Dark Skin in a White Coat

During Becoming A Doctor week, I, like many of my classmates, found myself distracted by the attempted coup at the White House. Watching the angry shouting and cursing of Right-wing rioters and Trump supporters, who were convinced that the recent election was rigged, triggered feelings of pain and sadness within me. I noticed camouflage, body armor, neo-Nazi and Proud Boys shirts, Confederate and U.S. flags waved together, and the noose and gallows. These were not distant images of fringe groups or extremists; they were all-too-familiar symbols of intimidation, subjugation, and terrorism toward black and brown bodies. I thought to myself, “this is America, this is who we are”.

What unfolded at our nation’s capital on January 6, 2021 reminded me how afraid I am as a black man living in this country. The fear I have is not distant or metaphorical; it’s real and paralyzing. I fear for my life when I hear about another confrontation with police ending in a black brother or sister’s death. I fear for my fiancé (a black woman), my unborn children, my family, and my close friends. I also fear for my future patients, especially those who look like me and whose skin color is darker than mine. White supremacy and racism are ingrained in the fabric of our nation – in our politics, education, government, law, housing, economics, and environment.

With MLK day approaching, I think about Martin Luther King Jr.’s rebuke of the healthcare system in the U.S.: “Of all forms of inequality, injustice in health is the most inhumane because it often results in death”. If MLK were alive today, I wonder what he would say about the present state of our nation and the huge health disparities that still exist between races. Black people have the highest rates of obesity, hypertension, diabetes, and hyperlipidemia, but also the worst outcomes. Learning these statistics about your people as a medical student is humbling.

I am 1 of 6 black males in a class of approximately 175 medical students at the Twin Cities campus. In 2019-2020 black males comprised 2.9% of medical school enrollment in the U.S., compared to the 3.1% enrolled in 1978-1979. Underrepresentation of black men is just as bad in medical leadership and academia. According to the U.S. medical school physician faculty data, 3.6% of full-time faculty in 2018 were African American or Black, while 5.5% were Hispanic, Latino, or of Spanish origin. Navigating the largely white medical environment while feeling like you have to represent your people every single day is isolating and beyond stressful. As if proving my value and fighting against internal and external stereotypes weren’t difficult enough, I am constantly reminded that I represent a medical institution that has historically experimented on, neglected, and harmed people of color. It pains me to see how the COVID-19 pandemic has only highlighted our nation’s sin towards its black and brown citizens.

I will never forget one of the patients I cared for while doing my surgery rotation. She was a woman with an extensive medical history that included obesity, diabetes, and colon cancer. She underwent an exploratory laparotomy due to a cecal perforation and intra-abdominal infection. I remember presenting her case the next morning and then walking into her room along with the rest of the surgery team. She was a black woman who wore a silk bonnet just like my grandmother. As we stood over her and examined her large incision and multiple drains, I couldn’t help but notice the power dynamic that existed between her and our surgical team. She was not only a patient of lower education and socioeconomic status compared to our group of highly educated physicians and physician trainees, but also a black woman at the mercy of an all-white team of physicians. I remember her saying that the pain was unbearable and that she needed stronger pain medication. My chief kindly and empathetically reassured her that her pain would improve and that the first few days were “the worst”. Our team walked out of the room, one by one. I was the last to leave. When I turned around, I saw her place her hand over her mouth and signal that she was about to vomit. After grabbing her a blue vomit bag and a box of tissue paper, I excused myself and left the room. In that moment, I felt terrible and helpless. I wanted to tell her that I held her small intestines in my hand to prevent them from falling off the table, as if they were the single most important thing in the world to me. I wanted to tell her about the anchoring stitches we carefully put in-place to secure her G-tube and diverting loop ileostomy. More importantly, I wanted to tell her that I saw her humanity and valued our shared identity as two black folks in a very white world.

In the past several weeks of rotating in psychiatry, pediatrics, and surgery, I have seen just how underrepresented we are in medicine. I have yet to cross paths with a black physician or surgeon in the hospital. As a third-year medical student, I realize that a physician’s empathy and connection to their patient can heavily influence their clinical decision-making and quality of care. That extra blood test or imaging study, that extra moment talking with a patient or their loved ones, that extra glance at a lab result, medication regimen, or wound care plan can make all the difference between a patient’s optimal recovery or unneeded suffering. When I rotated at a pediatric hospital in Minneapolis, I saw first-hand how institutional racism and prejudice delayed the diagnosis of critical subglottic stenosis in a 3-month-old African American infant with existing laryngomalacia. Her parents’ pleas for the doctors to fix their baby’s stridor and hypoxemia were repeatedly ignored by medical providers. It took several admissions to the hospital before ENT was finally consulted.

I’m thankful that the faculty and administration of my medical school are speaking out against racism and pledging to make major changes to “our curriculum, our leadership, our recruitment strategies, and our healthcare practices”, according to Dr. Tolar. However, to be honest, I’m cautiously optimistic. Promises, initiatives, and listening circles must turn into concrete action. Representation in medicine needs to be better than what it was 40 years ago. Recruiting more physicians who are racially, ethnically, and culturally representative of our patient populations will improve the quality of our care and the health outcomes of the people we serve. I don’t want a black woman in pain to feel isolated or unheard. I don’t want the desperate pleas of young black parents to be disregarded. That is why it’s so important for me to be where I am. This is our America and there is still more work to be done.

Sources Cited:

Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Published 2019.

Association of American Medical Colleges. Diversity in medicine: Facts and figures 2019. Figure 18. Percentage of all active physicians by race/ethnicity, 2018. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018. Published 2019

Message from Jakub Tolar, MD, PhD, Campus Public Health Officer. CO:VID Collaborative Outcomes: Visionary Innovation & Discovery. University of Minnesota email. http://view.ecommunications2.umn.edu/?qs=3929dd2741c50fcdbb00cd983d0aaf997b8c479d8fd856a850abc3944a5f4eb15d5db5efb032036c4bb7bdee747aeea4f64bce4c15ae3b237bec40d9c22bd7a68dc3209622e9b3650a9ca7bbbadd3932

Association of American Medical Colleges. Figure 15. Percentage of full-time U.S. medical school faculty by race/ethnicity, 2018. Diversity in Medicine: Fact and Figures 2019. https://www.aamc.org/data-reports/workforce/interactive-data/figure-15-percentage-full-time-us-medical-school-faculty-race/ethnicity-2018. Published 2018.