Racist. Anti-Racist. Microaggression. Institutional Racism. The Power Of A Definition.

I find my body tenses at the word “racist.” It also tenses at the word “earthquake.” I ask you to be aware of your body as you read this essay. I suggest wiggling your toes, shrugging your shoulders, and taking slow abdominal breaths.

7:18 a.m. Shift change. The 8.0 magnitude earthquake hits. Nurses, medical students, and physicians improvise care for patients. One public hospital completely collapses. Another’s OB/GYN tower falls, killing patients and medical staff. Somehow, newborns survive and are found days later — they are the “miracle babies.” This is el terremoto of 1985 in Mexico City. Nothing, nobody is unaffected. The poor and indigenous suffer the most, but the quake unites public and private hospitals. The focus is on care for all — all people, no matter the color of their skin or their social status.

Anti-racist: A health care worker who supports anti-racist patient care through actions and expressing an anti-racist idea.

January 2018. The bitter cold wind blows in the obstetric ward. The mother next to the window lies shivering with glazed eyes. Her second baby is dying. Her first died years ago. She had hoped to hold a baby, her baby. Health care workers had dismissed her wishes to become pregnant and had encouraged her to get an abortion when she did conceive. She is 46 years old, after all, too old. At least, too old for an indigenous woman in southern Mexico. Not long ago, she gave birth to a healthy baby boy. Shortly afterwards, he became sick. He has coarctation of the aorta — a patent ductus arteriosus dependent lesion. The family can not afford more prostaglandin for him. The public hospital will not transfer him to Mexico City for the lifesaving operation. He is sentenced to an early, needless death.

Racist: A health care worker who supports racist patient care through actions, inaction, and expressing a racist idea.

2020. I steady my back against a wall as I breathe in the reality of COVID-19 and how the public charge law from February is turning medical care into crime for many Latinx in the U.S. I know the pandemic is disproportionately affecting the populations of Black, indigenous, people of color. Tears stream down my face, and I feel helpless. I try to let the grief flow through my body, but it catches in my shoulders and neck. I steel myself for the day and focus on my work as a physician for solace.

My first patient is 14 years old — obese and pre-diabetic with sleep apnea. He sits with his legs over the exam table, looking at me expectantly. His caramel-colored skin is etched with darkness at the elbow and neck creases.

“I want to study to be a doctor.”

The world freezes. The white fluorescent light beats down on me. My mind spins with how to respond to this boy — this boy of color, this boy forgotten by society. As he describes his school, I almost see the discolored walls and hear the jeers of his peers. I almost breathe in the moldy air of the rented apartment he tells me about, where his bedroom is also the living room. I almost smell the dinner cooking and feel his family’s embrace.

But I don’t. I am privileged. I have light skin. I work as a doctor.

I hear myself acknowledging his interest in health care and explaining how there are many different careers in medicine — medical assistant, billing, nursing. And then I catch my breath and myself. I am discouraging him from his goal of becoming a physician. I quickly add the word doctor to the list and cringe. I have propagated institutional racism.

Institutional racism: A form of racism that is embedded as normal practice within society or an organization. It leads to discrimination in health care, housing, and education, among other issues.

My second patient is a 4-year-old child whose mother has declined an interpreter. I loom over the mother as I enter the room with my professional attire and stethoscope. Then I sit. She sits across from me, speaking the English language with an accent I struggle to understand. I respond in my American-West-Coast-accented English. I worry I won’t understand her and feel annoyed that the visit will be more difficult. What if I miss something because of her accent? Why couldn’t she just use an interpreter and make my life easier?

And then I feel guilty for my thoughts. The stool squeaks under me, and my neck tenses while nausea fills my gut. To assuage myself, I say something to support her. I hear myself exclaim how she speaks very good English. And then I catch my breath and myself. I am diminishing her with a microaggression. I take a breath and add how I, too, speak very good English.

Microaggression: Marginalizing human beings and denying their worth. Often subtle and indirect.

As clinicians, we see suffering every day. We also suffer ourselves. Our training was likely harsh — long hours, belittling words, demeaning actions. We were not seen or heard. Now we are expected to see and hear others.

We are also stressed. Work in health care is often exhausting. Now, with the pandemic, we worry for our jobs, our livelihoods, our future. We are asked, sometimes demanded, to do more with less. We are in the middle of a worldwide health care crisis, and yet our work is diminished. Again, we are not seen nor heard. It is not fair.

I acknowledge our suffering in this. I acknowledge my pain, sadness, anger. I acknowledge yours. I ask you to breathe, see your suffering, feel the suffering in your body, and gently acknowledge it with kindness.

If we can acknowledge our own suffering, we can see the suffering of others. We can save the miracle babies and unite together to care for all, like in the earthquake of 1985. We can see when we marginalize others and propagate racism, and redirect our course.

Definitions ground us in our profession and in our world. Definitions matter because they help us pause, give our body a moment to settle, and our breath time to move in and out. Our racist actions, inactions, and comments are invasive throughout our waking hours, but we can change them if we can define them.

Racist. Anti-racist. Microaggression. Institutional racism. Don’t let the words keep you tense. Let’s move forward together and breathe.

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