Black Man in a White Coat (16 page)

I was not alone among black students when it came to facing limiting stereotypes. Pete, who was a few classes ahead of me at Duke, told me that more than once both nurses and patients had mistaken him for a patient escort even though he always wore a necktie and white coat. His classmate Susan one-upped him: After she'd finished performing a physical exam at a man's bedside, he asked her to take away his tray and bring him coffee. When she refused, he told her that she was not doing her job and that he would report her to her supervisor. Their stories sounded uncomfortably like another version of Dr. Gale asking me to fix the lights in his classroom. No matter the successes that led us to medical school or our achievements there, it seemed some segment of the population would never fully recognize us.

The insults didn't stop once you became a doctor. During her child psychiatry fellowship at Duke in the 1970s, Jean Spaulding, the first black woman to attend medical school at Duke, encountered a family that didn't want her to treat their grandchild: “Oh no,” they said. “She's a black person, and she can't treat our grandson.” Another black doctor described a scenario in recent years where the chief of a clinical service walked into a patient room in his white coat, flanked by several white residents and medical students, only for the woman to ask him to take her tray away, as she had assumed he worked in the cafeteria.

Nor were these stereotypes restricted to the South. Otis Brawley, executive vice president of the American Cancer Society, and Pius Kamau, a Denver-area thoracic surgeon and newspaper columnist, have recounted similar experiences with patient and family prejudice in their writings. Brawley, while a medical resident at a Cleveland hospital, describes caring for a terminally ill man whose family repeatedly questioned his “credentials, competence, and education.” Kamau, while on duty one day, discovered that his new patient, critically ill, had a swastika tattooed across his chest. After fixing “hate-filled eyes” on Kamau, the young man refused to acknowledge him, choosing to communicate to the doctor through various white nurses and other staff, “as if I spoke in another language,” Kamau wrote.

Dr. Marcella Nunez-Smith of Yale explored this issue in a 2007 project where she conducted detailed interviews of twenty-five African American physicians practicing in the New England states. The study revealed a recurring theme of black doctors facing discrimination from some of their white patients. As one medical subspecialist phrased it: “We have just met and they want someone else. I don't think that most patients want to discriminate against me … but patients sometimes expect us not to do a good job or as well as somebody else would do.”

A pediatrician offered a more blatant story: “I was removed from taking care of a white individual. The division chief and I talked later. The parents were uncomfortable with me taking care of their child. They told him they didn't think I would be capable because of my race.” Nunez concluded that the pervasive nature of negative race-related experiences leads to “racial fatigue” that contributes to higher rates of job dissatisfaction and greater changes in career trajectory among black physicians. A life in medicine was tiring enough without the added baggage that race sometimes brought with it.

By the time I met Chester, I had certainly heard about other doctors' experiences with patient prejudice and had experienced it in a more benign form myself during medical school. Neither context, however, had prepared me for the day when Chester demanded “no nigger doctor,” nor how that request would shape the aftermath of our initial encounter.

I was no longer a medical student whose only real objective was to learn. I was a doctor. Despite my inexperience, I would be the one nurses called when an issue arose with Chester. I could order tests and prescribe or withhold medications that directly affected his well-being. How would Chester cope with this situation? Would he request another doctor? If not, would he continue to refuse to speak with me? Would he allow me to draw blood or do other procedures on him? Would I have to deal with a family full of people who shared his prejudices?

*   *   *

On the night of his admission, Chester had drifted in and out of consciousness, the result of his combined kidney failure and pneumonia. The next afternoon, the medicines we administered had started to take effect, treating his infection and gradually restoring his kidneys to working order. By the following morning, his third day in the hospital, he was wide awake.

