, it not only diagnoses ERT as a pathological reality but also offers tenable treatment. Internal Social Justice™ is a personal and professional practice of tending. It is not a destination.