Black Man in a White Coat (15 page)

I called Kerrie on the drive home at the end of that first day. We'd gotten engaged a few months earlier. She was working extra evening and night shifts at a local hospital to finance our wedding. I told her how stressed I felt. “Hang in there,” she said. “It's only going to get worse.”

She was right. The next day brought the start of my first thirty-hour shift. By the late morning, I was slowly feeling a little more comfortable with my new job, as I started to get to know our patients. But as my anxiety began to settle, Audrey, the second-year resident, burst into our workroom, her 100-pound frame opening the door with enough force to scatter papers across the floor. I flinched.

“We've got an admission,” she said.

“What's the name?” I asked, prepared to write this information on my clipboard.

She frowned. “I forgot already,” she said, shaking her head in disgust. “Anyway, he's a seventy-something white guy with shortness of breath, fever, a white blood cell count of twenty [thousand], a creatinine of 2.5, and an oxygen saturation of eighty percent on room air.”

Interns were not the only people reduced to colors and numbers. From her description, I knew that our patient was showing signs of infection as well as injury to his kidneys. Along with Gabe, the medical student on our team, we took the stairs down to the emergency department.

“We're from Green-Two,” Audrey told the ED doctor on duty. “Which one is ours?”

“Over there,” he said, pointing to the room closest to the nursing station. “Good luck.”

I looked at the chalkboard and saw Chester's name. Just as we were about to meet him, a middle-aged ED nurse approached me. “Watch out for that one over there,” she said in a thick Caribbean accent.

“What's wrong?” I asked.

I expected her to say the patient was agitated, confused, or some combination of the two. Instead, she leaned toward me and lowered her voice. “He asked a white nurse why there are ‘so many niggers' working here and said he did not want any ‘nigger doctors' taking care of him.”

“What?” I asked in disbelief, barely able to get out this single word. “He said that?”

“Verbatim,” the nurse said. “We ought to kick his ass out on the street.”

I glanced over at my colleagues, both of whom looked horrified. Although we were still relative strangers, I had spoken with them long enough to form first impressions. Gabe was a nature-loving type from California who had gone to college at UC-Berkley. Audrey was Jewish and very interested in women's health issues. Both seemed to have progressive sensibilities, and they bristled at Chester's language.

Audrey stared at me, wounded. It took a few seconds for her to regain her composure. “Don't worry,” she said. “You don't have to go in.”

“I'll be fine,” I said, forcing myself to breathe slowly. The idea of caring for a sick person was daunting enough without this other element. “But maybe you should do the talking.”

With Audrey leading the way, we approached Chester's bedside. He looked the part of a hospital patient, dressed in a gown, his body connected through plastic tubing to an oxygen tank, a liter of IV fluid, and a bag to collect his urine. His abdomen protruded as if carrying a full-term child, a sign of liver disease or perhaps simply a lifetime of bad eating. A scraggly beard covered much of his ashen face. He smelled as if he had gone days, maybe weeks, without a bath.

After Audrey made introductions, Chester grimaced and strained to lift his head off the pillow. His voice was feeble and raspy. “Where's my real doctor?” he asked.

It is not uncommon for patients to question the skills of interns and residents and ask to see their supervisor. But because of the nurse's advance word, his request took on a sinister tone.

“We are your doctors,” Audrey fired back. “And I am the one in charge.”

Chester looked past her, his eyes settling on me for an instant, his face a nasty scowl, before they rested on Gabe. “I only wanna deal with you.”

Gabe was just two years out of college, and with his deer-in-the-headlight gaze, looked as if he still belonged there. No patient could possibly mistake him for being our leader. Evidently, Chester didn't just hate “nigger doctors,” but female doctors too.

Audrey clenched her right hand so hard that she snapped the hook on her ink pen in half. “I'm in charge,” she asserted again, “so you can either answer my questions now or we can find you another doctor, which could take hours.”

