I'm on my anesthesiology rotation right now and working with an an African American CRNA. Usually the people I'm surrounded with in the provider role are white and Asian while the scrub techs and other staff are black and brown. "Back on the plantation" as a Black medical school classmate of mine would bitterly assert when talking about the clear racial underpinnings of power dynamics in the hospital. I was waiting in the OR and when he first walked in I initially thought he was a scrub tech and nevertheless politely greeted him. As he walked over to the anesthesiology counter I immediately stood up and introduced myself as respectfully as I could to counter the automatic assumptions I knew I was still making in my head. Last week when an Asian scrub tech walked in, I assumed he was the attending! Granted, I knew my attending had an East Asian last name but, again, at fault. The CRNA and I began chatting as we walked to see the patient. As a tall, white man swooped in without as much of a hello to either of us, the CRNA looked at me and grinned, "that's the attending. I've worked with him before and don't think he likes brown folks like us very much". I nodded. He continued "I mean he's never said anything to me and it could just be that he doesn't like me personally". Without thinking, I muttered, "well sometimes you just know at a visceral level. The unspoken still leaves an impact". He looked back and smiled and we looked at each other in silence as the attending walked out and away without a word.
The white doctors thought she was faking it. “She’s just pretending that she can’t walk,” my resident said dismissively. We were caring for a little black girl with sickle cell anemia, and I had rushed to report that the usually peppy child couldn’t walk, observing the girl’s large eyes water as she struggled on the hospital floor. My team of doctors, all White, commented on how “dramatic” the child was being, and that her worsening hip pain was simply a ploy to stay in the hospital longer.
Stay longer? I thought. What child wants to stay in the hospital longer? Several hours later, we are called frantically to the little girl’s room. I see the purple beads in her hair shake and jump as the child suffers a seizure and loses her eyesight to PRES syndrome, a rare complication of worsening sickle cell anemia. The little Black girl had to experience a near-stroke and temporary blindness before her doctors understood that her pain was not a lie, but a symptom of something very serious. The idea that a Black girl was "tricking" them to stay in the hospital longer was abominable. I've looked back on this story many times and was never able to separate the racial bias from the outcome we observed. Afterwards, the resident who dismissed my concerns never brought up the girl to me, or expressed remorse for missing the signs. Nobody ever debriefed about what happened, but continued seeing patients as if the girl's complications couldn't possibly have been caught earlier - even though I had brought it up to them. I will never forget the girl's mother repeating "it will be okay, baby" over and over again, tears streaming from her eyes, as the little girl shook in pain. I went to the school administrator to discuss the topic of diversity and admissions, with the hopes that I was about to engage in a productive and thoughtful conversation.
After talking with the administration about diversifying the student body and broadening admissions outreach, they told me that students of color would be more likely to come to the university if I were the face they were talking to. They also stated that students of color tend to turn down admissions to this school (a top-tier institution) even though the school admits plenty of people of color every year. They also asked me to take on what seemed like an unreasonable amount of work to recruit students of color to this university myself as a medical student. I thought, shouldn't this be someone’s full time job? I left the meeting feeling discouraged and guilty that I didn't want to take on the work. Can't I just be a student looking to further my education, or must I be the face of a university that doesn't support me? I still struggle with this conversation and wonder if I should have said more. Ever since I entered a health professional program, there were things that made me feel isolated but I couldn't quite grasp what it was. I was coming in with both a chronic illness, which inspired me to become a health professional in the first place, and a minority background in a class that was majority white. I started to get the impression by both peers and professors that we by default knew better than others. The constant insinuation seemed to establish the lack of importance of listening and emotional intelligence in working with people. It wasn't unusual for students to joke around about accents, mock people who live in underserved areas and the such. Discussions on a healthy lifestyle would be framed as "I hope I don't become obese" or "get diabetes."
I tried to ignore these as best as I could because being the only minority student, I didn't want to be seen as somebody lacking a sense of humor or being "overly PC". But I would also be lying to myself if I didn't admit I felt out of place many times. There were hardly discussions on health disparities, but I do remember one diversity initiative. I heard peers asking why we should learn this stuff and some expressing that it goes away if you don't talk about it. An atmosphere that rejects understanding the social circumstances of others made me continue to lose sight of why I chose to be in a health profession in the first place. With my own personal experiences and a prior interest in journalism, I had the tendency to focus on people in the context of current events, especially the focus on socioeconomic/political circumstances leading to injustices both domestic and abroad. It sometimes felt that paying attention to these things was divulging in an entirely different subject matter than my major, and sometimes I wondered if I was "wasting my time" being too invested in stuff that were not posed as issues relevant to my program. I'd go back and forth questioning if I should have studied something else. Finally, I had an opportunity to do a project relating to health disparities. I was encouraged by faculty, so I felt that my environment was likely very supportive. During the course of the project, I discussed my ideas with a director working in a multicultural facility on campus. He had warned me not to be overly optimistic about its reception, as past efforts didn't always work out well. When I presented on the topic, some of the same faculty members who had encouraged me in my endeavors didn't even make eye contact throughout the presentation and were rather lost on their phones or other business. When I was finished, I was hoping I'd be asked questions or suggestions, but instead what ensued was an awkward silence. Later, I worked at a clinic which specifically served an underserved population. Often I was working under white practitioners who I would get visibly frustrated when a patient didn't understand English or make assumptions that I knew made the patients uncomfortable as well. Sometimes patients would look to me to answer questions or facilitate the appointment just because I was the only other visible minority present and seemed to show some sense of understanding, even though I didn't have the full medical expertise. I felt exhausted and unsure of how to tackle many of these issues sadly pervasive in healthcare from academia to the practice setting. But seeing initiatives like these and spaces for students and practitioners to discuss their experiences makes me realize I'm not the only one and that my focus on these issues is something that is certainly very important. At one medical school in California, our problem-based learning cases frequently present patients of color as non-compliant, poor, and diseased. What is most concerning about this is that the majority of these cases are pediatric patients. Our pediatric cases so far this year have been: a Tunisian immigrant with sickle cell, a black child with diabetic ketoacidosis, and a white child with Leg-Calve-Perthe's disease. The case presented the white child as a brave "trooper" in dealing with his pain. On the other hand, our black female patient with diabetic ketoacidosis was described as "combative" in a tone that was clearly racially biased. When this was brought up to the faculty, they completely ignored our concerns, stating that "combative is a common word used to describe patients." Basically, we were told to suck it up and stop being so sensitive. When we brought up the clear racial biases that affect patient care and are reflected in this case, our ideas were not acknowledged, along with other ideas we have presented about educating students about the social determinants of health. It pains me to know that we are perpetuating these stereotypes at a top ten medical school. Furthermore, since our PBL curriculum is shared with other schools, we are not the only school using these biased cases as 'teaching tools'. This is one of many instances that demonstrate the clear bias embedded in our education.
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