Open Wounds

Yesterday, I had the “privilege” of being invited to dinner with a visiting professor at an expensive restaurant near the Dartmouth campus. As with many of the social intricacies of academia, in particular Ivy League institutions, tradition is important, and this was one of those traditional dinners. When a professor is invited from out-of-town to give a lecture, a dinner will often be held the evening before the lecture as a less formal gathering for the visiting professor to get to know a handful of the faculty and make him or her more at home. Sometimes graduate students (or in this case, residents) are invited as well. I have been to several dinners like this mostly at snooty restaurants like the Harvard Club, but this was my first one since arriving at Dartmouth.

Last night was one of these “get to know the professor” dinners with about 14 senior surgeons and residents invited, many of whom already knew the visiting professor. To paint the picture of this “informal” gathering clearly, just picture a table of mostly white men wearing suits or navy blue blazers, enjoying a 5-7 course meal of haute cuisine and several bottles of expensive wine. (I had the Iced Malapeque Oysters with Sake Ginger Mignonette as an appetizer, Seafood Chowder for my soup, a Tossed Mesculun Salad with Champagne Vinaigrette, the Pan Seared Atlantic Salmon with Spicy Smoked Pecan Glaze and Wehani Rice for my entree, and Crème Brule for dessert. Now that’s a pretentious dining experience, and I don’t even drink wine…) All the while, about four to six servers and staff (who are often persons of color) are whirling about and waiting on you like you are on the Titanic’s maiden voyage. It almost feels like you have stepped back in time to the Gilded Age with American aristocracy (who the Ivy League schools initially served exclusively.) It’s real tradition at its anachronistic finest with all the ostentatious behavior to go with it. The only difference is that today there are a couple of Ivy League women seated at the table along with a dark face in his blue blazer trying to fit in among the aristocrats.

Aside: The American Aristocracy that controlled the private institutions of higher learning attempted to keep their institutions “blue-blooded” in response to accusations of discrimination in the mid 20th century by developing and administering standardized entrance exams for admission to Harvard and Yale. They wrongly assumed that their children were smarter than the middle class children, and children of color and would perform better on these exams. These admission tests led to the demise of aristocracy based admissions and the rise of meritocracy based admission. The Harvard College class of 2008 is 50% female, and only 60% white, and many of those white students are Jewish.

Now the first time I was invited to one of these dinners, I truly felt that I was fortunate to be eating at a restaurant that I could never afford myself. However the excitement was quickly replaced with reluctance and misgivings as I realized that these dinners came with some unexpected intangibles. The conversation was always about things that only people of means could relate to like sailing yachts, flying planes, or world travel. (Last nights visiting professor talked for a half hour about his hobby which is under water photography. He showed us several pictures he snapped of rare fish and sharks off the coast of Papua New Guinea. It always amazes me how at a table of a dozen Ivy Leaguers there will be 5 or 6 that are pilots or highly trained scuba divers or whatever…) As the conversation danced over many topics, it occasionally would land somewhere that I have a modicum of knowledge about, but for some reason, my input always seems to be a little awkward like I’m trying to fit in, so I usually remain quiet anyway.

At some point I usually become acutely aware of the servers. I notice how the other guests treat them like non-persons and never acknowledge them with as much as a thank-you, because they are too busy eating, drinking or discussing the tax-shelter implications of owning multiple vacation homes. I can’t help but feel uncomfortable that some black woman ten years my senior is calling me “sir” and “doctor” while scraping crumbs off our table, and keeping her head bowed all the time in a clear posture of subservience. I try to make eye contact to communicate to her that I appreciate and respect her, but she’s not taking the chance of being ignored by the brother in the navy blue blazer, because he looks pretty well acculturated to the aristocratic lifestyle to her.

So after having been to a couple of these dinners, I now have mixed feelings about these types of outings, but I thought last night’s dinner might be a bit better since it was here at Dartmouth which among the Ivy Leagues seems to have the least pomp to its circumstance.