Chester looked around in silence as if weighing his options. Finally, his discomfort trumped his prejudice. “What do you wanna know, lady?”

Audrey gripped the pen tighter. “How long have you been having trouble breathing?” she asked.

“I … I don't know.”

Audrey waited for him to say more. When he did not, she looked at me and sighed before turning back to him. “Did it start today? Yesterday? Last week?”

“Longer,” he replied. “Maybe a few months. But it's gettin' worse.”

Along with a lung problem, shortness of breath is a classic symptom of heart disease. She asked him about chest pain: “Yeah,” he said.

She tried to get a sense of where in the chest the pain was, whether it was constant, and when he had first noticed it. But Chester couldn't offer any useful answers. Nor was he able to tell us about any previous or current medical problems. Since this was his first admission to our hospital, we had no prior records. It appeared that he had gone years without seeing a doctor, and was, as I would discover was the case with many people, seemingly detached from his own body.

Audrey continued to question him until, like a witness on a painful cross-examination, Chester put his hands over his face: “I feel bad all over. Can't ya'll just fix me?”

We gave up on the interview. We took turns doing a physical exam: tapping, poking, and prodding his fragile exterior and listening for problems that could be heard but not seen. His EKG and early blood tests didn't suggest a heart attack, so our attention focused elsewhere. His lungs sounded as if they were badly congested. With his fever and cloudy chest X-ray, pneumonia was the most likely diagnosis.

“What an ignorant asshole,” Audrey said, as we left the ED and headed upstairs.

“You handled him pretty well,” I said.

“You too,” she replied. “I'm really sorry about what he told the nurse.”

The last thing I wanted was for her to feel sorry for me or think of me as some kind of racial victim. “It's okay,” I said. “He didn't seem to like you that much better.”

We shared a quick laugh. I spent the next hour or so entering Chester's treatment orders and writing his admission note in the chart while answering nursing pages about my other patients. A second new patient arrived shortly afterward, this one healthier and able to give us a coherent story that made our work easier. And he seemed to have no problems with me or Audrey. A few minutes after I had finished his paperwork and was set to take a short break, a fellow intern entered the workroom.

“I need to sign my patients over to you,” he said.

I looked at my watch. It was shortly after five p.m. “Okay,” I said, feigning calm.

This was standard practice. Someone had to be responsible for the patients on the teams who were off duty, otherwise each intern would be on call every night. He showed me his list of patients, which contained their names, diagnoses, medications, and active issues. One person needed his blood drawn at nine p.m. to measure how well his blood thinner was working. Another needed blood culture samples taken to rule-out an infection if she developed a fever. A third was getting an emergency head CT scan after falling in his bathroom, so I needed to review the results with the on-call radiologist. Over the next forty-five minutes, two other interns tracked me down with their lists. One had five patients, the other ten. More blood draws and blood cultures and images to review with the radiologist. My head started to throb.

By the time all the interns had checked out their patients, it was nearly six p.m. My appetite was shot, but I rushed to the cafeteria and forced down a greasy hospital-issued steak that was my last opportunity for any food for several hours. As I returned to the ward, my stomach rumbled in much the same way it had before a basketball game or important interview. This time, though, the stakes were much higher. I was responsible for more than thirty patients, many seriously sick. One of them could easily die from something I did or failed to do. Doctors aren't alone in facing life-and-death scenarios on the job, but I couldn't imagine an inexperienced pilot being left to fly a commercial jet solo.

Fortunately, no one died or came close to it on my first night. In fact, nothing occurred that was beyond my level of training. But that didn't mean things were easy. The workload was steady as I admitted three more people while covering the other teams' patients. Between trips to the emergency department, the radiology suite, and back to the medical ward, I must have logged five miles on foot while trying to stay alert on a sleepy brain. In the end, I didn't sleep at all. I might have had twenty minutes here or there to shut my eyes. The hospital had a room where we could sleep, but I never found it. As the sun shone through dingy hospital windows the next morning, I felt my body shutting down. My joints ached. My muscles trembled. I needed a bed.

