Black Man in a White Coat (24 page)

During basketball practices and games, whenever we played poorly, some coaches and older players would say that we were acting like fags or sissies, as motivation to make us work harder and perform better. We, in turn, used that same language to taunt our teammates and opponents. Back then I used those words more times than I can count. I never openly ridiculed anyone or harbored any violent impulses toward kids I thought might actually be gay. I simply avoided them.

My homophobia persisted in college. One day after a game or practice, a black teammate, talking about a gay singer or actor he'd seen on television, proclaimed that if his son ever started to act effeminate, he would “beat it out of him.” With his quick temper, there was every reason to believe that he was serious. Two or three teammates chimed in, agreeing with him. A few others laughed or smiled. I shrugged in tacit acceptance, as if trying to beat homosexuality out of your own child made as much sense as attacking someone who'd harmed your family. Or maybe I shrugged because we'd all heard so many statements like this before that it hardly seemed remarkable. No one objected or seemed troubled by his ignorant rant.

That same year, I was having lunch with a group of classmates, all black men, when we had a similar discussion. “There is no way I could have a gay son,” Allan said.

“Maybe it's not in your control,” his roommate said. “Maybe people are born like that.”

“That's crap,” Allan replied. “It ain't natural. It's all about how you raise your kids. Dudes turn out that way when they don't have a strong male influence.”

The notion that being raised by a woman would make a man desire another man doesn't make sense, especially given how many black boys are raised by single moms, but we all accepted his flawed logic. He won the argument with a stupid answer.

My attitude finally began to change during medical school where I worked with a few gay doctors and medical students, the first people I'd known well who were openly gay. I realized that in our shared experience in the medical field, our lives had a lot more similarities than differences. Further, my medical education revealed a certain commonality shared by all people. Even if one sexual, racial, or gender group got a given disease more frequently than another, all of us were vulnerable to sickness, injury, and, ultimately, death. From all I could tell, gay people, like everyone else, sometimes dealt with these problems well and sometimes did not. Across the span of a person's life, where so many things, both good and bad, could occur, being gay (or not) was just one part of any narrative.

The medical profession has historically suffered from similar homophobia. Until the early 1970s, homosexuality was regarded as an official psychiatric illness. Dr. Mark Schuster, chief of general pediatrics at Boston Children's Hospital, has spoken at length about his experiences as a gay Harvard medical student during the 1980s, when some doctors openly discriminated against gay patients and medical students. Schuster once saw a surgeon refuse to operate on a patient whom he suspected of being a lesbian. Later, when Schuster came out to a professor who'd previously given high praise to his work, the professor revoked his offer to write Schuster a recommendation for pediatrics training. Shuster reflected that he often found himself in the burdensome position of choosing between being a doctor and being openly gay.

Surgeon and writer Pauline Chen recounted a similar version of medical antigay bias in a 2012
New York Times
article, in which a supervising physician during her training chastised a group of young doctors for prescribing a “homosexual dose” of medication, meaning one too weak to properly treat the patient's problem. During my own surgery rotation in the late 1990s, the senior surgeon, frustrated with his junior colleague's efforts, told him that he was “operating like a fag.” In each case, powerful people were using homosexuality as a proxy for weakness and incompetence.

By the time I met George and Monica, I'd grown up enough during medical school to begin moving past this sort of bias, at least enough to recognize it when I saw it and to take care never to perpetuate it through my words or actions. As a black man, hating gay people simply didn't add up. How could I get upset about being discriminated against because of my race while ignoring, or worse yet, being a part of, prejudice that others faced?

But many blacks see it differently. In the era of HIV/AIDS, much has been said and written about homophobia within our community. Black people are often described as the most homophobic racial group in America. There is some data to support this contention. In 2008, black voters supported California's Proposition 8 renouncing marriage rights for gay couples at higher levels than all other racial groups. A 2013 Pew Research Center poll showed that while half of whites supported same-sex marriage, just over a third of black respondents felt similarly.

