Black Man in a White Coat

by Damon Tweedy, M. D.

  “Ah,” Ron said. “Ain’t nothing quite like the projects.”

  I’d seen my share of harsh housing projects growing up in the Washington, D.C., area and in college in and around Baltimore, but I’d always viewed them from inside a moving car at a distance. Through the lens of my childhood, “ghettos” were the areas my parents and neighbors had moved from in search of something better in the suburbs. “Projects,” on the other hand, were something altogether worse; they were the places that led to D.C. being dubbed the country’s murder capital in the late 1980s and early 1990s, and later made Baltimore the centerpiece for the critically acclaimed TV crime drama The Wire.

  We parked about fifty feet away from a rusted metal trash bin surrounded by broken bottles, cigarette butts, and fast-food bags. Nearby, two young boys, probably no more than ten or eleven, threw an old football back and forth, seemingly oblivious to the hazards around them. The complex housed a half-dozen or so dingy, two-story brick buildings, each about the width of a basketball court. They were set on a hilly two or three acres of what was once a completely wooded area, giving the impression that the developers were trying to isolate its occupants like prisoners or psychiatric patients. The building design only added to this feeling, with its dark metal doors and wire-mesh windows, the kind I’d seen on locked wards to keep patients from escaping or leaping to their deaths. Weeds and bare dirt filled what should have been grassy areas. I doubted that a grounds crew ever made it out here.

  Nearly twenty years after its popular release, this scene brought the lyrics from Grandmaster Flash’s seminal 1982 rap hit “The Message” into my head.

  Broken glass everywhere

  People pissing on the stairs, you know they just don’t care

  A skinny, unkempt, wrinkled-looking man stood in a dirt patch, staring at us. My mind flooded with a sequence of negative assumptions: he was either an alcoholic or drug abuser; he had schizophrenia or some other mental illness; he had HIV, Hepatitis C, or syphilis. Was it my medical training that caused me to see him as a list of potential health problems rather than as an individual? Or was it the many ways in which I’d been indoctrinated by both white and black people, throughout my life, to see poor blacks as inferior and susceptible to so many problems? My reaction troubled me. What good came from thinking this way?

  “You should probably stay here,” Ron said. “Make sure nobody runs off with this thing. Just don’t look scared and they’ll leave you alone. Be sure to keep the doors locked just in case.”

  I wasn’t sure if they were trying to protect me or their property.

  “I’d take off the white coat,” Kurt said. “And your necktie. Don’t want them thinking you’re a rich doctor or anything.”

  In other circumstances, the comment might have made me laugh. The white coat had been given to me by the school, and I’d purchased the necktie on sale for less than ten bucks. I only had fifteen or twenty dollars in my pocket. I didn’t even own a credit card or cell phone.

  “I thought this was an assault,” I said, as I looked around. “Shouldn’t the police be here?”

  “Sometimes we’re the first on the scene,” Ron said. “This sounds like a fairly minor domestic incident. That’s pretty low priority for them. They’ve got bigger fish to fry.”

  As they locked the ambulance doors behind them and headed toward the unit to assess our patient, I fought the urge to follow them. My reaction surprised me. It wasn’t as if I was afraid of black people. My childhood neighborhood, for as far as I could travel on foot, was so thoroughly black that it might as well have been legally segregated. And that enclave was certainly not immune to some of the problems of urban life.

  In Durham too I’d had contact with poverty and crime. While Duke paid for my tuition, I was on my own with room and board. In an effort to keep down the size of my future loans, during my first year I’d settled into a low-rent apartment complex with a classmate. Although the area surrounding our ground-floor apartment was poorly lighted, I never felt physically threatened, day or night, not even after our unit was burglarized while we were at school taking our exams. My roommate and I both figured that the perpetrators had pegged us for uppity Duke students and learned our daily routine so they could break in while we were away. They were probably furious to discover how little we owned.