Never before had I pulled a true all-nighter. Even in medical school, where I worked diligently to prove to Dr. Gale and others that I belonged at Duke, I made certain to get at least a few hours of rest each night. As long as I could remember, sleep had been a top priority. When friends in high school and college bragged about staying up late, I frequently slept eight or nine hours each night; rarely did I get less than six or seven hours. Yet here in my new life, this luxury was simply not possible. I felt like punching a wall.

When I left the hospital later that afternoon, I was so frayed that my encounter with Chester felt like a distant memory. But he would soon return to the forefront of my thoughts.

*   *   *

I was an official M.D. when I met Chester. That meant that I had spent two of my required four years in medical school completing rotations across a variety of fields, such as surgery, pediatrics, and neurology. During those years in the hospital and clinic, I worked with hundreds of patients and families, but always under the clear direction of at least one physician. No one mistook me for their doctor, nor did I have that responsibility.

At least once a day during my rotations, my race would come up in an interaction with patients. The racial conversation was usually implied rather than explicit, as one person after another, usually white, took one look at me and inquired about my basketball skills.

Most asked: “Did you play ball?” The more presumptuous asked: “Where did you play?”

Others offered career advice: “You're wasting your time in school. You should be playing in the NBA.”

“A tall black like you with long arms and legs should be on a basketball court and nowhere else,” an elderly man once said to me, much to the dismay of his more-tactful daughter.

Some simply refused to believe that I didn't play for Duke. “What is Coach K really like?” a UNC–Chapel Hill fan asked me. “Is he really as much of a jerk as he seems to be?”

The truth was that I'd only had two passing encounters with basketball coaching legend Mike Krzyzewski—once outside the hospital and another time at a campus gym—and both times he seemed quite pleasant, in clear contrast to how he sometimes came across during games on television. But I was wasting my breath trying to explain that to this die-hard Tar Heel fan.

“How on earth do you balance your hospital schedule with all your games and practices?” another patient's wife inquired, the lines on her face conveying deep concern for my well-being.

One day, as I was heading from the medical ward toward the cafeteria, a middle-aged man approached me, his hands shaking, his voice trembling. “I don't normally do this, but you look like a famous basketball player I've seen on TV,” he said. “Can I have your autograph?”

He must have thought that my white coat and necktie ensemble was my Clark Kent cover to disguise my true identity as a basketball superhero. I politely refused to autograph his napkin, telling him that he had mistaken me for someone else, but he probably thought I was displaying the kind of elitist snobbery that many associate with Duke.

Rarely did these sorts of comments, when taken in isolation, really bother me. Like many stereotypes, this one had some truth behind it. After all, black players make up more than 75 percent of NBA rosters, six times our numbers in the general population. And back then, I was a youthful, slender, six-foot-six former hoopster. It was not as if they were asking a five-foot-five guy with stubby fingers and a beer gut if he could do a 360-degree dunk simply because he was black.

Yet along with some people's certainty that I could dribble and shoot came, at least to my thinking, an assumption that I was a dumb jock. In other words, athletic talent, at least for black players, was inversely proportional to native intelligence. This perception had followed me since high school. Back then, while discussing the prospect of college, one of my coaches flat-out predicted that I couldn't score better than 800 on my SAT (the older version was based on a 1600-point scale), even though he knew I had a near-perfect grade point average in a magnet-school curriculum in which students routinely scored above 1200. A few years later, during a basketball camp, a college coach refused to believe my actual SAT score, suggesting at first that I had misread the score before later accusing me—in front of a handful of other coaches and players—of lying to make myself look good.

So as patients and families asked about my athletic résumé, I worried less about their perception that I must be a good basketball player than I did a question specific to my future: Would they doubt my ability to be a competent doctor? If so, would that hinder my career?