Based on the comments of public figures, as well as private discussions I've been part of over the years, it's clear that many black people reject a link between the civil rights struggles of the 1950s and 1960s and the contemporary legal efforts on behalf of gay people. Barack Obama framed the issue during a 2008 presidential campaign speech, which took place at Ebenezer Baptist Church in Atlanta, Dr. Martin Luther King Jr.'s church. “If we are honest with ourselves,” Obama said, “we'll acknowledge that our own community has not always been as true to King's vision of a beloved community. We have scorned our gay brothers and sisters instead of embracing them.” It was fitting that Obama's comments took place where they did, as black churches are widely seen as a main source in shaping the community's antagonistic attitude toward gays. In some of the black churches I've attended, the antigay sentiment has ranged from tacit disapproval to outright denunciation. For every Reverend Calvin Butts in Harlem and Reverend Dennis Wiley in Washington, D.C., both supporters of gay rights and acceptance, there are many more clergy who take the opposite stance.

In recent years, a handful of gay black celebrities have spoken on the issue. In a 2011 interview with the
New York Times
, CNN anchor Don Lemon asserted that being gay is “about the worst thing you can be in black culture. You're taught you have to be a man; you have to be masculine. In the black community, they think you can pray the gay away.” Lee Daniels, director of the movies
Precious
and
The Butler
offered a similar perspective, saying: “Black men can't come out. Why? Because you simply can't do it. Your family says it. Your church says it. Your teachers say it. Your parents say it. Your friends say it. Your work says it.”

To be sure, certain white churches, public figures, and political organizations can be equally virulent, if not worse, in their condemnation of gays. Hispanic and Asian cultures also possess their own share of homophobia. But when it comes to how these beliefs intersect with health, blacks are the group least able to afford such attitudes. In 2010, the Centers for Disease Control and Prevention reported that gay and bisexual black men, despite being a much smaller group than white gay and bisexual men, accounted for approximately the same number of new HIV infections; in 2011, this black group surpassed their white counterparts. Among the many causes of higher HIV/AIDS rates among black people, homophobia and the resulting sexual secrecy clearly play an important role. The time has come for the black community to confront some of its prejudices toward gay people.

*   *   *

In the final days of my internship, I had a chance to display my ever-increasing acceptance of gay people, but I almost blew it with one harmless-sounding question. On the medical ward one night, I admitted a young man named John. He'd developed sudden-onset chest pain at work, and within an hour, found himself in our emergency department where he was quickly diagnosed with a pulmonary embolus—a blood clot in his lungs. He was being admitted to the hospital to receive intravenous blood thinner and to search for any underlying cause of the clot. Before this, he'd been in great health. I stared at the age listed on his chart. We were both thirty. I wondered how I would have handled such a health scare. Would it have prompted me to quit the grueling life of medicine and find something else to do?

After taking the usual medical history concerning his recent physical symptoms and past health problems, I turned to his social history. As the medical internship year went on, I often found myself more interested in patients' social and emotional backgrounds than in their medical histories. A heart attack or stroke could only manifest itself and be treated in so many ways, but each person had the potential to teach me something about a particular part of the world or way of life that I'd never experienced, allowing me to grow both as a doctor and a person. For this reason, I'd found the field of psychiatry increasingly appealing.

John had grown up an only child in Raleigh and played baseball in high school. His dad was a lawyer and had attended the University of North Carolina at Chapel Hill (UNC) in the early 1970s during the era when black student enrollment there climbed. His mom was a high school history teacher who had also graduated from UNC. John followed his parents' path in going to UNC. After law school at Georgetown, he'd come back to North Carolina and become a junior associate at a law firm in Raleigh.

He drank one or two beers on the weekend. He'd never smoked cigarettes. He tried marijuana once during his freshman year at UNC.

“Do you have a wife or girlfriend?” I asked, as I continued the social history inventory.

