‘I Am Tired’: What Black Doctors Need You To Know Right Now
The experience of frontline healthcare workers during the coronavirus pandemic has been and remains headline news. We know what the experience is like without personal protective equipment, to be infected with Covid-19, and the potential risk for serious mental health outcomes. What we don’t know is how this is disproportionately affecting black doctors. Black doctors who have seen more patients who look like them be infected and die from coronavirus. Black doctors who go to work and can feel isolated and alone in their lived experiences, as they make up only 5% of the physician workforce. And, black doctors who once again witnessed the brutal murder of a black man, George Floyd, on camera by a police officer.
We can hypothesize based on what we know and say this will affect their mental health more, but we also need to hear directly from them. This is the time to listen and learn and center their experiences. In the first half of this two-part series, in their own words you will hear from a range of voices, from pathologists to psychiatrists, who will tell you what it means and feels like to be a black doctor right now in the middle of two pandemics, Covid-19 and the national reckoning with racism.
Valerie A. Fitzhugh MD, Associate Professor and Chair (Interim), Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School
When the news about George Floyd broke, I went through a myriad of emotions. The one that has been the most consistent is the pain. It’s a raw, visceral pain. Every time this happens (and it is heartbreaking to have to keep saying every time), I think “That could have been my brother, father, brother-in-law, cousins, etc”. I think back to when I’ve gotten pulled over; “Keep your hands on the wheel, be respectful, and maybe this will be OK.” I am so tired.
I have gotten used to being an only. As a black woman in pathology, there is a sprinkling of us about the country. In many subspecialties of pathology, such as bone and soft tissue, genitourinary, medical renal, and forensics, we are very few. So, imagine this scenario: a poorly written press release interpreting the preliminary findings of the autopsy lacking the word everyone was waiting to see: homicide. Instead of seeing that word, the release seemed to accuse George Floyd. Suddenly, I was being asked to interpret this “autopsy report“. Gaslighting at its finest. I found myself in an intersection between my race and my profession.By defending the presence of forensic pathology, and in particular, this forensic pathologist, was I siding against my people? I was afraid many would think so. The morning after the press statement was released, I took to Twitter. @DrFNA was on a mission. I took great care in my tweets. I made it clear that I was hurting. I explained the difference between coroners and medical examiners. I also explained, with much rightful outrage regarding the press release, that this was not the preliminary autopsy report, and that, despite our rage, we needed to wait. As a community, we are so used to corruption in the handling of cases involving us. It became a “here we go again” moment. This pain was compounded because there was a video that showed it all.
Alden Landry MD, MPH, Assistant Professor, Emergency Medicine, Beth Israel Deaconess Medical Center
I’m tired. I’m frustrated. I’m overwhelmed. I am stretched thin. I don’t feel like I have enough time in the day. I’m not ready to have a conversation with you, but it seems like I have to. These are all thoughts, phrases, and utterances that I have expressed to my colleagues over the past the few weeks. Just as we were stabilizing from the Covid-19 pandemic and recognizing that we had likely made it through the first wave, we were hit again, but this time with police brutality. These past few weeks have been an outright assault on my mental health. Sleep is a luxury, sadness is commonplace, and anger comes quickly when off-putting comments are uttered by colleagues, even those considered friends.
When I am in the Emergency Department caring for patients, I am a physician. It is my career, it is my profession. It is not who I am though. It is not what defines me. If it were up to me, I would describe myself as a Christian, husband, father, Texan, lover of many things including beaches, BBQ, mojitos, and a good chocolate chip cookie recipe. Unfortunately, that is not how this society in America would describe me. Reflexively, without knowing anything about me, this society defines me as black man and along with that ascribes the stereotypes to me. When people know who I am and what I do, it is easy to know these attributes about me. When the assumptions are made without knowing me the default options are often that “I am less than” or a threat.
Being a black physician in times of injustice means checking your emotions at the door because your professionalism may be called into question if you bring in concerns from the outside world into the practice of medicine. It often feels as if you have to strip your other identities away and carry yourself in a manner that is stoic and aloof to society while being compassionate to the patient in front of you. As George Floyd struggled and pleaded “I can’t breathe,” I couldn’t breathe because I felt that pain. As a doctor it would be malpractice and a violation of the code of ethics of the profession to ignore someone the way the police officer did George Floyd. Sadly enough shortly after we saw the video, a case was presented at our department’s Morbidity and Mortality conference and the chief complaint was “I can’t breathe.” I immediately drew parallels to the two situations. So did the other black physicians in the group; disappointingly, many of my white colleagues did not see the same parallels. I sent an email to the group to explain to them what I was feeling and likely what the other black physicians in our group were feeling. Unfortunately, it feels as if it may have fallen on deaf ears as many struggled to reply, while others seemed to have shied away despite me openly expressing discontent. It took a week for my hospital, medical school, and the professional organizations that I belong to ultimately speak up and denounce racism, call for societal reform, and speak out against police brutality. It seems as if no one wanted to be the first to speak up. It also seems as if everyone was scared to say the wrong thing, not realizing that saying nothing was just as bad if not worse.
