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.
