“So now you think I have all these implicit biases, don’t you?” My Caucasian attending rolls his chair towards me. The words are already out of his mouth. And now I’m acutely aware, once again, that I’m African-American, gay, and in a position of hierarchical vulnerability. I’m alone in this room with him. All because I wanted to privately address that he called me the name of the only other African-American doctor in our program in front of everyone during morning rounds. His words hang there as he does that thing he does where he stares. Calculating as I scramble for a response. The rolling feels like a threat. I have a panic attack, and that all-too-familiar vice locks around my mind. Nightmarish fingers squeeze my heart so it’s fit to burst. My breaths become shorter. My body flushes with ice. I want to say, “Yes. Yes, we all do and should be working on our implicit and explicit biases.” I want more than anything to be able to say, “Back away from me. Now.” But I can’t. Why can’t I? Well, I’m African-American and gay. I’m not allowed to have a voice anymore. It doesn’t matter that I’m a psychiatry resident training at a prestigious hospital. It doesn’t matter that my colleagues and I have proved again and again that there are serious issues of racism, homophobia, misogyny, and other instances of bigotry arising in soul-shattering ways in the hospitals where we work. What tears at my soul the most as I rush to find the right answer? I was past this sort of thing once. In college, I learned that I am so much more than African-American and gay. I’m a scientist, a dreamer, and an academic. At a liberal university, I briefly lived in a world where I could be myself—a world where, for a brief time, I was safe. But when I got to medicine, I learned that wasn’t true anymore. Being African-American and gay has been a lethal combination. In medical school, classmates asked if I got in because of affirmative action. When I became class president, they said it was because I’m a minority. Everything was about my skin color and who I had sex with. I still have nightmares and wake up screaming from the memories. I hoped residency would be better. The residency director said there weren’t significant issues regarding racism or homophobia in our hallowed halls. She said that if issues arose, they would be handled, and I would be supported. I shouldn’t have known better from my medical school experiences. I guess I was a little naïve when I first came to residency. Or, rather, I was ever-hopeful. At that moment, though? With the attending who rolled his chair towards me? It wasn’t about aspirations and hope anymore. It was about survival. I maneuvered internally as he rolled his chair away and said it was so “interesting” that I had brought up what I had. As he said that he “didn’t want to talk about this right now,” I played the game. Even as he said, “you’re leaving the rotation tomorrow, and you didn’t like being here anyway,” even though I had just told my other attending how much I liked the rotation. I played chess because that’s what you do as a minority in medicine all too often: You play chess to survive. That was three years ago. Since then? I’ve been called the “N-word” by a patient. I’ve been called a “fag” by another who was gay, and it stopped my heart. I had an attending tell my program director I rolled my eyes at her. She later said she couldn’t see my face and thought I might have rolled my eyes. I’ve had to explain over a hundred times that not wearing a tie doesn’t mean I’m “unprofessional.” There’ve been sigh-inducing moments when I have to remind people how minorities who speak up are told they have a “bad attitude.” There have been periods when I’m frustrated beyond belief when I’m asked if I’m there as transport, to pick up someone’s food, or they turn away from me when I’m talking. My story is not an uncommon one. A 2017 survey found that 59% of responding physicians had been degraded, belittled, or harassed by patients based on characteristics such as their race, gender, sexual orientation, or ethnicity. And that’s only speaking to bigotry experienced in patient-physician interactions. There’s even a term for when such behaviors are normalized, when systemic organizational practices fail to respond to discrimination or microaggressions appropriately: institutional betrayal. My experience of bigotry in medicine has been awful, but some things have helped: namely, finding people who ask about all facets of my identity, who see me as more than that gay, African-American resident. People who have said, “There is a problem, and we’re here to help. We will truly stand by you and speak up for you and others, because this shouldn’t be your fight.” Inside and outside the hospital, I try to hold onto my memories of the world I lived within during college, where conversations about racism, homophobia, misogyny, and bigotry wove throughout our discourse and made our friendships stronger. And, although I’m purposefully leaving my current hospital system for fellowship elsewhere, I’ve stayed in the medical field because we can do better. I’m here, doing what I can with others to bring forth that vision I hold inside of that better world I once lived within. Because I know we can reach that world. Because each and every one of us deserves to live in such a world. K. C. Ardem is a psychiatry resident and can be reached on Twitter @ardem_c Source
