Thoughts on Race

Below are a few vignettes that have shaped my thoughts on inequality, racism and inclusiveness. I wrote this essay to get ready for a forum on diversity and inclusiveness at the school where I teach.  A caveat – I refer to race many times in this essay, but I should make it clear that scientifically, there is no such thing as race.  The whole thing is a cultural concept, so please take my use of the word in that context.  

Keiko

When my mother Keiko emigrated from Japan in 1953, one of the first places she lived was on a naval base in Charleston, South Carolina.  My father, a submariner, was at sea for months at a time, so much of her acculturation to American Life was done by Vera, her next door neighbor.  One day, the two of them went to the laundromat to do laundry.  The sign on the door of the business said “Whites Only,” and my mother told Vera she couldn’t go in.  “Oh, it’s okay, you’re Oriental, they don’t mean you,” said Vera.  “But I have blue towels,” Keiko responded.  

When Keiko is in a good mood and tells this story, she is telling a story about how naïve she was when she first came to America.  When she is in a bad mood, she relates this story as one about how ridiculous American race prejudice is.  “This is America’s shame, and the whole world knows it,” she says.  Keiko is a pretty politicized person who made her daughter watch the Watergate Hearings when said daughter was only 6 and would have preferred to be outside playing and who allowed the TV to be on during dinner to facilitate current events discussions around the table.  She thinks racism wastes what’s best America.  The way she understands it, America is supposed to be a land of equal opportunity and a melting pot that can absorb and support and promote all types of people.  Keiko gives money to the ACLU.  She cites Bobby Kennedy and Martin Luther King as her heroes.  Keiko is proud to call herself a Chicago Democrat.

Keiko didn’t talk to me for 6 weeks after she found out that I had purchased a Samsung TV, because Samsung is a Korean company.  Keiko thinks Korean people are particularly stupid and stubbornly wrong-headed.  As a child, I remember her telling me that some Koreans learn Japanese in order to do business in Japan.  I asked her if any Japanese people learned Korean.  My mother thought this was the funniest thing I had ever said.  She called up her Japanese friends up on the phone and they all had a good laugh at such a preposterous idea. If you tell my mom she’s racist, she’s offended.  If you point to her views on Koreans as proof, she’ll tell you you’re wrong.  The things she believes about Koreans are not racist beliefs.  In fact, they are not beliefs at all, they are facts.  It’s just true.  

People, including Keiko, are well intentioned.  I believe that, for the most part.  They haven’t chosen to be racist – they have been indoctrinated by society into a point of view, usually from birth, that seems normal and right to them.  That point of view can be very specific and rooted in the history of a place – allowing my mother on the one hand to be ashamed of the segregation she saw in the American south at the same time she exhorts me to buy a Toyota instead of a Hyundai.  Korea was a military rival of Japan’s, so Keiko’s attitude and the propaganda that shaped it makes sense to us in a large scale, political way.  We accept that countries have disputes and fight.  The toll of this system of belief on individual people, though, seems to me to be an uncounted casualty of war.

Jim

My father’s family comes from Muhlenberg County, Kentucky.  There’ve been a few country songs written about it, but its claim to fame is as the birth place of Jefferson Davis, the President of the Confederacy.  Kentucky was a border state during the Civil War, with many families split – some fighting for the North and some for the South.  I know this happened in my dad’s family, because in the mid 1860’s, half of the family kept the surname Roberts, while half suddenly became Robards.  Name shifting was a common practice in families split by the Civil War. The Robards married into the Todds, and if you’re wondering what side they were on, I’ll tell you that my great-grandfather’s name was Jefferson Davis Todd.  I think that makes it pretty clear. My grandfather was named Franklin Pierce Todd, after the 14th president of the United States.  Pierce preceded Lincoln and the Civil War and although he was a Northerner (born in New Hampshire and educated in Maine), he saw the abolitionist movement as a threat to the unity of the nation.  He named Jefferson Davis as his War Secretary.  Policies enacted during his presidency set the stage for southern secession.   My dad was Jim Franklin Todd – three generations of men named after heroes of the confederacy.  

