Black Man in a White Coat (2 page)

To a twenty-three-year-old first-year medical student, high blood pressure and kidney disease sounded like a death sentence. Worst-case scenarios flashed through my mind: Dialysis. Kidney transplant. Transplant rejection. More dialysis. Infection. Death. Was I destined for a similar fate as my uncle and grandmother? Or something worse? Would I even reach fifty?

The image of Jim flashed through my mind. A few weeks after leaving the hospital and moving into the rehab facility, he died from a massive blood clot that lodged in his lungs. He had just turned forty. I drove home from the clinic picturing Jim in an open casket. But instead of a stirring eulogy and traditional funeral hymnals, I heard Dr. Wilson's voice reciting statistics on race and stroke.

*   *   *

As I struggled to make sense of the prospect of facing chronic illness in my twenties, I became consumed by the broader health problems of my race. Along with the many patients I saw who gave life to my professors' statistics came reports of prominent black men who had met similar fates. Harvard Law graduate and billionaire CEO Reginald Lewis died at age fifty from cancer, while football legends Walter Payton and Reggie White died in their mid-forties from rare disorders, just a few years before
60 Minutes
mainstay Ed Bradley succumbed in his mid-sixties to cancer. Journalist Ron Howell chronicled the premature deaths of his black classmates from Yale in a 2011 article for the university's alumni magazine that generated national interest. A large bank account, Ivy League schooling, Hall of Fame busts, and a quarter-century run on America's most-watched program stood no match against early death for these black men.

Why do black people suffer more health problems than other groups? What do these challenges mean in their everyday lives? How do their struggles play out before a largely white medical community? How can we begin to solve these seemingly intractable problems? Do I have a special role to play as a black physician? Confronting these questions has led me on an intellectual and emotional journey, one that I've tried to capture in the pages that follow.

I've divided the book into three sections, corresponding to the different phases of my medical life. Part I surveys my medical school years. Part II explores my grueling twelve months of medical internship as a newly minted doctor. Part III examines my subsequent years in psychiatry training and in early clinical practice. Throughout each stage, race played a recurrent role, at turns predictable and unexpected, often annoying, sometimes disheartening, and occasionally uplifting. By sharing my story, as well as the stories of some of the patients I've met over the past fifteen years, I hope to humanize the dire statistics and bitter racial debates and paint a fuller picture of the experiences of black patients, as well as that of the black doctors who navigate between the black community and the predominately white medical world.

In tracing my journey along the intersection of race and medicine at the end of the twentieth century and the dawn of the twenty-first, I make no claim to speak for all black physicians or black patients, yet I am confident that much of what I have written will ring true to their varied experiences. By putting human faces on these serious dilemmas, I hope to contribute to a much-needed public dialogue on improving the health of black people. Jim's fate—a young black person robbed of his future—is one that far too many of us suffer.

 

P
ART
I

Disparities

 

1

People Like Us

It was a hot late-summer morning, a month into my first year as a Duke medical student. The classroom of nearly one hundred students buzzed with energy. After a few weeks of mostly tedious lectures that seemed no different from the science classes we'd taken in college, our professor had just finished the first half of his presentation on the case of a young boy with a rare childhood disease. A short film had brought the complex scientific data in our textbook to life in the words and actions of the boy and his parents. Following the video, the professor talked about promising therapies for this disorder. Finally, we were getting glimpses of the clinical knowledge that we'd come to medical school to learn. I could hardly wait for the second part.

But that wasn't the only reason that I suddenly felt better. My first few weeks at Duke had been an exercise in expanding insecurity as I learned more about my classmates. As one of a handful of black students, I naturally stood out, but race was just part of the story. In those early days, it seemed that all of my classmates came from professional, well-to-do families. My mom never entered a college lecture hall; my dad did not finish high school. While my brother, Bryan, had been the trailblazer of our immediate family in graduating from college, medical school was a different league. The majority of my classmates graduated from high-prestige colleges like Duke, Harvard, Yale, or Stanford. I'd gone to the University of Maryland–Baltimore County (UMBC), a young school with a limited national profile. Could I hack it at Duke? Determined to use this fear as a buoy rather than a deadweight that could sink me, I probably spent as many hours studying in that first month at Duke as I had my entire senior year of college.

The effort paid off. Our midterm scores had just come back, and, to my immense relief, I had done well, firmly within the top half of the class on each exam. As I stood to stretch during the break before the professor resumed his lecture, I was finally starting to feel comfortable, or at least what qualified as such for a first-year medical student.

The mid-class break offered time to use the bathroom, grab coffee, or simply remain in place and gossip. I preferred to move about, as the lecture hall, with its folding seats, dim lighting, and sticky floor, had the uncomfortable ambience of an old movie theater. On my way out, I chatted with a few people and overheard one group discuss plans to camp out for Duke men's basketball tickets.

When I reentered the lecture hall a few minutes later, Dr. Gale, our professor, headed in my direction. Ordinarily, he didn't socialize with students, so I expected him to walk past without acknowledgment. Instead, he stopped directly in front of me.

“Are you here to fix the lights?” he asked.

The sounds of the classroom seemed to vanish. So did my peripheral vision. Calm down, I told myself, maybe he was talking to someone else and only seemed to be looking at me. I glanced behind me. Nobody there. A few classmates were within hearing distance, but they seemed too engaged in conversation to notice us. Maybe with all the background noise, I had misheard him.

“Did … did you ask me about fixing the lights?” I said.

“Yes,” he replied, irritation creeping into his voice. “You can see how dim it is over on that side of the room,” he said, gesturing with his index finger. “I called about this last week.”

Reflexively, I stroked my chin and looked down at my clothing to check if I seemed out of place. Clean-shaven, and dressed in a polo shirt and khaki slacks, I thought that I'd done a decent job of looking the part of the preppy first-year medical student. Obviously I had failed.