I arrived a little late on purpose to avoid the “cocktails” portion of the evening. As I took my seat, I was introduced to the visiting professor by one of my mentors, Sam. I told the guest of honor where I had gone to medical school and was doing residency, which is what people are usually wondering when someone who does not fit the aristocratic mold walks up. Of course, my impeccable professional pedigree gives me instant credibility like growing up in a rough neighborhood confers instant “street cred” to someone in urban culture. After the brief introduction, the conversation turned to the usual superficial pretentious topics that the aristocrats like to discuss. I took my usual pose of quiet interest as my mind was wandering in assessment of the social implications of the present company. There were three female surgeons at the table in addition to ten white male surgeons, and then there was me. The conversation was dominated by the white males who occasionally involved one of the female surgical residents who was the only one of the three women that was attractive.

Dinner ambled on, and as the second glasses of wine were being finished, the political correctness of the conversation started to relax. One of the male surgeons made a comment to the attractive female resident about her “pretty toes” and I thought to myself…well I guess it’s better to be excluded than to be included in the conversation as a sexual object. She hardly blushed, and it was clear that she was used to this type of talk. When they were not making semi-flirtatious comments to the attractive resident, the conversation degenerated into a series of stories and anecdotes as everyone tried to one-up each other for the most entertaining tale.

Two of the older male surgeons had trained with the visiting professor in the 1970’s at Michigan, and they all three began trading old stories that had clearly been told many times before. Many of the stories they told were related to the end-of the-year chief resident roast that was held every year. These roasts were often quite raunchy, but they recalled fondly that there were no wives or girlfriends allowed. They seemed not to notice that the three women at the table would not think this was such a great arrangement.

At this point, I was thoroughly detached from the conversation and had turned my attention to the dessert menu that had just been distributed when the political incorrectness took a different direction. The visiting professor told a story that opened with a motor vehicle collision that he was in that was caused by a “Korean driver”. Of course my attention was re-established by this comment. I looked around the table, and no one else seemed to raise an eyebrow as he continued the story which eventually drew great laughter when it concluded. For a moment I pondered asking what the drivers’ race added to the story, but realized that it was not the time or place for such militancy…after all I was wearing my navy blue blazer, not my dashiki. I shrugged it off, but he had lowered my threshold for taking offense at that point.

Before I continue, I should tell you that I usually give physicians the benefit of the doubt when comments like this are made. Most doctors are culturally competent in mixed company. These were academic physicians from Ivy League institutions, so they are by-and-large liberal minded, socially progressive for their species. I’m sure not one person at that table was openly hostile to women or minorities in surgery, and many of them may even promote the notion of diversity within the surgical field, but often ideological support of cultural sensitivity may not translate into genuine empathy and thoughtfulness once a few drinks have been downed in an “insider” forum like this dinner. While on one hand this surgeon had clearly slipped a stereotype of Asians into his story (there were no Asians at the table), doctors walk a thin line in regard to stereotypes. When we describe patients to one another, we usually give the race of the patient, because race helps risk stratify patients when developing a diagnosis. If I say a “black man with anemia and episodic pain”, one would think about sickle cell, but if I am presented with a white man with the same symptoms, sickle sell is statistically less likely. Likewise, if I say "a 25 yo black woman with an opportunistic infection", statistically she will be more likely to have AIDS than an Asian male with the same symptoms. It’s a slippery slope, because some of the things we associate with race and disease are rooted in stereotypes as well as objective statistical data. Basically we profile people all the time when we communicate, and not just by race. We may describe a white man as "disheveled" to indicate that he appears homeless which would be a way of saying to another doctor, he’s likely to be alcoholic with liver disease. Sometimes, it works the other way too. We may say "a well-dressed intelligent black man", as to way to express that this patient is less likely to be affected by the scourges of poverty despite his race which would usually make poverty more likely. We communicate in this way in great detail, and while it’s done in the name of clinical investigation, we all attach value judgments to these characteristics. For instance, when a patient is described as obese, the clinical purpose is to get others thinking about problems like diabetes and obstructive sleep apnea, but it may also get others to make value judgments like over-eating and laziness. That’s just how humans are. We all have our stereotypes. Political-correctness teaches us to not mention race, gender, social status, education, and sexual-orientation, because they do not determine a persons character and behavior, but pragmatism is required in medicine and other fields (law enforcement, sociology, etc), that requires us to think about these factors. Because of that, doctors are quick to reveal the race of people when telling any kind of story, because it’s part of our usual communication pattern. I know that I do it as well. That is why I’m usually slow to take offense at something like this “Korean driver” comment. It’s more habit than bigotry, but a part of me can’t help but suspect ignorance and maybe even a little maleficence lurking beneath such a comment. So for the rest of the dinner my sensitivity to racial comments was heightened, and race came up three more times before dinner concluded.