  But that brush with crime involved personal property, not threats to physical safety. In this secluded housing project, in contrast, I could almost feel the ghosts of past violent crimes. Along with Washington, D.C., Atlanta had one of the highest crime and murder rates in America during the 1980s and 1990s. As I took in my surroundings, I couldn’t imagine a more likely place for bad things to occur. Just as I’d been unaware of the full extent of the paramedics’ medical acumen, I’d also managed not to understand how dangerous their jobs could be, entering into the same situations and neighborhoods as cops, only without a weapon or bulletproof vest.

  As darkness began to fall, I steadied myself by watching the two boys who were playing football. The image made me think about my childhood, playing basketball for hours at a time in my backyard or at the nearby playground, imagining myself as Dr. J, Magic Johnson, or Michael Jordan. While modest, my surroundings were, for the most part, clean and safe. The young boys here had to sidestep shattered glass and feasting rodents while acting out their athletic fantasies.

  Eventually, Ron and Kurt emerged from the apartment building. A young woman walked between them like a criminal suspect being escorted by cops. She wore a ragged sweatshirt and paint-stained jeans, her natural hairstyle shorter on the sides than on top. With a gloved hand, Kurt applied a gauze pad to the left side of her neck. He walked back to the rear of the ambulance while Ron entered on the driver’s side.

  “More crazy shit,” Ron said to me, as he took off his gloves and shoved them into a red biohazard bag. “She got stabbed with a dirty needle by some other crazy chick down the hall. Both of them are probably junkies. Fightin’ over some punk-ass dude.”

  As we drove away, taking the woman to Grady, the two young boys continued to throw the football back and forth, now under the glow of a dimly lit streetlight. I wondered if someone—a parent or older sibling—had an eye on them to make sure they stayed safe. I tried to imagine my ten-year-old self in their shoes. How might my life have turned out differently had I grown up there, with a mother like the one we were hauling off to Grady?

  On the way to the hospital, the people and the problems I’d seen that month flashed through my mind: Lucy’s poor health and premature death triggered in part by her son’s latest legal problems; Sean battling life-threatening gunshot wounds rather than college-prep classes; and all the other patients whose array of health problems had as much, if not more, to do with socioeconomic factors than with the medical conditions that I’d learned about in textbooks.

  Graduation was just a few months away. I’d entered medical school focused on my own academic accomplishment and other selfish rewards of life as a future physician. But four years of medical school, where I’d witnessed the health problems of black patients and experienced my own, had changed my perspective. I wanted to find some way to help make life better for the Leslie’s, Tina’s, Lucy’s, and Sean’s of the world. Only I wasn’t sure where to begin.

  PART II

  Barriers

  5

  Confronting Hate

  On a humid Tuesday morning, Chester arrived at a busy Durham emergency room. While the other patients around him made the usual requests for pain medications, diagnostic tests, and reassurance that they were not about to die, Chester gave an entirely different kind of demand.

  “I don’t want no nigger doctor,” he said to a nurse on duty.

  I was about a month into my yearlong medical internship, the time when aspiring physicians make the abrupt, brutal transition from knowledge-seeking medical student to first responder at the scene of a three a.m. cardiac arrest. I was struggling with this adjustment along with the rest of my colleagues,
my mind focused on the objective analysis of lab tests, EKGs, and chest X-rays—medical tasks that had nothing to do with race. But Chester’s words had unceremoniously shoved me out of 2003, and back into a world that felt more like 1963.

  I’d continued on at Duke for my internship, having grown comfortable with the medical center and North Carolina. The day before meeting Chester, I had arrived an hour prior to the start of my initial shift on the general medicine service, determined to make a good first impression. At the hospital, alone in the physician workroom, I used the down time to review the charts of the patients whom I had inherited from the previous intern.