“No,” I said, stumbling to come up with a reply. “I don't have anything to do with that.”

He frowned. “Then what are you doing here in my class?”

My mouth went dry. Why had he intentionally singled me out in this way? Race was the first thought that entered my mind. I tried to summon an attitude of 1960s-era Black Power defiance, but what came out sounded like 1990s diffidence. “I'm a student … in your class.”

“Oh…” he said.

Dr. Gale looked away, then walked off without another word. I staggered to my seat, sitting through the second part of his lecture like a robot, tuning out his voice. What had started out as a promising day was spoiled.

During lunch a few hours later, I replayed the encounter to three black classmates as we sat out of range of others in the cafeteria. I'm not sure what I was looking for, other than the chance to vent to people who might understand what I was feeling. Their response surprised me: Two of them burst out laughing.

“That's messed up,” Rob said, almost choking on his hamburger.

“At least he thought you were a skilled worker,” Stan said, as the two laughed harder. “He could have asked you to pick up his trash or shine his shoes in front of the entire class.”

“That's not funny,” Marsha said, glaring at them.

“What else are you going to do but laugh about it?” Stan shot back.

“He's right,” Rob chimed in. “You know you want to laugh too.”

Marsha started to say something about reporting the incident or confronting the professor, but her militancy evaporated as Stan and Rob started quoting the comedian Chris Rock. I don't recall the specific joke, but it made me smile and calmed me down enough that I could eat my lunch. Racial insults—big and small—were a part of our lives and sometimes humor was the best way to deal with it.

Yet the good feelings didn't last. The afternoon lectures gave way to a different course, and with it, another professor. I could not concentrate at all. “Are you here to fix the lights?” played over in my mind. In high school and college, I had been mistaken many times for a potential criminal, hired help when I was a paying customer, and most favorably, as a six-foot-six budding professional basketball player. But it's one thing to be insulted by a stranger you'll never see again, and something altogether worse for your professor—who assigns grades that dictate your future—to cast you in such a limiting way.

Trying to apply reason to the situation, I told myself that at Duke, Dr. Gale saw many more black maintenance workers than black men in his class. And I also firmly believed that there's no shame in blue-collar work. My dad spent thirty-five years as a meatcutter at a grocery store while my maternal grandmother—Grandma Flossie—worked her whole life as a housekeeper, or in the parlance of her times, a cleaning lady. What bothered me was Dr. Gale's assumption that I had no business in his class unless I arrived in some service capacity. Sensitive as I already was about my place at Duke, this incident stabbed at the core of my insecurity. With one question, Dr. Gale had shattered my brittle confidence and my tenuous feeling of belonging at Duke.

*   *   *

In a color-blind world, Duke might well have rejected me; at the very least, its admissions committee would not have offered me a full-tuition scholarship to its medical school.

This troubling revelation occurred to me less than an hour into my first day on campus. The Duke Med Class of 2000 had gathered for the first time, crowded into an old lecture hall that was in its last year of use. It was a typically humid August day in North Carolina, with the temperature already approaching eighty-five degrees by mid-morning. Inside, an antiquated but powerful air conditioner chilled the room to the mid-sixties. Our eyes focused on the speaker who stood at a small lectern. An anesthesiologist by trade, she had short graying hair and spoke in a monotone that could put you to sleep without medicine. Nonetheless, the room crackled with tension. Our medical lives were about to begin.

“Congratulations,” she led off. “I'm proud to say this is the most accomplished class we've ever had during my time at Duke.”

Nervous laughter filled the room. On a scale of cutthroat competitiveness, future doctors are worse than Olympic hopefuls. Pre-meds arrive with better grades than those who attend law, business, or other graduate programs, and this is no coincidence. Although most schools deny it, getting into medical school is, to a large extent, about numbers. In keeping with our numerical obsessions, we craved our first glimpse of how we measured up against each other.

She began with our college grade point averages. “The mean was 3.7 on the standard 4.0 scale,” she said, leafing through papers that defined our lives as data.

My GPA was higher, but I discounted this edge since I had attended a less prestigious college than almost everyone around me. That realization had sunk in months earlier, during my admission interview at Yale. “I'm not sure the grades from your undergraduate college reflect what you'll face here and beyond,” an elderly surgeon told me, his faced lined with worry as he viewed my transcript. And with that swipe of his verbal scalpel, he cut my straight-A record down to what seemed a B-minus average.

Next up were our scores on the MCAT, the medical school equivalent of the SAT. “The average combined score was 34,” our Duke professor announced.

I'd scored a few points below this class average. Based on percentile rankings that she went on to explain, my result was still as good as, or better than, those of a third of my classmates, but that did nothing to prevent my empty stomach from twisting into a painful knot. While admissions committees do consider other factors, I'm fairly certain that my community service record, leadership skills, and interview performance all rated average at best. These were not the talents that made Duke offer me a scholarship.

Things got worse as she boasted about the number of students from various prestigious colleges. “Twenty-five percent of the incoming class has an undergraduate degree from Duke,” she said.

Another quarter came from the Ivy League, most either Harvard or Yale. Of the remainder, the vast majority hailed from other elite private colleges, such as Stanford and Johns Hopkins, or highly regarded state schools such as the University of Virginia or the nearby UNC–Chapel Hill. While I had considered many of those schools four years earlier and been accepted to several, I attended the lesser-known University of Maryland–Baltimore County. At the time, it felt like the perfect choice, as it offered a full scholarship, the opportunity for playing-time on a Division I basketball team, and was only a forty-five-minute drive to my parents' home. But now at Duke Med, I felt like a scrawny thirteen-year-old on a basketball court with grown men.