The next “racial” comment came in a story about a white surgeon with poor surgical skill and equally bad bed side manner that came in to consent a patient for a major operation. The gentleman telling the story described the patient as a “skinny little black man”. The punch line was that this patient got up and left the hospital, because this surgeon’s bedside manner was so inappropriate that the patient said “I’m getting out of here”. Now on the face of it, there is nothing offensive here, but as I said, my threshold for offense had been lowered. Is it because the patient was black that he was “street smart” enough to know this surgeon was no good. The image of the “skinny little black man” conjures up images of a paranoid, mistrustful, and illogical brother marching out of the hospital with a George Jefferson swagger as he states defiantly, “I ain’t letting no crazy white man cut me open”. Now this image was only implied by the storyteller, and it’s not even really a negative stereotype, as stereotypes go, but for some reason it grated my nerves a little that the patient’s race was needed to give the story its “full effect”.

Ten minutes later, the word black came out of another person’s mouth as he told a story of a surgeon in Michigan that did sigmoidoscopies and would “preach” a sermon to the patient as he did the procedure. Halfway through the story, the storyteller felt the need to describe this surgeon physically to give the story its “full effect”. He said the surgeon was obese and looked like a penguin with skin as “black as midnight” and that he had a rich baritone voice that he “preached” in. Now at this point, I was definitely bothered. I’m not sure why I was bothered. There just seemed to be something wrong with describing this surgeon’s skin color as “black as midnight” to me. The story teller wanted to paint the entire picture in exact detail, but I was saying to myself “is a midnight complexion as unsightly as obesity?” “Is he trying to use the stereotype of blacks as hyper-religious to give his story effect?” “Does he want us to picture this surgeon as a caricature in “black face” singing negro spirituals and longing for the cotton plantation as he does surgical procedures?” Clearly, I’m reading into these comments too deeply…right? Well whether it was meant innocently or not, I had reached the point of anger. No one had clearly stepped across the line of racial impropriety, but it felt like they were dancing awful close to the line to me, and I wanted nothing more than for dinner to be over, but we were not done yet…

The final story that bothered me was told by a surgeon who had been quiet most of the evening, but seemed to be a rather soft-spoken and sensitive gentleman. He told a story about the year that the chief resident roast was held at a ritzy country club and the drinking got out of hand, and some of the residents starting challenging each other to go skinny dipping. Well, it just so happened that this was the first year they had ever had a black chief resident (which the story teller mentioned as it was central to the story). Well some of the guys had already jumped into the pool, and they were all trying to get the chief resident to cannonball, too. Then the story-teller described the look of horror on the faces of the country club staff, because “they would have to drain the pool if he jumped in”. Well at this point my epiglottis betrayed my feelings, because I choked very loudly on the tea I was trying to swallow as this comment was made. The story-teller was no racist. He thought it was crazy that these WASPy country club managers would have drained the pool, because a black man had gotten in. He told the story out of indignation that the country club was racist. For some reason though, this story made me just as uncomfortable as the previous perceived infringements of political-correctness. I was further made uncomfortable by the fact, that everyone could see that this story bothered my as I coughed uncontrollably on my Earl Grey.

