My patient called me the N-word [PODCAST]

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“There were many things to be processed about that event. It happened within the context of the COVID-19 pandemic, its disproportional effects on the African American community, and a few days after the murder of George Floyd, an African American man killed at the hands of a Minneapolis police officer by asphyxiation. His murder was the third in a row of recent and widely publicized, unjust killings around the country. First, Ahmaud Arbery; second, Breonna Taylor; and third, George Floyd — all within a few short months. Their deaths sparked a social zeitgeist that exposed America’s divisions and systemic racism at a level we haven’t seen in a long time.”

Toba Bolaji is a surgery resident and can be reached on Twitter @tobabolaji.

He shares his story and discusses his KevinMD article, “The day my patient called me the N-word.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Toba Bolaji. He’s a surgery resident, and he wrote the KevinMD article “The day my patient called me the N-word.” Toba, welcome to the show.

Toba Bolaji: Awesome, thank you. I’m happy to be here.

Kevin Pho: So we’ll get into the article a little bit, but first off, can you share your story and journey to where you are today?

Toba Bolaji: Definitely. So yes, my name is Toba Bolaji. I’m a current PGY-3 resident based in Wilmington, Delaware, Newark, Delaware, as well. I was born in Nigeria, but I call Toronto home. I lived there and grew up there, and then came to the States for school. I was first in Pittsburgh, in Philadelphia, from Mexico, and now in Delaware. So it’s been a cool journey. Many amazing people have made great impressions on me and pushed me in the direction of where I am now, so I’m definitely appreciative.

Kevin Pho: So over the last year of the pandemic, of course, it’s affected pretty much every facet of the medical system. So talk about how the pandemic in general has affected your surgery training.

Toba Bolaji: Yeah, it’s been interesting. In the first months of the pandemic, we were trying to figure out, as an institution, how to allocate resources and tailor the hospital environment to what was going on. We saw, at Christiana, a lot of changes. For one, as a surgery resident, there was a national standstill with elective cases, and so our volume went down pretty significantly, and that actually meant some time off for us. The traditional 80-hour weeks went down to much less than that over a period of probably one to two months. And since then, we’ve had to pivot as it relates to meetings and our education time. And then, obviously, that time outside of the hospital has also changed, so, honing in on how we deal with our stresses and how we find wellness, we’ve had to pivot in that direction too.

Kevin Pho: I would imagine. One of the articles that was written on my site, I think a few years ago, was talking about the decreasing number of training hours one has in the hospital, and of course that’s compounded by the pandemic. Now, you obviously have been in surgery training for the last couple of years. Is there a concern about the fewer procedures that residents in general are doing?

Toba Bolaji: Yeah, no, that’s a good point, and I think that answer probably varies depending on where you train. I can think about where I train currently, and I think we’re fortunate in the sense where we aren’t really concerned about volume as much, and so our numbers by the end of our training seem to do well in comparison to the best in the country. And so we don’t have that concern much.

I think, as a general medical field, surgical field, the way we manage patients these days is less and less invasive and more and more nonoperative. But I think that just comes down to technology, and so we have to find a way. How do we integrate technology into what we do? And sometimes it’s not necessarily learning fewer procedures, but different approaches to procedures. Robotic surgery and laparoscopic surgery have, in some aspects, become the standard of care in many traditional procedures. So I think it’s about pivoting and knowing how to still keep up my skills and/or learn new skills, given the times.

Kevin Pho: All right, so let’s transition now into the KevinMD article that you wrote. It was written back in March, and it’s titled “The day my patient called me the N-word.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Toba Bolaji: So the article starts off with a story, an anecdote about an experience I had with a patient. The event actually happened a little over a year ago, this time last year, in the middle of some of the social issues that had been going on around us. And I had this experience, and, as you’ll see in the article, it pivots. It takes off into how this experience propagated a cascade of thinking through how we as a medical community think through, or really don’t think through, and discuss some of these social-type issues.

And so the point of the article is to say, “Hey, this thing happened to me.” And it wasn’t really, I didn’t feel victimized. I just recall the feelings that I had: I didn’t really feel victimized. I didn’t feel like anyone needed to avenge my honor. I didn’t feel like that patient necessarily needed to be reprimanded or anything. But what I did feel is this kind of timidity, or timidness, when it came to telling people, because I didn’t know how people would feel about it, and I didn’t know what kinds of discussions that would raise. And so I say that I was nervous that if I told my closest colleagues, their silence on the matter, which in some ways I could have predicted, would probably have been more hurtful than the event itself.

Kevin Pho: For those who, again, didn’t read the article, can you just give a general scenario of what happened with that patient and what happened to you after? You mentioned there was a little bit of timidity, but share: What did you do after that event?

Toba Bolaji: So the story is one where I’m taking care of a patient, and we rounded on the patient in the morning. Usually on post-op day two, we take off the surgical dressing, and as anybody who’s ever had surgery knows, sometimes even taking off the tape can be really painful. So as I do with all my patients, I ask if it’s OK to take it off, and I use a little rubbing alcohol to make it come off more gently. And this patient, obviously aggravated by the taking off of the tape, in a moment of frustration, kind of yells the N-word at me. In the moment, I froze, because I never really thought that could happen, or would happen at work, where someone saw me as the physician, in a situation where I’m providing care for them. How could they almost demean me in a way, given that kind of relationship or rapport that we would have?