  By this stage of my training, I had developed a familiarity with the chart notations and abbreviations that had once looked like inscriptions from ancient times. As I skimmed through their medical records, I understood the basics of my patients’ medical problems. But it turned out that this working knowledge and my early arrival offered no preparation for the onslaught that ensued the minute my shift started.

  At exactly eight a.m., my pager chirped with a numerical message. I dialed the four-digit extension. “Hello, this is D … Dr. Tw … Tweedy.”

  “Are you sure?” the nurse asked.

  My delivery still needed work. “Yes,” I answered.

  “Are you the Green-Two Intern?”

  My name was irrelevant. It had been replaced by a seven-digit pager ID and color-number scheme. I knew I had been assigned to the Green medical group but could not remember the team number. I looked at the top of the printout on my clipboard, which contained all of our patient and team information. Yes, I was the Green-Two Intern.

  “Mr. Jones and Mr. Patrick both need something for pain,” the nurse told me.

  My mind went blank: Who were these people?

  I scanned the printout again. One person had been admitted for pneumonia, the other for antibiotic treatment of a diabetic leg ulcer. Audrey, the second-year resident who would be my supervisor for the month, was on the phone with another doctor. I had spent my initial few weeks of internship on a specialty consult service, where, given the complexity of the patients, a senior physician made all the decisions while I stood back in the role of glorified medical student.

  But they held much higher expectations for us on the general medicine unit. These were “our” patients, and something as basic as ordering pain medicine fell within our responsibilities. With Audrey occupied, I faced my first solo decision as a doctor. And I whiffed.

  “What do you think I should give them?” I asked the nurse.

  As soon as the words left my mouth, I wanted to pull them back. The nurse laughed. “You’re the doctor,” she said.

  My mind raced. For my own pain, I might take acetaminophen (Tylenol) or ibuprofen (Motrin), or Oxycodone if things got really bad, such as after my knee surgery. But these patients had more complicated issues. Both had histories of alcohol and drug abuse. One had liver failure, the other bleeding ulcers. Because of these problems, I knew my options were limited—but suddenly I couldn’t quite remember which drugs were a bad fit for which condition.

  I frantically scanned their medical records again as I tried to recall the dosage frequencies for common analgesics. After agonizing a bit more, I settled on an appropriate drug for each: Tylenol for the one with bleeding ulcers, Motrin for the one with liver disease. For a few seconds, I felt a measure of pride; I had done the work of a real doctor. By the time I’d written the orders, however, three other numerical pages had come through. Each call required me to do something I had never done before; evaluate and treat a high potassium level (which can damage the heart), prescribe an insulin regimen for a new diabetic, and interpret the results of a urine test and prescribe the proper antibiotic. Over the next few hours, I scrambled to stay afloat. The system was treating me like a doctor, only I didn’t feel like one at all.

  I called Kerrie on the drive home at the end of that first day. We’d gotten engaged a few months earlier. She was working extra evening and night shifts at a local hospital to finance our wedding. I told her how stressed I felt. “Hang in there,” she said. “It’s only going to get worse.”

  She was right. The next day brought the start of my first thirty-hour shift. By the late morning, I was slowly feeling a little more comfortable with my new job, as I started to get to know our patients. But as my anxiety began to settle, Audrey, the second-year resident, burst into our workroom, her 100-pound frame opening the door with enough force to scatter papers across the floor. I flinched.

  “We’ve got an admission,” she said.

  “What’s the name?” I asked, prepared to write this information on my clipboard.

  She frowned. “I forgot already,” she said, shaking her head in disgust. “Anyway, he’s a seventy-something white guy with shortness of breath, fever, a white blood cell count of twenty [thousand], a creatinine of 2.5, and an oxygen saturation of eighty percent on room air.”

  Interns were not the only people reduced to colors and numbers. From her description, I knew that our patient was showing signs of infection as well as injury to his kidneys. Along with Gabe, the medical student on our team, we took the stairs down to the emergency department.