When I arrived at the hospital that morning, I met with Sanjay, a fellow intern who had been on call overnight and covered my patients. He still had on a hospital-issue scrub top from the night, having had no chance to freshen up and change back into his shirt and tie. He scratched at his five o'clock shadow as he gave me updates on my patients. He told me that one of them—a young man with a blood clot—had developed mild chest pain. He'd done the necessary workup and everything had come back fine thus far. Sanjay commented that this man wasn't very nice, which was true. I told him, however, that he was lucky he didn't have to go see Chester.

“What do you mean?” Sanjay asked.

I told him about Chester's “no nigger doctor” comment. “That sucks,” he said, wincing. “If it makes you feel better,” he said, “the last time I was on call, I saw a real racist asshole too.”

“What happened?” I asked.

“He asked me where I was from. I told him New Jersey. He said: ‘You must mean New Delhi. I've never seen anyone from New Jersey who looks like you.' Then he laughed out loud. He's lucky I'd already drawn his blood. Otherwise, I might have made it extra painful for him.”

I cringed. Sanjay's parents had come to the United States from India and settled in New Jersey several years before he was born. He had lived his entire life in America. He liked rap music, football, and science fiction movies. He was as American as anyone else, only some people couldn't get past his physical appearance. Up until then, I'd been so focused on the challenges black doctors dealt with that I hadn't given thought to what other minority doctors might face.

Audrey, my resident supervisor, arrived in our workroom a few minutes later along with Gabe, our medical student. She looked totally refreshed, her body seemingly accustomed to the quick recovery required to survive on the hospital wards. Gabe and I, novices to this way of life, looked and felt as if we needed a few more hours of sleep.

“Where do you want to start?” I asked, as I scanned the list of patients on my clipboard.

“We might as well get the worst one out of the way,” Audrey said.

We all knew whom she meant. The three of us headed down the hallway where we passed by hospital staff going about their duties. At least half of the nurses who gave medications and the phlebotomists who drew blood on our unit were black. The nurses' aides, who measured vital signs according to doctors' orders, were exclusively black. Chester had come to the wrong hospital if he hated black people. And then he'd had the bad luck to wind up in the care of the one medical team that had a black doctor. He probably thought that he was in hell.

We took a collective deep breath and entered Chester's room. “Good morning,” Audrey said.

Chester gave a silent, forced grimace, clearly unhappy to see we were still his doctors.

A middle-aged woman and young man sat at his bedside. She gruffly introduced herself. “Molly,” she said, frowning at us. “I'm his oldest girl.”

She wore a T-shirt that proudly displayed the Confederate flag. Her face had the weathered look of someone who'd spent too much time in the sun, smoked too many cigarettes, and drank too much alcohol. “This is my son, Thomas,” she told us.

The young man nodded. He had a crew cut and thin forearms covered with menacing tattoos. His shirt pocket flaunted a smaller Confederate flag. To my sensitized eyes, he looked the part of a virulent racist. Instantly, my own racial prejudice arose, as my imagination put him in an old pickup truck, heading to a roadside bar where he would get drunk and get in a fight over a girl who wore too much makeup.

With manners similar to her father, Molly derisively asked: “Who's in charge here?”

Audrey dispensed with pleasantries and explained Chester's case in cold, clinical terms. At that point, we were confident that his kidney failure was secondary to his pneumonia, and we were still trying to determine if there was some other problem taking place with his lungs. Molly challenged her at first, but Audrey maintained an attitude that conveyed “I know what I'm talking about” as she replied to every question. After a few minutes, Molly and her son seemed satisfied that Chester was getting good medical care, even if they disliked who was giving it.

As we stepped outside the room and headed to see our next patient, Audrey made a fist. “Ignorant jackasses,” she said. “I think we should trade patients with another team. At least two of the teams here have only white men. We might as well give these fools what they want.”