My father voted for Obama – twice.  My dad had roots in a family that should have resulted in a bigot, but he became the opposite of that. He was frank about the racism he himself espoused when he was young. His grade school class was taken on a celebratory field trip every year to Jefferson Davis’ Birthplace and learned far more about him than about Abraham Lincoln (also a native son of Kentucky).  He was taught to think and speak from a racist perspective and he didn’t know any different.  And then Jim, who had never had more than 1 pair of shoes at a time in his 18 years enlisted in the Navy.  The USN gave him more than one pair of shoes, but it also gave him the opportunity to see the rest of the world.   Through the Navy, he met all kinds of people from all walks of life and he found out that it was enjoyable and freeing to appreciate all sorts of ideas and world views. In short, he was open to life and let it change his mind. He joked that he had no choice, because he was sealed in a tin can under the ocean for weeks at a time – they all simply had to get along. 

My father was a work in progress.  He wasn’t too sure about Affirmative Action, not at all sure about gay rights, and he wouldn’t allow me to pick the French horn for a band instrument because it “wasn’t for girls.”  But my point here is that my father did not peel away from his racist roots because someone told him his views were inappropriate or because his school had a mission statement that said that intolerance would not be tolerated.  He changed his mind because he got an opportunity to see for himself that there was a different way to live.  He was placed into a system where people were interdependent and where adherence to military code mattered more than skin color.  He saw for himself how much better it worked that way.  He saw for himself that there was nothing in his fellow men to be afraid of.

No one changes their minds because we tell them off on Facebook or argue with them on Twitter.  No one changes their minds because we put up signs saying We Believe This or That.  They change their minds when they see a system that works in which they have real opportunity to develop.  They change their minds when they feel it’s safe and in their own self-interest to let go of their fear.

Nazis

I had the opportunity 3 years ago to travel to Germany with the medical and law schools when we presented a CME/CLE conference on doctors and lawyers during the holocaust.  I learned a lot of things in preparing for this trip that I thought were firmly in the past which I now sadly realize equip me to deal with the present.  I learned about the dangers of government involvement in the doctor/patient relationship.  I learned about how easy it is for The State to manipulate science and medicine into doing its bidding.  But most importantly, I learned about how a society can own – in fact must own – its failures in order to move forward.  

Unbeknownst to me, while the rest of the world reeled in disbelief over the atrocities of the Holocaust, Germany preferred to sweep it under the rug for many years.  The War made people crazy (something Keiko, who lived through the second world war in Japan also often says), it’s over, let’s move on.  My dad maybe was a Nazi, but I’m not, so what is there to talk about?  But the unfinished business of the atrocities wouldn’t go away, and more than a decade later, Germany had to figure out how to own what it had done.  As far as the state was concerned, it was over.  But as far as the people were concerned, it wasn’t.  

For the German state, reparations involved money to families of survivors of the concentration camps, and state support for German companies like BMW and Siemens so that they could settle lawsuits brought against them for using the forced labor produced by people in the camps.  Personal reparations on an individual level are harder to discern, but a lawyer at the conference had a very interesting perspective on what it meant for him.  “From the Holocaust we can see that a group of people, a country, can go insane sometimes,” he told us.  “The rest of the world must have the ability to intercede.”  Instead of working for a law firm in Germany, or for a municipality, he chose instead to focus his practice on International Tribunals, World Courts and Global Human Rights Campaigns.  He was involved in Truth and Reconciliation efforts in Bosnia-Herzegovina and Rwanda.  “My fathers lost their minds and did something evil.  I cannot take it back.  But I can be responsible for not letting it spread. That is my duty.”  It was after his discussion with us that one of the women in our group said something profound.  “If Americans owned Slavery the way the Germans own the Holocaust, we wouldn’t have a “race” problem,” she said.  And I think she was right. 

Patients

Every so often, a patient will say something that provokes a strong negative reaction in me.  I had a patient who refused to submit an application to Medicaid even though his hospital bill was going to be astronomically high.  “I’m not about to do anything associated with that N**** in the White House,” he told me.  The facts that Medicaid is a state sponsored program and that President Obama’s race has nothing to do with his medical bill didn’t seem relevant.  It was obvious that he wanted to tell me something about his world view more than he wanted to have a discussion.  Another patient pulled up his gown for me to listen to his heart and revealed tattoos of swastikas and white power slogans.  What should I do? I think all of us have wondered about that from time to time, and I think the question is going to come up more and more in the future.  