With the social unrest on full display as protests rose across the country, I was driving into work for an overnight shift. Because of my clinical responsibilities I was not able to join in the peaceful protest. My duality as a physician and a black man were in conflict.
James Baldwin once said, “To be a Negro in this country and to be relatively conscious is to be in rage almost all the time.” To be a physician and to be a black man is to be in a constant state of rage but to have to bottle those emotions up even if it may be to your own detriment.
Rebekah Fenton MD, pediatrician and adolescent health advocate, Chicago, IL
#GeorgeFloyd, #Minnesota, and #BlackLivesMatter trended on Twitter. Just reading those three lines, I knew two things: another unarmed black man was murdered by police violence and my heart couldn’t take reading it.
A few days before the news broke, I suddenly developed a pounding heart rate. Probably anxiety, I thought. When the pounding followed me the next couple of days, I tried every calming trick that I know: breathing exercises, prayer, meditation, etc. It didn’t go away. My father, a physician and concerned parent, recommended I see a doctor just to make sure. I set up a telemedicine visit and cried while explaining my frustration with the lack of control. “We can get an EKG and some labs”, the physician summarized, “but, like you said, the etiology is most likely stress.” I cried even more. My body was clearly trying to tell me something, but how long would the message last?
I felt stuck in flight-or-fight, my body pouring non-stop adrenaline into the bloodstream. I worried that remaining in this state too long would be toxic to my mental and physical health. Chronic stress leads to increased inflammation in the body, and increased risk of mental health concerns and chronic disease if there’s no intervention. I also felt betrayed by my body for expressing emotions that my conscious mind could not comprehend. I thought I was fine: stress managed and feelings processed. I had a great deal of stressful experiences in the last two years, and I had survived them without a health scare. Why now, body, when I thought things were better? After many more tears, I expressed gratitude to it for carrying me through all those experiences. I honored my body’s strength and elevated its voice; I committed to slowing down and listening for as long as it needed.
I had to break from social media for days to get the rest I needed and the space to process my stress. I love advocacy, and I knew I couldn’t work for others until I first tended to myself. I carried the stress of situations I couldn’t change and therefore feelings I couldn’t release. I brainstormed with my new therapist how to set boundaries so I could experience safety within them.
On Sunday, Charlie Dates, a black pastor in Chicago, described the sacred quality of breath and called on everyone to acknowledge that taking it away is murder. I cried, not for myself, but for George Floyd, those whose breath were similarly taken away, and all who rushed to the streets to stand for equal value of black lives. While this is a major moment in US history, it is a peak in a mountain range of experiences for black people in this country, an acute on chronic stress. I can recall where I was and what I was doing when I heard that Trayvon Martin’s killer was not convicted. The faces of Mike Brown, Sandra Bland, and Tamir Rice are etched in my memory like family members. This is the toll of being black in America, seeing a black person killed and hurting, on top of everyday stress, because it’s nothing new.
Utibe R. Essien MD, MPH, Assistant Professor, Department of Medicine, University of Pittsburgh School of Medicine
I’ve spent most of the past week looking for the words. Looking for the words to comfort my younger brothers, whose memories of past, unanticipated interactions with the police were triggered by the murder of Mr. George Floyd. Looking for the words to say to the black medical student and black intern on my medical team as we walked together on rounds, business as usual, the masks on our face a subtle reminder of the ongoing Covid-19 pandemic that continues to ravage through our communities. Looking for the words to encourage myself that with each new day, the tears in my eyes, the lump in my throat and the pressure in my chest will soon go away and I will be okay again.
But I am not okay. The image of Mr. Floyd, a black man like me, dying on the hot concrete in Minneapolis has haunted me every day. His dying words, “I can’t breathe”, have brought back moments that were so common as I trained to be a physician. Despite the myriad of famed physicians and scientists that once walked the hallowed halls of Massachusetts General Hospital, theirs were not the names that marked my residency training. Those names were Michael Brown. Freddie Gray. Walter Scott. Eric Garner.
