Black Man in a White Coat

by Damon Tweedy, M. D.

  We gave up on the interview. We took turns doing a physical exam: tapping, poking, and prodding his fragile exterior and listening for problems that could be heard but not seen. His EKG and early blood tests didn’t suggest a heart attack, so our attention focused elsewhere. His lungs sounded as if they were badly congested. With his fever and cloudy chest X-ray, pneumonia was the most likely diagnosis.

  “What an ignorant asshole,” Audrey said, as we left the ED and headed upstairs.

  “You handled him pretty well,” I said.

  “You too,” she replied. “I’m really sorry about what he told the nurse.”

  The last thing I wanted was for her to feel sorry for me or think of me as some kind of racial victim. “It’s okay,” I said. “He didn’t seem to like you that much better.”

  We shared a quick laugh. I spent the next hour or so entering Chester’s treatment orders and writing his admission note in the chart while answering nursing pages about my other patients. A second new patient arrived shortly afterward, this one healthier and able to give us a coherent story that made our work easier. And he seemed to have no problems with me or Audrey. A few minutes after I had finished his paperwork and was set to take a short break, a fellow intern entered the workroom.

  “I need to sign my patients over to you,” he said.

  I looked at my watch. It was shortly after five p.m. “Okay,” I said, feigning calm.

  This was standard practice. Someone had to be responsible for the patients on the teams who were off duty, otherwise each intern would be on call every night. He showed me his list of patients, which contained their names, diagnoses, medications, and active issues. One person needed his blood drawn at nine p.m. to measure how well his blood thinner was working. Another needed blood culture samples taken to rule-out an infection if she developed a fever. A third was getting an emergency head CT scan after falling in his bathroom, so I needed to review the results with the on-call radiologist. Over the next forty-five minutes, two other interns tracked me down with their lists. One had five patients, the other ten. More blood draws and blood cultures and images to review with the radiologist. My head started to throb.

  By the time all the interns had checked out their patients, it was nearly six p.m. My appetite was shot, but I rushed to the cafeteria and forced down a greasy hospital-issued steak that was my last opportunity for any food for several hours. As I returned to the ward, my stomach rumbled in much the same way it had before a basketball game or important interview. This time, though, the stakes were much higher. I was responsible for more than thirty patients, many seriously sick. One of them could easily die from something I did or failed to do. Doctors aren’t alone in facing life-and-death scenarios on the job, but I couldn’t imagine an inexperienced pilot being left to fly a commercial jet solo.

  Fortunately, no one died or came close to it on my first night. In fact, nothing occurred that was beyond my level of training. But that didn’t mean things were easy. The workload was steady as I admitted three more people while covering the other teams’ patients. Between trips to the emergency department, the radiology suite, and back to the medical ward, I must have logged five miles on foot while trying to stay alert on a sleepy brain. In the end, I didn’t sleep at all. I might have had twenty minutes here or there to shut my eyes. The hospital had a room where we could sleep, but I never found it. As the sun shone through dingy hospital windows the next morning, I felt my body shutting down. My joints ached. My muscles trembled. I needed a bed.

  Never before had I pulled a true all-nighter. Even in medical school, where I worked diligently to prove to Dr. Gale and others that I belonged at Duke, I made certain to get at least a few hours of rest each night. As long as I could remember, sleep had been a top priority. When friends in high school and college bragged about staying up late, I frequently slept eight or nine hours each night; rarely did I get less than six or seven hours. Yet here in my new life, this luxury was simply not possible. I felt like punching a wall.

  When I left the hospital later that afternoon, I was so frayed that my encounter with Chester felt like a distant memory. But he would soon return to the forefront of my thoughts.

  * * *

  I was an official M.D. when I met Chester. That meant that I had spent two of my required four years in medical school completing rotations across a variety of fields, such as surgery, pediatrics, and neurology. During those years in the hospital and clinic, I worked with hundreds of patients and families, but always under the clear direction of at least one physician. No one mistook me for their doctor, nor did I have that responsibility.

