The racism in medical education cannot be ignored

The abandoned retractor clatters dangerously close to the other edge of the sterile field, saved only by the quick reflexes of the scrub nurse. The attending lets out a brief laugh, “I guess we’re using the Madagascar technique,” then it’s back to the operation at hand. Minutes pass as I continue to stand in my assigned place at the attending’s side, prepared to offer whatever meager contribution I can to this operation’s success. Then, again, an instrument nearly slips off the field only to be saved by, again, our nimble scrub nurse. The attending lets out another laugh, “It’s OK, we’re using the Madagascar technique.”

The resident’s curiosity is piqued, “What do you mean by the ‘Madagascar technique?’”

Without breaking stride, the attending explains matter-of-factly, “Madagascar, you know, Africa. Less civilized.”

She works busily in silence, hands moving steadily, surely over the exposed flesh on the table. She speaks up once more, “It’s an animated movie too, so it’s less offensive,” then back to business. And once again I am rudely reminded of my own unique vulnerability as the only Black person in the room, even as I quickly secure the mask of cold professionalism on my skull.  We are still in an OR; the fact that I am wounded does not give me leave to bleed.

As a Black man pursuing the MD, it is impossible for me to ignore how our numbers thin the farther I climb toward this mountaintop. When the AAMC reports that there were fewer Black men enrolling in medical school in 2014 than in 1978, they are merely quantifying the feeling of isolation that I experience more days than not. I am a stranger too long in a mostly friendly enough but still foreign land, longing for a home that grows exponentially farther away in emotional distance with the passage of time.

This feeling is hardly helped by the innumerable casual slights offered to me by patients, residents, and attendings. The patients that continually ask me where I’m from, where I’m “really from,” where my parents are from, because they simply cannot wrap their mind around a Black man in a white coat who calls America home, even as he continues to patiently assert this in his undeniably Midwestern accent.

The resident who thinks the height of comedy is imitating her Liberian patient’s accent. The attending who commandeers the beginning of a team conference to complain about protests against racist microaggressions while the only Black student in the room is left to squirm in the corner. The offenses continue ad nauseum.

Individually, one would be hard-pressed to notice most of them. But when the blows come week after week, individual difficult interactions coalesce into something more sinister, a constant drumbeat whose steady rhythm is a constant reminder of my status as the outsider, the perpetual other. The feeling is hardly helped when I observe the odd sort of solidarity that is formed and maintained by these interactions.

One week, it’s an attending complaining about microaggressions, the very next the chief resident is in on the joke and a good laugh is shared by persons secure in their knowledge that they will never know the pain of the objects of their ridicule. I observe these interactions remotely, an astronaut in deepest space, observing a distant sun on a monitor before me. Contemplating all the light that cannot touch me, the warmth I cannot feel.

In my school, we have a form students can fill out anonymously when they’ve been mistreated. It is common to hear attendings and residents mocking the form, right before or after they do something they believe will offend the sensibilities of the “soft” students working under them.  I can hardly blame them; in a career already suffering under the burden of heavy documentation, one more form signaling one more onerous task under the seemingly all-powerful bureaucracy is hardly going to win over hearts and minds.

Yet, our collective dialogues over racism have become so poisonous that face-to-face conversation is nigh impossible; the mere hint of racial issues makes hackles rise as we talk past one another, and the issues go unsolved. And it is ultimately the patient’s loss as precious time and energy that could be spent addressing their issues is diverted to internecine strife.

This impasse is my motivation for writing this, a direct appeal to others’ better angels. In the moments between clinical hours, when I am able to speak with students who look like me, I seek advice and insight. “Smile, even when it hurts,” says one. “Take what they feed you and use it to work harder, longer and shut them all up,” says a chorus of others. Implicit in all these statements is an assumption that we cannot expect better; that the arc of the moral universe ends here. I refuse to believe that.

As I persevere and become the physician that all my patients, every color and creed, need and deserve, I don’t want to see my team as just another obstacle to surmount. I want to succeed because of the people around me, not in spite of them. And I’ve seen too many instances of physicians acting with superb empathy toward patients and med students alike, even towards me, even from those physicians who would later offer stinging insults by way of careless remark or tasteless joke.

If I truly believed that my superiors were irrevocably racist, writing this essay would be of little use. What I see is blindness to the harm done by careless words.  I want to push past the venom. I’ve spoken to more than one other student of color who has felt the need to offer written complaint. And I still can’t speak for all, but overwhelmingly our motivation for doing so is not petty revenge or self-satisfaction, but a desire to spare the next student from similar treatment. Honest criticism seeking receptive ears; I truly believe we can find them.

The author is an anonymous medical student.

Image credit: Shutterstock.com

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