For some reason Eric Garner’s death has stuck out to me the most. Perhaps because his was the last video I could convince myself to watch, never again subjecting myself the pain of seeing another man’s life taken from him. Perhaps because his death reminded me of home, the NYPD uniforms from my childhood surrounding him as he choked out his now infamous final words, “I can’t breathe.” I wonder if Mr. Floyd thought about Mr. Garner as he walked out of that Minneapolis grocery store one last time, his last words eerily echoing Mr. Garner’s from five years before.
As I reflect over these deaths, I can’t help but think about the historical pattern. I think about the months following Mr. Garner’s death, the anger still welling inside of me as I cared for patients within the hospital walls while my colleagues and supervisors remained silent as though nothing was happening in the world beyond. I think about the Grand Rounds lecture I was sitting in one December morning in 2014 when I received the notification that a grand jury would not indict the officer whose chokehold ended Mr. Garner’s life. I think about the warm August morning in 2019 when I turned on the radio to hear that the same officer responsible for Mr. Garner’s death was finally terminated from my hometown police department, over 4 years later.
Like Mr. Garner and Mr. Floyd, I still can’t breathe. I can’t breathe knowing that the same chronic conditions that Mr. Floyd’s autopsy report held responsible for his death are the same ones that placed him and so many other black and brown Americans at higher risk from Covid-19. I can’t breathe knowing that while my friends and colleagues have spent the last three months fighting hard on the frontlines to ward off the deadliest virus of our lifetimes, my community is now fighting hard on the streets to ward off the not-so-novel disease of racism that has been killing black people for the last three centuries. I can’t breathe wondering if the protests, the emails, the kneeling, and the outrage will finally be enough this time, or if in another five years will I be in the same position, helplessly looking for the words.
Theodore Nyame MD, Plastic Surgeon, Charlotte, NC
Watching George Floyd being murdered by a police officer was heart wrenching. It served as yet another painful reminder that many in this country view my life as disposable because of my black skin. Many people do not understand the reality of what it is like to live in this country as a person of color.
The first time I was stopped and searched by the police, I was 13 years old and riding my bike in my neighborhood with a friend. We casually rode by a police cruiser and soon noticed that we were being followed. Suddenly, the siren came on and my heart began racing. We were questioned and searched for no reason. In that moment, my relationship with police officers was forever changed. From a psychological perspective, something changes when you are made to feel like a criminal at such a young age. More recently, I was pulled over for an expired license plate tag. Two officers approached my vehicle from both sides with their hands on their holsters. They parked in a way that cornered my car in. As I turned over my license, I noticed they had called a second patrol car in for “backup.” Invariably they asked the same questions I am asked whenever I get pulled over: 1) is this your car? and 2) are you really a doctor? It’s never spoken, but I know when they see “Harvard Medical School” on my license plate, they think the car is stolen. This has happened in every U.S. city I have lived in.
In time, I have learned to wear scrubs or keep scrubs in my car as proof. It is analogous to being in an abusive relationship and doing everything possible to keep the abuser happy in order to avoid being abused. In fact, I wear scrubs or something that identifies me as a doctor almost everywhere I go. I do this not to show off, but in hopes of being seen as “less of a threat.” I’ve noticed that people treat me nicer. The constant need to appear less threatening is a painful reality for many people in this country. As a father of two young black children, I hope they never face racial bias but sadly, I know that is unlikely. I am reluctantly preparing myself for the day I will need to sit them down and explain what the color of their skin will mean to some people. I am not writing this for sympathy but for those that deny that racial bias exists in 2020.
Sandy Charles MD, Cardiologist & Director of Novant Health Women’s Heart & Vascular Center
As I painfully watched George Floyd being killed, I feared that one day that lifeless body lying beneath a police officer could be my loving husband or my precious son. The psychological toll of being on the frontlines of the Covid-19 pandemic was easily surpassed by the dread of possibly losing a loved one to racially motivated violence. As a physician, I made an oath to protect and preserve human life and I treat all patients with the utmost respect and compassion, no matter their race, religion, or socioeconomic status. Despite upholding myself to these basic standards, I’m faced with the heartbreaking reality that our country may never provide my beautiful black children with equal treatment. I have trained over 14 years to become a cardiologist, however, I am repeatedly referred to as a nurse by many patients. Despite performing countless lifesaving procedures, I am repeatedly told that I do not look like a doctor and questioned whether I have been adequately trained to do my job. Being black in America is draining. Whether it’s watching unarmed blacks being continually murdered by police or daily reminders that you are considered innately inferior in the workplace, I look forward to the day when we are truly seen as equal.