I was dismayed at this idea. A change in teams would mean notifying our supervising faculty physician along with one of the senior chief residents, not to mention forcing this bigoted man and his progeny onto someone else. Even if Audrey was the one making the request, I knew that our supervisors would assume that I was the one behind it. At that stage of my career, at the bottom of the physician totem pole, dealing with a racist family sounded infinitely preferable to drawing more attention to myself than I invariably did. I preferred to just suck it up and move forward, just as I had with Dr. Gale during my first year of medical school. Once again, I feared developing a reputation of being hypersensitive on racial matters. So I convinced Audrey that we would be fine. All we had to do was stick to the medical facts, as she had proved with Molly. “You're right,” she conceded.

Each day, I updated Chester's family on his progress. The visitors expanded to include a sister, another daughter, and a few grandchildren. Whatever doubts the family may have had about me they kept to themselves, perhaps comforted in knowing I was supervised by someone they saw as competent. Gradually, while tending to Chester's physical ills, his family provided me with a view into his life. He had been married for fifty years and took care of his wife in her final months after a stroke. They had three daughters and seven grandchildren. He worked in a textile factory most of his life. He loved fishing.

About a week and a half into his stay, Chester finally acknowledged me when I asked him one morning how he felt. “Okay, doc,” he said. “I think I'm gettin' better.”

I felt a sense of calm rush through me now that he had recognized me on my own terms. On the overhead television, a sportscaster from ESPN was projecting which teams had the best chance to win the World Series. I decided to try to connect with him.

“Do you like baseball?” I asked.

“Love it. Ever since I was a little boy,” he said. His eyes lit up. For a few moments, an old man in a decaying body tapped into his youth.

“Who's your favorite team?” I asked.

“The Braves,” he said. “Even going back to when they was in Milwaukee.”

At the time, the Braves were a powerhouse team. But they were also known for their biggest star for two decades, Hank Aaron, a legend who faced racial insults and death threats in the 1970s as he approached, and eventually surpassed, white slugger Babe Ruth's home-run record. How did Chester reconcile his love for this team with his hatred for blacks? Maybe in the same way that I sensed he was grudgingly coming to accept me as his physician.

A few days later, his oldest daughter Molly began to soften too, as she asked about my personal life for the first time. “Do you know what kind of doctor you wanna be?”

“I'm not sure,” I said. “Maybe a heart specialist.”

“You should be a surgeon,” Molly said. “You're good with your hands.”

I smiled. The day before, I'd drawn blood from Chester after the phlebotomist had failed. In truth, however, I had a nervous temperament that would have doomed me in surgical training. But with Chester, my needle sticks were smooth. Being challenged had brought out my best.

“You got a family?” Molly asked.

“Molly,” Chester admonished, as if his daughter was still a small child. “You ain't supposed to ask doctors personal questions like that.”

“It's okay,” I said. I told her that I was engaged and hoped to have children one day.

“I'm sure you'll be a good dad when the time comes.”

Tension oozed from my back and shoulders. For the first time, I felt relaxed around them. Suddenly I was having a regular conversation with regular people, not feeling like I was running from a mob that wanted to see me locked in jail or strung from a tree.

Jean Spaulding described developing a “wonderful relationship” with the family that initially refused to have her treat their grandson. Neurosurgeons Ben Carson and Keith Black described similar breakthroughs in their early years as doctors. In his book
The Big Picture
, Carson recalls encounters with patients at Johns Hopkins who “obviously came in with a bias against people of my race,” highlighting the gratitude most of them felt after he had treated them or their children. Black recounted a particularly stunning interaction during his neurosurgery training at the University of Michigan. “I would like to thank you for two things,” the patient said to him: “one, for saving my life, and two, for changing my point of view. Before you took out my brain tumor, I didn't like black people.” Decades later, I was navigating the same path that each of them had traveled, and finding it no less rewarding.

But as Chester's prejudices eased, his body rapidly failed him. Within a few days, his kidneys, after early improvement, began to shut down again. He also developed a multidrug-resistant infection in his bloodstream that, along with his kidney failure, led to a dangerous acidic state in his blood. A CT scan of his internal organs confirmed our worst fears: His pneumonia was the complication of an aggressive cancer that had spread throughout his body.