Black Man in a White Coat (4 page)

Yet this probably offered little consolation to the two black students who'd been forced to repeat their first year. It is often said that the hardest part of an Ivy League education is getting admitted. But for a significant group of black students, surviving medical school is a real hurdle. Some critics of racial affirmative action, such as Supreme Court Justice Clarence Thomas, contend that “stigmatized” black people are the real victims of racial preferences. Those in Thomas's camp assert that these black students' failures are largely due to a lack of adequate preparation or a mismatch between the student and the school they attend. Affirmative action supporters, on the other hand, are more inclined to believe that social aspects—such as feelings of cultural isolation faced by otherwise qualified black students—play a larger role.

During those first few months, as I was living the experience that so many had talked about in abstract and intellectual terms, I feared that both factors were working against me. As a black man from working-class roots and a state university, I worried about my future at Duke. Was I destined to become another academic casualty?

*   *   *

My racial anxieties intensified after Dr. Gale asked me to fix the lights in his classroom. Clearly, he didn't see me as a Duke medical student, nor was I confident that I could succeed at this level. According to Shelby Steele, a self-described conservative black scholar at Stanford University's Hoover Institution, this is one of the costs of affirmative action: It “nurtures a victim-focused identity in blacks” and increases their self-doubt as “the quality that earns us preferential treatment is an implied inferiority.” Steele makes some valid points, but his theory did not predict how I responded to Dr. Gale.

The way I saw it, confronting Dr. Gale about the incident seemed like a bad idea because he had final authority over my grade. What would I say to him? How would I expect him to react? Likewise, I felt that reporting the incident to a medical school administrator would prove futile, and possibly even damaging to my future at Duke. His words hadn't been blatantly racist, and I envisioned that his middle-aged white colleagues would have had trouble understanding why I had interpreted them that way. These influential people were likely to perceive me as a hypersensitive, borderline-militant black male looking to make everything into a racial issue. Given my innate aversion to controversy, that wasn't the reputation I wanted.

Further, if I complained to the administration, exactly what result would I have sought? For Dr. Gale to give me a formal apology? To all black students at Duke? Would I have wanted him forced into racial sensitivity training? Or something more serious, such as suspension or removal from his teaching duties? I couldn't imagine any of that happening; all I could foresee were future repercussions against me if I was labeled a racial agitator. If that was the power to be had from exposing this encounter, or identifying myself as a victim, then I wanted no part of it.

Given Stan's and Rob's reaction to the incident—laughter—I doubt my other black classmates would have acted differently. And yet I was furious. I had to do something with that energy in my own way, to show Dr. Gale how wrong he'd been. So instead of taking my case public, I turned inward and did what any good medical student knows best: I studied my ass off.

Day after day, I spent just about every waking hour with textbook in hand. I was determined to prove to each of my professors—but especially Dr. Gale—that I wasn't a token student admitted to medical school by accident or pity. After class, I headed straight to the library, reviewing my notes and rereading the material until the wee hours of the morning. No matter how enticing the invitations to take a break with classmates, I declined. For those next several weeks, I slept only three or four hours each night.

Other black doctors have traveled this same terrain. In his memoir,
Brain Surgeon,
Los Angeles–based neurosurgeon Keith Black recounts a similar episode during his medical school years at the University of Michigan in the 1980s. While working under a young physician he perceived as racist, Black was assigned to present a case to the chairman of the department. He prepared more diligently than ever before. “Obviously the chief resident was going to be gunning for me,” Black wrote, “but I decided that I would not live down to his expectations. It was time to stand and deliver.” Black warded off his supervisor's attacks and impressed the chairman so much so that the chief resident had to give him the highest evaluation possible, setting Black on his path to neurosurgery. Ben Carson, in his first memoir,
Gifted Hands
, tells a remarkably similar story from his surgical internship of his perseverance in the face of a chief resident from Georgia who “couldn't seem to accept having a Black intern at Johns Hopkins.”

In the days after the final exams, a nervous energy again pulsed through our class. With single-minded perspective, many of us attached the same importance to these results that a patient might to a skin biopsy or blood test. When word spread that the scores had been posted outside the main administrative office, we crowded around the 10-point-font printout that was stapled inside a large glass case. The report identified students by a number that had been given to us individually to maintain confidentiality. Along with our separate scores, the printout showed the class mean and graphed the results on a bell-shaped curve.

“There are some gunners among us,” a classmate mumbled to her friends.

The word
gunner
, slang for a hyper-competitive student, was new to me. We were all overachievers in a broader sense, but it was socially unfashionable to appear too ambitious.

Ordinarily, I might have cared about that distinction, but I was too preoccupied with proving myself to Dr. Gale. I knew I had done well on his exam; nonetheless, I was surprised by the result: In my class of one hundred students, I had received the second highest score.

Since the final counted twice as much as the midterm, I hoped that I had earned Honors, the grade reserved for the top ten or so students, even though my midterm score was nowhere near the top. I carried my exam to Dr. Gale's office during his scheduled student hours to find out the verdict. His cluttered office was open for visitors. We were alone to hash out my fate.

This was the first time we had stood face-to-face since our exchange a few weeks earlier. His eyes darted away for an instant as he tugged at his shirt collar. I knew that he recognized me. Surely, he understood that our initial interaction was at least potentially insulting, if not something more. Were the roles reversed, I would have apologized profusely—if not at the time of the mix-up, then definitely the next time we spoke. But Dr. Gale had no such plan.

“How can I help you?” he asked.

I gave him my midterm and final exams and asked whether I had met the cutoff for Honors. His eyes widened as he looked at the final exam score. He removed his glasses and squinted before putting them back on to make sure his vision was not failing. He then stared at my ID card, to see if the name on the exam matched my Duke badge.