For me, the real question is “what is my job?”  And when I am standing in the hospital room, or behind the ER curtain, or in the clinic, I am committed to standing in a Patient-Centered place. My job is to provide a healing experience for the patient.    That means patients get to say whatever they want to say, including things I don’t like to hear.  My job is to focus on their medical problem and do the best job with it that I can.  When I became a physician, I gave up the right to treat people according to how much I like them or refuse to treat people on the basis of their personal creed.  I have to silo off my repulsion, and remembering that these sorts of statements come from a place of fear helps me retain my ability to empathize with them.  

Life teaches you strange lessons, sometimes, and I learned one a few years ago that shaped my views on this subject.  I was working with a husband and wife who were very religious born-again Christians.  Betty was extremely ill and unlikely to recover her health. In addition, although she could not speak due to a tracheostomy, she would often cry and shake her head “no” when she was undergoing tests and procedures – everyone caring for her felt deeply conflicted about what we were doing.  Her husband was vehement about “doing everything” to prolong her life, as he was expecting God to perform a miracle.  The words used to describe Mr. Wood in the medical record were “unreasonable,” “religious fanatic,” and “not acting in the patient’s best interest.”  When her case was signed out to me, I was told I would have trouble with him. 

And indeed Mr. Wood was very wary when we first talked.  It was important for him to tell me that he was a born again Christian and that he believed in miracles.  I don’t talk about my own religious background to patients often, but I told Mr. Wood that I had grown up in a similar church with similar beliefs.  I can still remember the look of relief on his face when he realized he was talking to someone who might not think he was a crackpot.  He pulled out his business card, the back of which detailed the platform on which he was running for President.  He told me he had been running for President every year since 1968, because he believed America was in peril if it didn’t have a born again Christian in the White House.  “See, I believe both George Bush and Bill Clinton are the Antichrist,” he began, and I stopped him.  “I don’t believe that,” I said - breaking my rule of letting patients say whatever they wish.  Mr. Wood stopped and thought.  “You don’t?”  He paused.  “I hope and pray you are right.”  And we changed the subject and talked about his wife’s health instead.  

I think about that moment, where Mr. Wood actually stopped and considered an opinion different from his own.  How did that happen?  I think it happened because we’d established that we had something in common.  He didn’t perceive me as a threat, so he was able to hear me.  That was a lesson to me in the importance of making every effort to find some kind of common ground with every patient I meet.  It is not easy – but it produces good results.  Do I actually sort of think that someone who has been running for President for the last 60 years is a crackpot? I do.  But I don’t think he was unreasonable, trouble, or malicious.   He was someone who was in desperate straits, and he made a lot of sense to me that way.    I found it so much easier to be kind than judgmental.  

It’s also much easier to be factual than horrified – which I try to remember when patients ask me to “sign me up with a doctor who speaks English” or make sure no brown people/female people/people of a particular religion are involved in their care.  I just tell them the truth.  I tell them that I will refer them to the best doctor I know for their problem and tell them about that doctor, so that hopefully they can appreciate what I appreciate about my colleague.  And I tell them that in our system, I can’t guarantee that they’ll never see a certain kind of doctor.  We all work together to provide care, so you’ve got to agree to us as a whole.  In my experience, most patients are willing to trade their prejudices for the promise of good medical care. Some will go elsewhere – and that is okay. 

That said, I think you have to put the negative feelings you sometimes have about patients somewhere.  You can’t just stuff them, they’re toxic.  Physicians and other health care workers see and hear all sorts of sad and terrible and unfair things through the course of the day, having to hear hateful or intolerant speech on top of that can really throw you.  I don’t think you can stop your patients from saying these things, but we need a safe space in which to talk about these things outside of the clinical encounter.  My hope is that we create these spaces, so that these conversations culminate in efforts that make our school community a better and better example of the positive power of inclusiveness.   

When I think about these people and experiences in my life, I can see the start of a path for action.  From Keiko, I understand that racism is a cultural product more than it is an individual’s character flaw, so I need to avoid blaming the victim and not let my distress at some of the things they say get in the way.  From my trip to Germany, I understand that I must find ways to take responsibility for the errors of the past, for until I do, the wounds will not go away.  From patients, I find that advocating for people with whose world view I disagree shows me that the power of empathy is greater than the power of judgment. And most importantly from Jim, I understand the power of a place that offers opportunity and fairness. I need to be part of efforts to make our school that kind of place, because it is places like that have always been and will always be the answer to the manifestations of fear and hate.