  At least once a day during my rotations, my race would come up in an interaction with patients. The racial conversation was usually implied rather than explicit, as one person after another, usually white, took one look at me and inquired about my basketball skills.

  Most asked: “Did you play ball?” The more presumptuous asked: “Where did you play?”

  Others offered career advice: “You’re wasting your time in school. You should be playing in the NBA.”

  “A tall black like you with long arms and legs should be on a basketball court and nowhere else,” an elderly man once said to me, much to the dismay of his more-tactful daughter.

  Some simply refused to believe that I didn’t play for Duke. “What is Coach K really like?” a UNC–Chapel Hill fan asked me. “Is he really as much of a jerk as he seems to be?”

  The truth was that I’d only had two passing encounters with basketball coaching legend Mike Krzyzewski—once outside the hospital and another time at a campus gym—and both times he seemed quite pleasant, in clear contrast to how he sometimes came across during games on television. But I was wasting my breath trying to explain that to this die-hard Tar Heel fan.

  “How on earth do you balance your hospital schedule with all your games and practices?” another patient’s wife inquired, the lines on her face conveying deep concern for my well-being.

  One day, as I was heading from the medical ward toward the cafeteria, a middle-aged man approached me, his hands shaking, his voice trembling. “I don’t normally do this, but you look like a famous basketball player I’ve seen on TV,” he said. “Can I have your autograph?”

  He must have thought that my white coat and necktie ensemble was my Clark Kent cover to disguise my true identity as a basketball superhero. I politely refused to autograph his napkin, telling him that he had mistaken me for someone else, but he probably thought I was displaying the kind of elitist snobbery that many associate with Duke.

  Rarely did these sorts of comments, when taken in isolation, really bother me. Like many stereotypes, this one had some truth behind it. After all, black players make up more than 75 percent of NBA rosters, six times our numbers in the general population. And back then, I was a youthful, slender, six-foot-six former hoopster. It was not as if they were asking a five-foot-five guy with stubby fingers and a beer gut if he could do a 360-degree dunk simply because he was black.

  Yet along with some people’s certainty that I could dribble and shoot came, at least to my thinking, an assumption that I was a dumb jock. In other words, athletic talent, at least for black players, was inversely proportional to native intelligence. This perception had followed me since high school. Back then, while discussing the prospect of college, one of my coaches flat-out predicted that I couldn’t score better than 800 on my SAT (the older version was based on a 1600-point scale), even though he knew I had a near-perfect grade point average in a magnet-school curriculum in which students routinely scored above 1200. A few years later, during a basketball camp, a college coach refused to believe my actual SAT score, suggesting at first that I had misread the score before later accusing me—in front of a handful of other coaches and players—of lying to make myself look good.

  So as patients and families asked about my athletic résumé, I worried less about their perception that I must be a good basketball player than I did a question specific to my
future: Would they doubt my ability to be a competent doctor? If so, would that hinder my career?

  I was not alone among black students when it came to facing limiting stereotypes. Pete, who was a few classes ahead of me at Duke, told me that more than once both nurses and patients had mistaken him for a patient escort even though he always wore a necktie and white coat. His classmate Susan one-upped him: After she’d finished performing a physical exam at a man’s bedside, he asked her to take away his tray and bring him coffee. When she refused, he told her that she was not doing her job and that he would report her to her supervisor. Their stories sounded uncomfortably like another version of Dr. Gale asking me to fix the lights in his classroom. No matter the successes that led us to medical school or our achievements there, it seemed some segment of the population would never fully recognize us.

  The insults didn’t stop once you became a doctor. During her child psychiatry fellowship at Duke in the 1970s, Jean Spaulding, the first black woman to attend medical school at Duke, encountered a family that didn’t want her to treat their grandchild: “Oh no,” they said. “She’s a black person, and she can’t treat our grandson.” Another black doctor described a scenario in recent years where the chief of a clinical service walked into a patient room in his white coat, flanked by several white residents and medical students, only for the woman to ask him to take her tray away, as she had assumed he worked in the cafeteria.