He looked at me uncomfortably. He stuttered. “No, I…”

I knew I'd made a mistake. During my rotation through another medical service earlier that year, I'd been supervised by an openly gay doctor who corrected another intern during a presentation for addressing the patient and the woman beside her as sisters when in fact they were long-term partners. John rubbed his hands over his knees, his eyes darting away from my stare; he wanted to change the subject. As with George, it hadn't even occurred to me that he might be gay. I tried to take my size-fifteen foot out of my mouth.

“Are you involved with anyone seriously? A partner, a friend, or anything like that?”

Beads of sweat sprang up along John's hairline. “Yes. I have a partner.”

Usually that was code for a same-sex companion, but I was done making assumptions. “How long have you two been together?”

“About three years. He should be here any minute. He was in court today.”

“Two lawyers,” I said. “That's almost as bad as a doctor couple.”

He nodded, smiled, and then told me a little more about their history together, which went back to their time as law students. I completed the rest of the medical interview and physical exam, just as I'd done hundreds of times before. We shook hands and I wished John the best. I hope I'd shown him that I was willing to discuss his personal relationships and treat them no differently from any other person. He'd just had a life-threatening episode and wasn't yet in the clear. He deserved to be treated the same way as the next person facing these same fears.

Although far from perfect, I'd come a long way from the teenager and young adult who'd been firmly homophobic. I deeply regretted the times I'd used gay slurs or laughed at demeaning jokes about gay people. As my pager beeped and I headed off to see the next patient, I thought about how society might be different if more people had experienced changes of attitudes the way that I had. Perhaps if George or Larry had been surrounded by acceptance rather than hate, maybe they wouldn't have felt pressured to conceal their sexual identities. Maybe tolerance could have saved Monica's life.

 

P
ART
III

Perseverance

 

8

Matching

Lonnie, a Durham native a few days shy of forty, decided one morning that he was going to celebrate this upcoming milestone by lighting birthday candles. But instead of setting them atop a cake, he tossed them onto the wooden porch of his neighbor's apartment. When the police and fire trucks arrived on the scene, Lonnie ran back to his apartment and began hurling kitchen knives out of a window. Within an hour, he was brought to the Duke emergency department, where, just a few months after finishing my medical internship, I was now on duty as a psychiatry resident.

“We've got a live one,” the charge nurse said to me.

I looked up from the computer screen, where I'd been checking basketball and football box scores. It had been a quiet Sunday morning in the psychiatric wing of the emergency department. One patient had gone upstairs to our inpatient psychiatric unit about an hour earlier. Another was calmly awaiting transfer to the state hospital following a serious suicide attempt. Both patients had been seen and treated overnight by one of my colleagues. I'd been on shift two hours without having to do much at all.

“What's the story?” I asked the charge nurse.

“Schizophrenic. Tried to set his neighbor's apartment on fire. He's been rambling about Al Sharpton and Jesse Jackson. Real delusional. It's probably safe to say that he's off his meds.”

“Or maybe he's high on something else?” I countered.

“I don't think there's a drug in the world that can make you this crazy,” he said.

We shared a quick laugh. From a detached point of view, psychotic behavior was sometimes quite funny. But when you stopped and considered the person behind these symptoms, it was profoundly sad. And if you acknowledged that such illness could strike a friend or child and ruin his life, it was downright scary. It was easier to laugh than to cry or feel helpless.

I opened the computer database and scanned for records. Lonnie had been here once before, about a year earlier. That time he'd come in believing that the FBI was sending him threatening messages through his cell phone, so he'd coated his phone in flour and cooking oil and set fire to it in the middle of a busy street. He received injections of antipsychotic medication and was shipped to the nearest state psychiatric hospital. As I always did, I checked his chart to see whether he'd had any alcohol or drugs in his system at that time that might have explained his behavior. He had none. The nurse was right; this guy was really sick.