The evening wrapped up shortly after that, and I eased my way out of the restaurant, but my mentor Sam got hold of me before I got away. We walked out into the comfortable New England summer night initially making small talk, and then Sam asked me what I thought of the “black” comments once we were out of ear shot of any of the other dinner guests. I was surprised by this, but Sam has always impressed me with his character and sensitivity. I asked him what he meant (playing dumb I suppose), and he outlined every one of the racial comments I mentioned above including the Korean driver comment. I paused for a moment, because I did not know how to answer him truthfully. I was reticent to explore such a sensitive topic with a white person, even one who had shown himself to be trustworthy and empathetic, so part of me wanted to lie, and say I didn’t even notice. (Given my near drowning in a cup of tea, ten minutes before, this was not really a viable option, as I had already shown my hand in this matter.) I thought for a moment, and figured that Sam must really care about how I feel or he would not have brought it up so I tried to answer him honestly.

This is what I said to the best of my memory:
“I was bothered by those comments, Sam. Every one of those comments bothered me progressively more and more, but the last comment made me realize something. I’m most bothered by the fact that I was bothered in the first place. The first three comments disturbed me deeply, and made me angry, and there is no reason to be getting angry about something that may not have even been offensive. Furthermore, if I thought the comments were inappropriate, I should have been able to calmly say so. I was bothered way past the point of calm. That final story bothered me, because it alluded to a painful part of black history. I did not want to be reminded that 30 years ago, a swimming pool would have been drained because I had been in it. I was bothered, because, I still feel out of place in a restaurant like this one with a group of white Ivy League academics.”

Sam and I discussed whether or not the comments were truly inappropriate, and he was convinced that they were, and thought I had every right to be upset. We talked for another few minutes, but then I went home to reflect on the night’s events. After having laid in bed and thought about what had happened, I realized some things. Even though Sam thought my feelings were appropriate, I think my feelings shed more light on my own attitudes than the attitudes of the folks who made the comments.

I told a half-truth earlier when I said that I felt like I did not fit in at this dinner. My feeling was more than feeling out of place, it was feeling inadequate or like I did not measure up. The truth is no matter how much I deny it or try to convince myself otherwise, I have some feelings of inferiority. Now I know this is not every black person’s experience, but if the truth be told, more of us feel this way (perhaps subconsciously) than will admit it. Most of us put on airs of feeling secure and confident when we are the only black person in the room, and many of us go further than that to actually claim superiority to other races, but that is often a front to cover up the insecurity that is smoldering below the surface. I know this, because in college, I became militant and developed an “I’m better than white people” attitude, but in hindsight, it was merely a reaction formation to my insecurity of showing up to that lily-white campus and trying to choke back the fears that I might not measure up to my white peers. Don’t get me wrong, even with these feelings of insecurity, I maintain pride in myself and my race. Black is beautiful, and I would never trade my culture and heritage in to be white. I love who I am. I love who we are. I just think insecurity and feeling inferior is something that all people struggle with, including white males. With me being a black man, I just have one more thing to feel insecure about at a dinner of all white people who are haves, and I still feel like a have-not. Whether the comments that had been made were inappropriate or not is moot, because my response to them was not based on inappropriateness. My response was based on general insecurity about whether I’m smart enough, hard-working enough, and long-suffering enough to measure up to the other people at the table. I just took the racial comments as a way to deride the white people at the table. It allowed me to deal with my insecurity, by turning these white men into villains, and gave me the feeling of moral superiority which eased the doubts of whether I measured up in other dimensions. I was able to quell any anguish I felt about not having grown up yachting, flying planes, and globe trotting by saying to myself, “at least I’m not an ignorant bigot.”