  Nor were these stereotypes restricted to the South. Otis Brawley, executive vice president of the American Cancer Society, and Pius Kamau, a Denver-area thoracic surgeon and newspaper columnist, have recounted similar experiences with patient and family prejudice in their writings. Brawley, while a medical resident at a Cleveland hospital, describes caring for a terminally ill man whose family repeatedly questioned his “credentials, competence, and education.” Kamau, while on duty one day, discovered that his new patient, critically ill, had a swastika tattooed across his chest. After fixing “hate-filled eyes” on Kamau, the young man refused to acknowledge him, choosing to communicate to the doctor through various white nurses and other staff, “as if I spoke in another language,” Kamau wrote.

  Dr. Marcella Nunez-Smith of Yale explored this issue in a 2007 project where she conducted detailed interviews of twenty-five African American physicians practicing in the New England states. The study revealed a recurring theme of black doctors facing discrimination from some of their white patients. As one medical subspecialist phrased it: “We have just met and they want someone else. I don’t think that most patients want to discriminate against me … but patients sometimes expect us not to do a good job or as well as somebody else would do.”

  A pediatrician offered a more blatant story: “I was removed from taking care of a white individual. The division chief and I talked later. The parents were uncomfortable with me taking care of their child. They told him they didn’t think I would be capable because of my race.” Nunez concluded that the pervasive nature of negative race-related experiences leads to “racial fatigue” that contributes to higher rates of job dissatisfaction and greater changes in career trajectory among black physicians. A life in medicine was tiring enough without the added baggage that race sometimes brought with it.

  By the time I met Chester, I had certainly heard about other doctors’ experiences with patient prejudice and had experienced it in a more benign form myself during medical school. Neither context, however, had prepared me for the day when Chester demanded “no nigger doctor,” nor how that request would shape the aftermath of our initial encounter.

  I was no longer a medical student whose only real objective was to learn. I was a doctor. Despite my inexperience, I would be the one nurses called when an issue arose with Chester. I could order tests and prescribe or withhold medications that directly affected his well-being. How would Chester cope with this situation? Would he request another doctor? If not, would he continue to refuse to speak with me? Would he allow me to draw blood or do other procedures on him? Would I have to deal with a family full of people who shared his prejudices?

  * * *

  On the night of his admission, Chester had drifted in and out of consciousness, the result of his combined kidney failure and pneumonia. The next afternoon, the medicines we administered had started to take effect, treating his infection and gradually restoring his kidneys to working order. By the following morning, his third day in the hospital, he was wide awake.

  When I arrived at the hospital that morning, I met with Sanjay, a fellow intern who had been on call overnight and covered my patients. He still had on a hospital-issue scrub top from the night, having had no chance to freshen up and change back into his shirt and tie. He scratched at his five o’clock shadow as he gave me updates on my patients. He told me that one of them—a young man with a blood clot—had developed mild chest pain. He’d done the necessary workup and everything had come back fine thus far. Sanjay commented that this man wasn’t very nice, which was true. I told him, however, that he was lucky he didn’t have to go see Chester.

  “What do you mean?” Sanjay asked.

  I told him about Chester’s “no nigger doctor” comment. “That sucks,” he said, wincing. “If it makes you feel better,” he said, “the last time I was on call, I saw a real racist asshole too.”

  “What happened?” I asked.

  “He asked me where I was from. I told him New Jersey. He said: ‘You must mean New Delhi. I’ve never seen anyone from New Jersey who looks like you.’ Then he laughed out loud. He’s lucky I’d already drawn his blood. Otherwise, I might have made it extra painful for him.”