Jasmine R. Marcelin MD, Assistant Professor, Infectious Diseases, University Nebraska Medical Center
The last few months have been pretty traumatic for black people in this country. As if it wasn’t bad enough to be battling systemic racism on a daily basis just to live, a Covid-19 pandemic emerged with unimaginable impacts on the black community. As if that weren’t enough, the killings of Breonna Taylor, Ahmaud Arbery, and George Floyd poured hot oil into already infected, gaping wounds. It is hard to really articulate the full impact that this has had on one’s life and mental health.
For the past few weeks, I have existed with a cloud of sadness over me; I cried frequently, I have been irritable, I have neglected most of my non-patient care duties. I’ve withdrawn from social media and virtual socialization with friends. I’m exhausted physically and emotionally. It takes a tremendous amount of energy to walk this path and still put on a brave face, pretend like nothing is wrong, be present for the people around you. Especially when those around you seem oblivious to not only your emotional struggle, but even oblivious to the profound impact of what is happening around us in the world. Most stressful for me has been to have this conversation over and over with my young son and watch as his face, crestfallen, registers some understanding of why racism exists. As I have been vulnerable about these feelings with my colleagues, I have come to realize what I am experiencing – I am grieving. Compounding my exhaustion is a personal desire to “do more”, to use my privilege as a physician with a social media platform and organizational leaders that seem willing to listen to my words, while at the same time recognizing that I still have other responsibilities of my job that I need to attend to.
I’m fortunate that I am surrounded by people who care deeply for me and my emotional well being. My husband and I, though we have processed this in very different ways, have daily discussions which help us both to decompress. My parents and siblings, although all living internationally, have given me the support and love I need to press forward. I have been welcomed into a phenomenal group of black women healthcare professionals and we have been texting and uplifting each other since the pandemic began, and this has been so therapeutic.
I’m still not okay, still not myself, but yesterday, for the first time, I texted a friend: “Today, I’m a little better.” Kneeling for George Floyd and for all the black community began a healing moment for me; as I cried for him, and Breonna Taylor, and Ahmaud Arbery, and Sandra Bland, and James Scurlock, and Trayvon Martin, and Tamir Rice, and all of the other black lives lost to racism in this country, I also cried for the future that I want my husband and sons to have; I cried for the care that I want my black patients to receive, the respect that black people deserve to have, and I cried for the hope that the American Reality one day, will finally live up to the Dream.
Amanda Calhoun MD, MPH, Adult/Child Psychiatry Resident, Yale Department of Psychiatry
I think people miss the point when they express compassion about how I must be feeling as a black person, a black doctor, “right now”. There is no “right now”. Racism has affected the lives of black people, long before Covid-19, and long before the televised lynching of George Floyd. Race affects every aspect of our lives, whether we want it to or not, and doctors are no exception. Is my mental health impacted by the constant, near daily, acts of racism I experience? Of course. But it always has been.
While I’m glad that the world seems to be listening now, while I’m glad that people are now acknowledging the racism that we face, I have to break it to you: this is not new for us. We just didn’t trust that non-black people would listen because society often silences us when we do bring up racism. We have been crying, for a long time, due to unarmed black people, children included, getting murdered—people who went unnamed and unnoticed. We have been struggling, for a long time, to do our work as physicians despite hearing racist jokes about our patients and witnessing unjust care based on the color of their skin. We have been having tear-jerking conversations, for a long time, about racism since we were preschool age, sometimes younger. We have been experiencing blatant and covert racism for a long time, a long time aka 400 years. There is nothing new about right now, except more people are listening.
Kimberly Manning MD, Professor of Medicine & Associate Vice Chair, Diversity, Equity, and Inclusion, Emory University Department of Medicine
Though history tells of the resilience of black Americans and the longstanding example of our ability to emerge from unspeakable horrors, know this: The impact is felt. Even when we can’t put our finger on why our eyes are stinging with tears or our chests feel tight, somewhere in the back of our minds we always know: You were stacked into boats, tossed into oceans, and hung from trees because, like beasts, you were deemed disposable. You were injected with syphilis, denied available treatment, mass incarcerated, and killed in broad daylight by your alleged protectors. So, the real questions are: how do you make a nation unthink something so deeply embedded into its fabric? How can you breath when suffocated by that truth?
I walk over to the freezer, look inside and tell my son: “We do have some popsicles. They were buried underneath all this frozen stuff.” He looks happy.
And so, I refresh my screen and return to charting on patients. I respond to emails from medical students and reconcile meetings on my calendar. Then I glance over at my son, content with his popsicle, and feel glad. Perhaps there are some other sweet spots that I’m overlooking right now. But these days? I’m just tired.