On “Between the World and Me,” Medicine, and Misogynoir

Several weeks ago, I read Ta-Nehisi Coates’s new book, Between the World and Me, a bold, compelling, and beautifully written letter to his son about the struggles and fears of being black in America — or more specifically, of being a black man in America. Over the past year, we have seen black lives being threatened and taken away by police, an acute reminder that the destruction of black bodies is, as Coates puts it, “heritage” in this country and will not end until the Dreamers, “those who believe that they are white” wake up from their Dream and realize the violence on which it is built.

Of the many themes in this book (Dreamers, fear, struggle, Mecca, etc.), the one that piqued my interest the most was that of the destruction of black bodies. Perhaps it is because I am in medical school, where all we think about is the body, but this question kept nagging at me: What does this theme or idea mean for medicine — an institution that has upheld, and in many ways continues to perpetuate, racism? The first thought that came to mind was that the institution of medicine itself was built on the destruction of black bodies and of maintaining the belief (or rather, myth) of the Dreamers — that they are white.

What I mean by the latter, and what Coates explains in his book, is that medicine (and science in general) has been used to justify slavery by describing distinct “biological races,” with the white race being the most superior, and the black, the least. This “scientific” knowledge was, of course, used to defend and justify slavery. And unfortunately, the idea of biological races remains hard to shake in medical practice, research, and education. Pulmonary function tests, for example, are still adjusted for race based on the age-old assumption that black people have different lung capacities than white people; black people are less likely to be given appropriate pain medication because of the implicit bias that they experience pain differently; and using racial categories in an uncritical manner in research studies can lead to false conclusions by failing to interrogate the ways that race and socioeconomic status are conflated. And in medical schools, race as a social, rather than a biological, concept is often glossed over, if mentioned at all.

But the literal destruction of black life is, in many ways, the heritage of medicine specifically, in the same way that it is the heritage of American society more generally. As Harriet Washington writes in Medical Apartheid, white doctors and surgeons experimented on black slaves, often denying them analgesia. Medical care for slaves was limited to the bare minimum needed to get them back to work rather than the standard of care provided to white folks. This history is hardly mentioned in medical curriculum (or at least, it has not been my experience, nor have my friends at other medical schools told me about discussing this topic in class).

What we will talk about, though, is the Tuskegee syphilis study, in which white doctors allowed syphilis to run its natural course in poor, black men, even after penicillin was discovered to be an effective treatment. Most, if not all, American medical students have heard about this study at some point in their educational journey, even before starting medical school. The Tuskegee study, which ran from 1932 to 1972, is taught in social medicine courses, bioethics courses, and even in microbiology courses as an example of racism in medicine as well as an example of how not to conduct medical research.

While it’s great that we acknowledge that the Tuskegee study happened and that we need to prioritize ethical research methods, it is a bit troubling that it is often framed as That One Time the Institution of Medicine Was Hella Racist. As I described earlier, the history of racism in medicine extends to well before that time.

But perhaps more troubling, especially for me as a black woman, is that in teaching that Tuskegee as That One Time Medicine Was Racist, we have also sent the message that racism in medicine only affects black men. This is a lie. Black women, too, have been subject to unethical experimentation and have been subject to things such as sterilization without knowledge or consent. That we are comfortable teaching racism in medicine as it affects black men but fail to acknowledge racism as it affects black women is misogynoir (i.e. misogyny specifically against black women). That we teach the Tuskegee syphilis study but not the history of gynecology, for example, is misogynoir. Few medical students are aware that Marion Sims developed the surgical technique to repair vesicovaginal fistulas by experimenting on black slave women, including three named Lucy, Anarcha, and Betsey (#SayHerName), who were unable to properly consent due to the power differential between physician and slave. Moreover, Sims failed to provide analgesia to these women while perfecting his technique, but then provided analgesia to white women he later operated on; this, too, is misogynoir. And that we know his name — but only those of three of the many black women through whom his discoveries were made, that we honor him as the Father of Modern Gynecology, and that we memorialize him in public spaces is misogynoir.

Misogynoir is also seen in the medical advances that have been made through research done on HeLa cells. These cells, cultured from a cervical biopsy taken from a black woman, Henrietta Lacks, and used for research without her consent, have led to medical breakthroughs that have allowed medical institutions to profit. This, too, is the destruction of black women’s bodies and misogynoir.