  I cringed. Sanjay’s parents had come to the United States from India and settled in New Jersey several years before he was born. He had lived his entire life in America. He liked rap music, football, and science fiction movies. He was as American as anyone else, only some people couldn’t get past his physical appearance. Up until then, I’d been so focused on the challenges black doctors dealt with that I hadn’t given thought to what other minority doctors might face.

  Audrey, my resident supervisor, arrived in our workroom a few minutes later along with Gabe, our medical student. She looked totally refreshed, her body seemingly accustomed to the quick recovery required to survive on the hospital wards. Gabe and I, novices to this way of life, looked and felt as if we needed a few more hours of sleep.

  “Where do you want to start?” I asked, as I scanned the list of patients on my clipboard.

  “We might as well get the worst one out of the way,” Audrey said.

  We all knew whom she meant. The three of us headed down the hallway where we passed by hospital staff going about their duties. At least half of the nurses who gave medications and the phlebotomists who drew blood on our unit were black. The nurses’ aides, who measured vital signs according to doctors’ orders, were exclusively black. Chester had come to the wrong hospital if he hated black people. And then he’d had the bad luck to wind up in the care of the one medical team that had a black doctor. He probably thought that he was in hell.

  We took a collective deep breath and entered Chester’s room. “Good morning,” Audrey said.

  Chester gave a silent, forced grimace, clearly unhappy to see we were still his doctors.

  A middle-aged woman and young man sat at his bedside. She gruffly introduced herself. “Molly,” she said, frowning at us. “I’m his oldest girl.”

  She wore a T-shirt that proudly displayed the Confederate flag. Her face had the weathered look of someone who’d spent too much time in the sun, smoked too many cigarettes, and drank too much alcohol. “This is my son, Thomas,” she told us.

  The young man nodded. He had a crew cut and thin forearms covered with menacing tattoos. His shirt pocket flaunted a smaller Confederate flag. To my sensitized eyes, he looked the part of a virulent racist. Instantly, my own racial prejudice arose, as my imagination put him in an old pickup truck, heading to a roadside bar where he would get drunk and get in a fight over
a girl who wore too much makeup.

  With manners similar to her father, Molly derisively asked: “Who’s in charge here?”

  Audrey dispensed with pleasantries and explained Chester’s case in cold, clinical terms. At that point, we were confident that his kidney failure was secondary to his pneumonia, and we were still trying to determine if there was some other problem taking place with his lungs. Molly challenged her at first, but Audrey maintained an attitude that conveyed “I know what I’m talking about” as she replied to every question. After a few minutes, Molly and her son seemed satisfied that Chester was getting good medical care, even if they disliked who was giving it.

  As we stepped outside the room and headed to see our next patient, Audrey made a fist. “Ignorant jackasses,” she said. “I think we should trade patients with another team. At least two of the teams here have only white men. We might as well give these fools what they want.”

  I was dismayed at this idea. A change in teams would mean notifying our supervising faculty physician along with one of the senior chief residents, not to mention forcing this bigoted man and his progeny onto someone else. Even if Audrey was the one making the request, I knew that our supervisors would assume that I was the one behind it. At that stage of my career, at the bottom of the physician totem pole, dealing with a racist family sounded infinitely preferable to drawing more attention to myself than I invariably did. I preferred to just suck it up and move forward, just as I had with Dr. Gale during my first year of medical school. Once again, I feared developing a reputation of being hypersensitive on racial matters. So I convinced Audrey that we would be fine. All we had to do was stick to the medical facts, as she had proved with Molly. “You’re right,” she conceded.

  Each day, I updated Chester’s family on his progress. The visitors expanded to include a sister, another daughter, and a few grandchildren. Whatever doubts the family may have had about me they kept to themselves, perhaps comforted in knowing I was supervised by someone they saw as competent. Gradually, while tending to Chester’s physical ills, his family provided me with a view into his life. He had been married for fifty years and took care of his wife in her final months after a stroke. They had three daughters and seven grandchildren. He worked in a textile factory most of his life. He loved fishing.