And so the article then transforms into this idea of: What do I do now? I don’t necessarily feel like my honor needs to be avenged by this, but I think people need to understand this is an experience that minorities in this field go through, and that it often adds to not feeling like they belong, or having imposter syndrome, and things like that. And so the lesson in the article really comes down to the fact that I struggled with: Do I do something I can talk about? Because if I went to my program director, if I went to my fellow residents, if I went to attendings, I was nervous that many people would just maybe not really know what to say, or not say anything at all, or even say the wrong thing, or whatever it may be. And that apathy that may come off of it would be more hurtful to me.

And so the charge at the end is telling people, telling medical professionals: We have hard conversations all day. That’s part of our training. We have no issues talking to patients about difficult diagnoses and plans of care, but oftentimes it’s just silence around these types of issues, and it really doesn’t make sense. We can’t really talk about the general wellness of people without addressing some of these inequities, and I think it’s kind of hypocritical, essentially, to be silent about it.

Kevin Pho: Tell me, what would have been a constructive response had you gone to talk to an attending? What are some points that that attending could have brought up, perhaps a constructive way to address it? So what would be your suggestions?

Toba Bolaji: That’s a good question, because often a lot of people, and it’s because this article has created a lot of good conversation as a product of it, because of my attendings and fellow colleagues. And the answer, I can’t say I’m an expert on the answer, but if I am telling people, I think that, one, there should be a validation of the person’s experience, saying, “I’m sorry that you went through something like that.” I think that’s key. And then there should also be a validation that, me as the attending, or me as the other person receiving the message, “I can’t fully know what it feels like to be in your shoes, but I’m willing to listen. And is there anything I can do to change these things?”

So I think it’s a validation of a person’s experience, but also, within that, you have to come humbly and say, “Hey, I can’t fully understand, because I don’t look like you. I don’t have the same skin tone as you. I can’t fully understand what it feels like, and I’m sorry for that.”

Kevin Pho: So in your article, you did a hypothetical response where someone may respond, “This is not a problem that affects me, so why should I care?” What would be your answer to someone who thought that?

Toba Bolaji: Yeah, well, I think the problem is it perpetuates a feeling of apathy that makes it feel like it’s OK. I don’t think that everybody has to. There’s a lot of injustice in the world, and you can’t attack everything as one person. You pick and choose your battles, and I do think that’s OK. But especially in the kind of social zeitgeist that we have, there is a specific call within this time to think about racial inequality, especially in this time that we’re in right now. And if that’s your response, like, “It doesn’t affect me, so why should I care?” I think it definitely gives off a very dangerous rhetoric, especially at this time. Not to say that you have to be on the front lines of everything and you have to outwardly fight, but there should be a consciousness of things going on, and I think an intentionality in wanting to understand it more.

Kevin Pho: In your article, you also bring up the murder of George Floyd. Can you speak to how that event has affected you as a physician?

Toba Bolaji: Yeah, I think I’m not alone in saying that these types of things have affected a lot of people who are, a lot of Black Americans and Black people in general who live in this country. I think, for me, it brings into question how close my own mortality potentially could be. I feel like there’s a privilege that we all have as physicians, right? In the community, we’re generally looked at favorably, meaning people generally have a specific respect, just by our earned title, good or bad. But at the same time, when I do see these kinds of senseless killings that don’t really make sense, and they’re very hasty, and I feel like there’s no thought process, and definitely not justified, it makes me think, “Wow, I could be one of those people.” Never did I think that I could, because I didn’t see myself in those kinds of situations, per se. But it often feels like, does it even matter? Like, just a small traffic stop leads to these kinds of things. I think many of us think about that a lot.

Kevin Pho: We are talking to Toba Bolaji. He is a surgery resident. He wrote the KevinMD article “The day my patient called me the N-word.” Toba, for those who don’t have your lived experience, what are some actionable tips on how we can better ally?

Toba Bolaji: A few things I would say. Don’t be afraid to ask questions, and when you do, ask humbly. Read about the history of these types of things and racial inequalities in general, things like redlining, things like the downfall of Black Wall Street. I think there are a lot of examples of racial inequalities, especially from a systemic approach, that we can call out, and that show that a lot of these issues are ingrained in the infrastructure of this country. And so I think it starts there. I think it’s doing the work behind the scenes to know about these things, but then also not being afraid to engage people and to ask questions, because oftentimes your silence, and your inability or your lack of courage to ask, can often be misconstrued as apathy.

Kevin Pho: And I guess from an institution standpoint, whether we’re talking about academic institutions, hospitals, or medical schools, what are some things that they can do?

Toba Bolaji: I think right now, diversity and inclusion is a big buzzword when it comes to institutional infrastructure and how they figure that out. And so a lot of people are starting to figure out what it looks like to be diverse, and I think it’s often just defined by the numbers and the fractional percentages of how many Black people do we have, how many Asian people do we have, how many white people, how many Latino or teenage people do we have. But I think the next stage of that is really inclusion. Now, how many people are actually sitting at the table? How many people from diverse backgrounds are actually sitting at the table and actually helping to make these decisions, and those decisions and opinions are actually valued? So it’s not just about diversity. It’s not just about having the numbers, but it’s about inclusion too. We have to forge that piece: Keep bringing people to the table.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Toba Bolaji: I mean, from my article, I think the point is, as a health care community, I think we need to be one of the people, one of the institutions and systems, that’s on the front line of equity, because that’s part of what we do. I mean, I may sound naive and ideal, and come off more as an idealist in that sense, but I think it’s hypocritical to not engage these things as much as we can.

Kevin Pho: Toba, thank you so much for sharing your time and insight, and thanks again for being on the show.

Toba Bolaji: Thanks for having me. Appreciate it.

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