These are the handful of examples that I know of black women’s bodies being destroyed for the sake of medicine. And I will admit that I only know a few because these stories are ignored more often than not (and the little I know, I learned from books* I read in the past, not from my medical school courses). Just as society has a broader problem of misgynoir (which has required us to #SayHerName as a response to the fact that #BlackLivesMatter is largely understood as #BlackMensLivesMatter), so does the institution of medicine. We — myself definitely included — are unaware of the ways that black women have been exploited in the name of scientific advancement and medical knowledge; this erasure is a form of misogynoir.

For those of us in medicine, racism — and specifically, misogynoir — is, as Coates would say, our heritage. We have profited off of the destruction of black bodies, both male and female, and until we can stare that ugly history in the face, we cannot truly address the ways we continue to destroy black bodies today.

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*Further Reading:
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington
The Immortal Life of Henrietta Lacks by Rebecca Skloot

When Alternate Universes Collide: Facing Racial Battle Fatigue as a Black Medical Student

When I started medical school last August, I arrived on campus excited to fulfill my childhood dream of becoming a doctor, eager to learn more about the body and its mysteries, and more than a bit nervous. “Medical school,” the physicians in my life told me, “is no joke.” But “everyone survives” they assured me. While I clung to this promise as I made my way through the year, I did so perhaps for different reasons than I first imagined.

As I expected, much of medical school education is based on memorization and is buzzword-heavy. I, like my classmates, have learned to make numerous associations during my preclinical studies: pituitary tumor, sella turcica, bitemporal hemianopsia; Crohn’s disease, transmural inflammation, skip lesions; decompensated cirrhosis, ascites, portal hypertension. So on and so forth, ad nauseam.

But for those of us keeping a close eye on the news, it seems that we are making additional associations — ones unrelated to medicine — as the lives of black men, women and children in America are lost to systemic racism, police brutality and other forms of injustice.

Read more >>
(Full article posted on in-Training.org)

Elsewhere on the Internet: Accepted.com

I recently interviewed with Accepted.com and shared a bit about my journey to med school and how intersectional feminism and social justice figure into the way I think about medicine. You can read the full interview here!

(Shout out to my friend Claudia Gambrah for the photo used in the interview!)

On Institutional Silence and the Status Quo

Last night, in the middle of reading news articles about the Baltimore riots and catching up with social media coverage of events on the ground, I received a Facebook chat from a med school friend with a link to an article defending the rioting, quickly followed by a long message that began, “I’m mad….” “I’m furious” was my reply. And so began our conversation about police violence and rioting — and about the responses to issues such as these within our med school.

Since starting medical school, I’ve had numerous conversations about racism and other forms of oppression with my classmates, many of whom are like-minded friends. These discussions usually occur privately on walks home, in study rooms, and online in private messages. And for the most part, the most open we are about issues of social justice is on Facebook, where we post articles and videos of current events like Ferguson, Staten Island, and now Baltimore and just let it be. (I, for one, do this often because it’s the easiest way to air my opinions without having to actually spell it out in my own words.) Outside of those spheres, however, there is relative quiet in the medical community.

The silence within medical institutions is something I’ve noticed since starting medical school this fall. The weekend before my med school’s orientation for first year students began, Mike Brown was shot and killed by a white police officer in Ferguson, Missouri. Little did I know then that Brown’s name would become a hashtag, that people would march to demand justice — not only in Ferguson but across the country, and that discussion of these events would be, by and large, absent from my medical school community in the months to follow.

I recall spending the first several months of med school feeling like I was in a bubble. On campus, there was no outrage, no public discussion, and almost no acknowledgement of what was going on “on the outside”: the militarization of police in Ferguson, the series of black murders at the hands of white cops, and the significant and largely nonviolent marches and die-ins happening in various cities. Leaving the bubble was an altogether different story. I would sometimes walk home with a couple of classmates (who quickly became friends once we realized we had a passion for social justice in common), and we would discuss current events and felt free to express our outrage at racist systems. Upon arriving home, I would check social media to see what I had missed during the day and would find my Tumblr dashboard absolutely flooded with text posts and screencapped tweets that provided updates from the ground in Ferguson or signal boosted incidences of police violence that mainstream news sites would either not cover or brush under the rug in favor of more “clickable” news items.

The difference between on-campus and off-campus was stark. On-campus, people were radio silent on these issues; off-campus, there was considerable and justified raging against oppressive systems.

I thought that perhaps the lack of discourse on campus was due to the fact that we were new students, still trying to figure out the lay of the land — who our friends were, how we fit into the medical system, and what sorts of things we could and could not do. Now, eight months later, I’m not so sure that the silence on social issues — particularly issues of race and police violence — is because we’re new students. Rather, silence seems to be the norm.

