“Just make him do it!” A voice rang out, followed by the sound of metal grating on metal.
I leaned past my computer screen toward the triage area to see a young man in handcuffs chafing at the bony prominences of his reddened wrists. Fading charcoal gray lines of graphic tattoos on his left forearm were almost indecipherable against his dark skin.
“I didn’t do nothing!” the prisoner shouted.
“That’s enough out of you!” a police officer commanded.
“Listen, we have to take your vital signs. Put on this gown.” The voice was from Carl, the charge nurse assigned to head the nursing team for the shift.
“I ain’t doin’ nuthin’. I don’t want to be here. I don’t want to put on that gown. I’m not doin’ nuthin’.” The young man looked away—away from the charge nurse who tried to stare at him straight in the face, away from the officer who looked only at the nurse, away from the audience comprising the full ER occupants, who were intently watching the show.
His white shirt, made brighter still by the contrast of his chocolate skin, quivered with every shallow exhale. His dark jeans were clean and fit perfectly, as if he had just been wearing them on a Diesel runway. His white trainers weren’t new, but they were certainly well cared for—bright, clean, polished. He couldn’t have been more than five foot nine and looked thin and frail under his fashionable attire.
The four officers who brought him in seemed like overkill—like rolling in military tanks to secure a small-town demonstration. At the same time, I can’t claim with absolute certainty that the show of force wasn’t indicated: I’ve seen a 125-pound man on PCP evince Herculean strength that required everyone in the emergency department to subdue him with injectable tranquilizers and physical restraints. I always felt bad watching a patient being wrestled to the floor, knowing that he could be injured, knowing that, heaven forbid, he could be killed, even though we were doing it for his protection and ours. Even when everyone has the best of intentions, things can go terribly wrong. Yes, the patient had chosen to take the PCP, necessitating that the authorities be called and he be brought to the ER, thereby involving us in the danger of his personal decisions. Although, in so many ways, we in the ER pay the price for a patient’s choices, it never feels okay when there is a complication. Because the stakes are so high, the moment we decide we have to go hands-on, the critical action is always contained in the question before: Is this truly necessary?
“You’re gonna have to make him do it,” one police officer said to Carl. “He has to be examined, so you’re just gonna have to make him comply.”
I shifted my chair to keep one ear and one eye on the commotion, eavesdropping as I clicked away at my computer. This section of the ER was circular, with the doctor’s station in the middle, so it was possible to keep an eye on most rooms. The situation didn’t appear to be defusing, so I knew I needed to wrap up my work and head to triage.
“What’s his name?” Carl asked.
“Dominic,” the same officer replied.
“Dominic, you’re gonna have to put on this gown and let us examine you,” Carl said firmly.
“I ain’t doin’ nuthin’. These cops are lying. I didn’t do nuthin’ and I don’t want to be examined. I don’t want to be here,” he exclaimed as drops of spittle flew from his mouth.
As if suddenly resigned, his face became a mask of calm, but that flying spittle told another story.
“Someone, please get the doctor,” an exasperated charge nurse entreated.
Hearing this, Lauren, the second-year resident who was my charge for that day, took five hurried steps over to the melee. Lauren’s steps were always hurried and overconfident. She was pale white, of average height, with a narrow nose and a frame as slender as her fine mousy blond hair, which fell limply in a taut ponytail at the nape of her neck. She would have been entirely nondescript if not for the salience of her habitual condescension. She, like me, had heard the drama unfold. I was the only attending physician on in my section and just wanted three precious minutes to finish up with the last five cases before delving into this quagmire.
I could practically hear Lauren put her hands on her hips as she asked, “What’s going on here? I’m Dr. Morgan. What seems to be the issue, officers? Carl?”
I took a deep breath, knowing that she would not be the one to resolve this situation. I just needed 170 more seconds to wrap up my work so I could smooth things over in triage. I also knew that I had to give Lauren a chance to at least attempt effective mediation. She was, after all, my trainee, and thus my obligation for the next nine hours, forty-seven minutes, and thirty-two seconds.
I took a deep breath for another reason: I wanted so badly, when I entered the triage area, to see black officers and a white prisoner, or at least one black officer and a nonblack prisoner—anything other than the stereotypical white cop/black prisoner scenario. But I had already surveyed the scene, so I already knew—I made myself take another breath—that in triage was the configuration of characters I least wanted to see.