  “We’re from Green-Two,” Audrey told the ED doctor on duty. “Which one is ours?”

  “Over there,” he said, pointing to the room closest to the nursing station. “Good luck.”

  I looked at the chalkboard and saw Chester’s name. Just as we were about to meet him, a middle-aged ED nurse approached me. “Watch out for that one over there,” she said in a thick Caribbean accent.

  “What’s wrong?” I asked.

  I expected her to say the patient was agitated, confused, or some combination of the two. Instead, she leaned toward me and lowered her voice. “He asked a white nurse why there are ‘so many niggers’ working here and said he did not want any ‘nigger doctors’ taking care of him.”

  “What?” I asked in disbelief, barely able to get out this single word. “He said that?”

  “Verbatim,” the nurse said. “We ought to kick his ass out on the street.”

  I glanced over at my colleagues, both of whom looked horrified. Although we were still relative strangers, I had spoken with them long enough to form first impressions. Gabe was a nature-loving type from California who had gone to college at UC-Berkley. Audrey was Jewish and very interested in women’s health issues. Both seemed to have progressive sensibilities, and they bristled at Chester’s language.

  Audrey stared at me, wounded. It took a few seconds for her to regain her composure. “Don’t worry,” she said. “You don’t have to go in.”

  “I’ll be fine,” I said, forcing myself to breathe slowly. The idea of caring for a sick person was daunting enough without this other element. “But maybe you should do the talking.”

  With Audrey leading the way, we approached Chester’s bedside. He looked the part of a hospital patient, dressed in a gown, his body connected through plastic tubing to an oxygen tank, a liter of IV fluid, and a bag to collect his urine. His abdomen protruded as if carrying a full-term child, a sign of liver disease or perhaps simply a lifetime of bad eating. A scraggly beard covered much of his ashen face. He smelled as if he had gone days, maybe weeks, without a bath.

  After Audrey made introductions, Chester grimaced and strained to lift his head off the pillow. His voice was feeble and raspy. “Where’s my real doctor?” he asked.

  It is not uncommon for patients to question the skills of interns and residents and ask to see their supervisor. But because of the nurse’s advance word, his request took on a sinister tone.

  “We are your doctors,” Audrey fired back. “And I am the one in charge.”

  Chester looked past her, his eyes settling on me for an instant, his face a nasty scowl, before they rested on Gabe. “I only wanna deal with you.”

  Gabe was just two years out of college, and with his deer-in-the-headlight gaze, looked as if he still belonged there. No patient could poss
ibly mistake him for being our leader. Evidently, Chester didn’t just hate “nigger doctors,” but female doctors too.

  Audrey clenched her right hand so hard that she snapped the hook on her ink pen in half. “I’m in charge,” she asserted again, “so you can either answer my questions now or we can find you another doctor, which could take hours.”

  Chester looked around in silence as if weighing his options. Finally, his discomfort trumped his prejudice. “What do you wanna know, lady?”

  Audrey gripped the pen tighter. “How long have you been having trouble breathing?” she asked.

  “I … I don’t know.”

  Audrey waited for him to say more. When he did not, she looked at me and sighed before turning back to him. “Did it start today? Yesterday? Last week?”

  “Longer,” he replied. “Maybe a few months. But it’s gettin’ worse.”

  Along with a lung problem, shortness of breath is a classic symptom of heart disease. She asked him about chest pain: “Yeah,” he said.

  She tried to get a sense of where in the chest the pain was, whether it was constant, and when he had first noticed it. But Chester couldn’t offer any useful answers. Nor was he able to tell us about any previous or current medical problems. Since this was his first admission to our hospital, we had no prior records. It appeared that he had gone years without seeing a doctor, and was, as I would discover was the case with many people, seemingly detached from his own body.

  Audrey continued to question him until, like a witness on a painful cross-examination, Chester put his hands over his face: “I feel bad all over. Can’t ya’ll just fix me?”