“Wow,” he said, unable to conceal his astonishment. “I am very impressed that you scored this high. You've definitely earned Honors. You have absolutely nothing to worry about.”

I had imagined this moment from the time I turned in the blue exam books the week before, playing out all the pointed things I might say to put him in his place. But now that it had arrived, all I could do was stand there mutely.

“Congratulations,” Dr. Gale said, his excitement showing no signs of dimming. “This is really incredible. Would you be interested in doing research in my lab?”

In just a few weeks, I had gone from pariah to prize pupil. This unmitigated praise felt like another aspect of Stephen Carter's “best black” syndrome. The stereotype of black intellectual inferiority was so ingrained that for a black person to do as well, or better, than whites and Asians, they had to be “exceptionally bright”—earnest admiration and condescension wrapped in the same package.

I thanked Dr. Gale and told him I would consider his invitation, although I had no intention of doing so. I wanted nothing to do with a professor who could be so dismissive of me one moment, only to change his mind without apology, as if his earlier comments could be erased like chalk on a blackboard. I left Dr. Gale's office—the last time I ever saw him on Duke's vast campus—with a confused mixture of pride, relief, frustration, and bitterness. “Are you here to fix the lights?” stirred then—and still today—each of those emotions.

In the nearly twenty years since that episode, Duke has made clear strides on the racial front. Under the direction of admissions dean Dr. Brenda Armstrong, Duke has become one of the most racially diverse medical schools. Many of Duke's black graduates have gone on to specialize at highly competitive programs nationwide. Perhaps my success and that of others has enabled certain professors to embrace something once unimaginable.

At that time, however, I had no concerns for future black medical students. My victory was strictly personal. No matter what else happened, I had proved to myself, Dr. Gale, and any other doubters that Duke had not erred in accepting me. It didn't matter whether my classmates were Asian or Jewish, had gone to Stanford or Princeton, or had parents who were surgeons or law professors. I could keep up with them, and rightfully assume my own place as their peer. Affirmative action, despite its flaws, had worked. I had held up my end of the bargain.

But the good feelings didn't last long. As I transitioned from the classroom to the clinical setting the following year, I was about to witness the far greater struggles of black patients play out before me.

 

2

Baby Mamas

We heard the shrieks as soon as the automatic doors sprang open.

“Is that her?” I asked the nurse, hoping the sound had come from the waiting room television, but fearing that it came from the patient we were about to see.

“That's her,” the nurse answered. “This ain't going to be pretty.”

We hastened our pace as we approached her room in the labor and delivery triage area, where I was working overnight. Inside, a flurry of activity awaited us. Two nurses worked quickly, one inserting an IV into the patient's arm, the other adjusting the fetal monitor. A large plastic bag containing the woman's bloodstained underpants had been pushed into a corner. A small tank pumped oxygen through her pierced nostrils. A blood pressure cuff and pulse oximeter were connected to an overhead monitor that displayed her vital signs. Our patient looked sicker than I had expected.

She needed a doctor. But I was just a medical student, less than halfway through my second year of school. Just about anywhere else in the nation, that would have placed me in a lecture hall or laboratory doing the usual pre-clinical coursework known to all medical students. However, Duke condensed the traditional two-year classroom training into a single year, with students beginning clinical rotations a full year earlier than usual. The advantage was that it allowed upper-level medical students a full year for independent study; the downside was that it made us grow up quickly. Instead of looking at slides of diseased tissue under a microscope, I stood before a screaming patient who needed help.

Minutes before, I was as relaxed as a second-year medical student on overnight duty at the hospital can be. My classmate Roger and I were sitting in the staff lounge, our eyes on the twenty-five-inch TV. The college basketball season was in full swing and Duke, after a few years of uncharacteristic mediocrity, was back near the top of the national polls. The Blue Devils were in the midst of a big run when Carla, one of the nurses on duty, approached us.

“We got a call about a new patient who just arrived,” she began. “I paged the resident, but she's tied up with another patient, so I figured one of you could start seeing her first.”

Roger looked at me. He had taken the last case, an anxious woman whom our supervisor sent home after reassurance that she had not had a miscarriage. This new one was mine.

“What's the story?” I asked, turning down the volume on the TV.

Carla provided a quick synopsis. “It's a nineteen-year-old black girl with unknown pregnancy dates and history who comes in with painful vaginal bleeding.”

For a seasoned physician, her description would have sparked immediate ideas about diagnosis and treatment. While I was years away from that level of skill, one thing that I had learned in my handful of months on the hospital wards was how to ask logical-sounding medical questions: “How far along does she think she might be?
”

I knew that she had to be at least halfway through her pregnancy for us to be seeing her, as the emergency department downstairs handled cases under twenty weeks. Still, we needed a far better estimate. The timing would indicate whether the fetus could survive outside the womb, needed medication to hasten lung development, or might be delivered safely without any of these or other worries.

“She says she wasn't aware of being pregnant,” Carla snickered, running her fingers through her reddish hair. “But from the looks of things, she's got to be five or six months along.”

Fresh off a psychiatry rotation at a state institution, I instantly wondered whether our new patient had a mental illness. At the psychiatric hospital, delusions about pregnancy were not uncommon. Two women insisted that they were pregnant despite all evidence to the contrary, one going so far as to accuse me of being the deadbeat dad-to-be of her imaginary set of twins. This sounded like the same type of psychotic delusion run in reverse.

“Good luck,” Roger said, turning back to the Duke game.

I followed Carla down a long hallway toward the labor and delivery triage area, where we evaluated new patients. Through a large window, I could see that the sun had almost set, with the moon emerging across the sky. The quiet of the adjacent waiting area reflected this peaceful scene, except that now it was punctuated by our patient's screams.