Most people agree that racism is born out of fear and insecurity. Allow me a silly analogy: People don’t hate squirrels for being squirrels, but if people had a fear that the squirrels were smarter, stronger, and better than they were, they would begin to fear squirrels, and then hate squirrels. Most people are not threatened by squirrels, so there is little venomous squirrel-hatred in the world. Likewise racism is born out of fear and insecurity. The hatred would not exist if no one was threatened by the other.

So, yesterday’s events showed me a lot about myself. It showed me that I have some substantial qualms with racial comments. While I was judging potential racism in these dinner guests, the reason I was so greatly bothered was my own racist attitudes. In medicine, we learn that a response out of proportion to the stimulus is a sign of underlying pathology. If I press lightly on someone’s abdomen, and they howl in pain, I can be certain that something inside is amiss. Likewise, when my whole evening is spent gauging potential racism at dinner instead of enjoying myself, and I lose control of my swallowing mechanism, while drinking tea, that shows that I have some underlying pathology.

Allow me another analogy if you please: A skinny person would not get internally bent out of shape if everyone was telling fat jokes at dinner. He might be indignant at the insensitivity of the joke-tellers, and he might even say something, but he would not begin to hate those joke-tellers, because he would not be threatened by them. Now if an obese person overheard the same comments, his response might be more than simple offense. It might be anger and hostility, but the reason his response might be more pugnacious is that he might feel insecure about his weight. If he had not learned to love himself and accept his obesity, then those fat jokes would unearth that painful underlying shame. His hateful response would be a reflection of his self-hate.

My response to the comments at dinner was not simple offense. If it had been, I might have confidently corrected those who had made the comments. Instead, my response was quiet, yet seething anger. My response suggests that there is some underlying pathologic feelings of inferiority that augmented my response to these comments.

One final analogy: When squeezing a lemon, the acid in the juice can reveal a small discontinuity in the skin around your finger nail. You may not have noticed that little tiny wound in your cuticle, but the lemon juice magnifies the unhealed skin as it burns and stings the sensitive underlying tissue. Likewise, we often have open wounds in our self-esteem. We may have done a good job of hiding those wounds and convincing ourselves it was healed, but when the acid of life is poured on us, we respond with agony revealing that not everything is truly whole and healed.

It is clear to me that I have some open wounds in my self-image. One of those wounds was created by racism. Someone might ask, “if you were born in the seventies, after the civil rights movement, where did these wounds come from?” This question might be asked by an insensitive white person, but every black person in this country knows that racism still hurts. I can remember every painful experience related to race going back to my first awareness of what race was. Whether it was some white kids that excluded me from playing with them because I was black in elementary school all the way up to the stares I got last week at the gas station, those experiences continue to wound me. Now intellectually, I have convinced myself that these wounds have healed. I told myself that I was as good as or better than any white person. I had fooled myself into believing that I had dealt with the insecurity of being a black man in a white academic world, but the lemon juice of last nights comments revealed that those wounds are still open and festering. I had just covered them up with empty logic, but you can’t heal an emotional wound with a logical dressing. Like physical wounds, emotional wounds need attention in order to heal. They don’t heal if they are ignored and covered up. On the contrary, if ignored, wounds only grows worse. Physical wounds need frequent dressing changes to remove bacteria and dead tissue. Sometimes, they even require surgical debridement to heal. Likewise emotional wounds need intensive regular care to heal.

I’m grateful that last nights comments bothered me, because it has revealed the underlying insecurity that I’m still grappling with. I’m reminded that anger and hate are not healthy responses to someone else’s ignorance. I’m reminded that I need to work on my attitudes about race and myself. I’m reminded that Jesus focused on only two commandments during his ministry: 1) Love God, and 2) Love your neighbor. I’m reminded that love starts with focusing on my attitudes and behavior, while hate begins with scrutinizing someone else’s attitudes and behavior. Finally, I’m reminded that the wounds of racism can’t be cured by denial and logic, but must be healed by introspection and confrontation of my own feelings of inferiority.


Your wounded brother,
chad

"No one can make you feel inferior without your consent."
Eleanor Roosevelt