To be clear, I’m not saying that medical students aren’t engaged in social justice; on the contrary, I have found an amazing network of people both at Penn and at other med schools who care deeply about justice and take action accordingly. What I’m suggesting is that public discussions of things like Ferguson, Staten Island, and the Baltimore uprising that is currently taking place do not occur in medical schools. At least, that’s not something that happens naturally, and I’m curious as to why that is, and it’s something that I’ve been discussing with my peers.

The best we can come up with is that medicine, like nearly all of society, is hierarchical. Although we are taking steps to move away from that structure, it remains deeply embedded in medical culture. It’s very clear from the moment when you first don your white coat where you belong: As a first year medical student, you are at the very bottom of the totem pole; your job is to listen, to absorb, and to regurgitate. And from what I hear from older students, it doesn’t get much better once you start rotations. Calling out a resident or an attending for an insensitive remark, for example, just doesn’t happen.

The problem of silence in medicine then isn’t that medical students are quiet. It’s that we’re taught to be quiet because that’s what we’re supposed to do as medical professionals. In the medical hierarchy, we are taught not to offend. We are taught not to make waves. We are taught that we cannot voice potentially unpopular opinions aloud, save in private conversations and behind closed doors. We know this because our attendings, our professors, and our institutions are quiet too.

In the months following Ferguson, my friends and I waited for public statements by our medical schools, our hospitals, and professional medical associations to at least acknowledge what was going on outside of our halls. They said nothing — not until medical students started taking part in protests, from attending marches in our white coats (I see you, New York friends who went to the Millions March!) to demonstrating in die-ins on our own medical campuses. Once students pushed the conversation on racism, police brutality, and medicine to the forefront, physicians started addressing the issue publicly. While I’m quite encouraged that discussion is starting to take place in spaces like NEJM, the larger culture of silence still predominates.

Institutional silence teaches us that professionalism in medicine is maintaining the status quo. It also means that we are taught that, on issues of race, we cannot be honest about harsh truths. We are not allowed to talk explicitly of white supremacy — and are barely taught about white privilege — when we have discussions of race and health. We are told that we should not say #BlackLivesMatter, as if affirming the value of Black life somehow implies a simultaneous devaluing of other lives (more on this in a future post). We are given the message that the role of the physician is to quietly practice medicine and not lend their voice in protest against a system that actively harms their patients — and colleagues — of color.

I’m not suggesting that med students and physicians alike need to come out to protests or participate in direct actions or anything of that nature (although that would be awesome!); I understand that that sort of activism isn’t for everybody. But what I am hoping for is the space to dialogue honestly and publicly about these sorts of issues. Speaking up and out about racism or other forms of oppression should not be something that we leave for our social medicine courses. It should not be controversial or “risky” to take a stand for justice within medical circles. And at the very least, talking about these issues should not have to happen only among like-minded friends. These are public issues; they deserve to be discussed publicly.

On New Beginnings

I almost feel like this post would be more appropriate for New Year’s Eve or Day or something like that because that’s when people start things afresh. But here we are; it’s March 10, and I’m about to start blogging.

Well, to be more accurate, I’m going to start blogging again. I’ve been blogging on various platforms and on different topics since I graduated from high school, always using a pen name or remaining anonymous. But this blog is new and different because it’s the first time that I’ll be writing about topics that are more closely related to my future career, as well as the first time that I’ll be using my own name. It’s pretty exciting… and kind of scary.

So I guess I should go ahead and introduce myself briefly. My name is Dorothy, and I’m a first year medical student at Penn Med. (“Oh, what kind of medicine do you want to practice?” asks every person who finds out I’m in med school, ever.) Right now, I’m interested in something in primary care. For a very long time it was pediatrics, but maybe I’ll follow my dad’s footsteps into family medicine… or maybe I’ll do something else entirely. Who knows? It’s still early in the game; I’ve got plenty of time to figure things out.

I’m also interested in social justice and intersectional feminism (as you might have noticed from the tag line on this blog), and I’ve recently started figuring out ways to incorporate activism into a career in medicine, mostly through organizing with White Coats for Black Lives. Using medicine as a means of advancing social justice is something I’m really excited about, so you’ll probably see a lot of posts about that.

I’m looking forward to getting some of my thoughts about medicine, intersectionality, and social justice on paper, er… the Internet, as it were. And, knowing my past blogging habits, I’m bound to share a bit about my journey through medical school (and perhaps into my residency and practice, if I manage to keep blogging for that long). Join me?