We are not yet at a time in America when the attributed or perceived actions of a brown or black or queer or Muslim “wrongdoer” are considered singular. Instead, such accused are seen as emblematic of an entire demographic, one labeled guilty before charged. And yet, the overwhelming majority of spree killers from the most notable mass shootings in U.S. history are male and white. The crimes of each of these assailants are repeatedly viewed as individual acts indicative of one sad, tormented man’s mental state and not of his entire gender and certainly not of his race. This privilege of individual self-determination is purposefully not extended to all. Strangely but not coincidentally, these massacres do not lead to large-scale examinations of the state of “maleness” or “whiteness” in America—both topics that Americans most desperately need to examine.
It could not be delayed any longer. I stood up and removed my gray fleece and put on my long white coat. At that time in my career, I always had my white coat with me. In truth, I used it more to hold a collection of medical references and my favorite pen light, which had pupil measurements on its side, than to show everyone that I was a doctor. In fact, I almost never wore it. I found it cumbersome to run around an ER wearing a long coat with full pockets. And indeed, it became a liability in the department: just another item I had to protect from blood, vomit, and bedbugs. But apart from what I could stash in its pockets, there were times when it was a useful costume. Sometimes I had to explain to a family member that her courageous mother had just passed away, or ask another if his father’s end-of-life wishes included cardiopulmonary resuscitation. The coat was my garment of choice for such conversations. It was a uniform that signaled expertise, authority, confidence. And now here was another scenario in which I had found it came in handy.
As I approached, Lauren was looking directly at the patient and saying, “Sir, you are going to have to do what we say. You did something that is dangerous and life threatening. Now you are under arrest. You must get in this gown, and then we will examine you.” No invitation, no question. Simply her interpretation of the events and a directive to comply.
No one moved.
Suited up, I approached the stalemate. I looked at the patient’s face. He was turned away, looking at nothing in the far corner of the room. His chin was tilted upward, his jaw tight, his brow glistening with the first signs of perspiration. His breathing was rapid and shallow.
I clasped my hands in front of my chest. “Hello, sir,” I said softly. He lowered his head to look at me. I was anywhere from twelve to four inches shorter than everyone else in the area. He and I were at least ten shades darker than everyone else in the triage room. “Sir, what’s your name?”
His jaw loosened just enough for him to say, “Dominic.”
“Yes. And your last name?” I asked.
“Thomas. Dominic Thomas.”
“Hello, Mr. Thomas. I’m Dr. Harper. I’m the doctor in charge here, so I just have to ask you a couple questions. I’m sure they’re the same ones everyone else has asked you. Please just bear with me. Can I first ask you why you’re in the emergency department today?”
“I don’t know. I didn’t do nuthin’,” he said, his voice rising. I saw his neck and shoulders begin to tense and his arms extend behind him. Nearly shouting, he continued, “They arrested me and brought me here for nuthin’.”
Officer Quigley, one of the four large white officers standing around the patient, spoke up. “Dominic here is under arrest for drugs. We raided the house and saw him swallow bags of drugs when he was trying to flee the scene. That’s why he’s here. We need you to examine him and get the bags out.”
Turning back to Dominic, I asked, “Mr. Thomas, did you swallow bags of drugs?”
He sucked his teeth and then replied, “No! They don’t know what they talkin’ ’bout!”
I looked back at the officer who’d spoken. He rolled his eyes and looked away.
“Mr. Thomas, of course I have to make sure you understand that if you or anyone swallowed bags of drugs, it is really dangerous. The bags could cause a blockage in your bowels. Even worse, they could leak and cause all sorts of things like heart attack, an inability to breathe, pain, and even death.”
“I got it, miss, but I didn’t do it, so it’s not an issue.”
“Okay, can I just ask you a couple more questions? It’ll be fast.”
“Yeah.”
“Do you have any medical problems?”
“No.”
“Do you take any medications?”
“No.”
“Are you allergic to anything?”
“No.”
“Any surgeries?”
“No.”
“Any alcohol or drugs today?”
“No.”
“And my last question. Mr. Thomas, would you like us to examine you today?”
“No. I wanna get outta here.”
“Okay, then we will discharge you.”
At this, the officers bristled. Officer Quigley exclaimed, “We brought him here for an examination. You have to examine him. That’s the procedure.”
“What procedure are you referring to?” I asked. I didn’t accept what the cop was telling me, and I questioned why he felt comfortable instructing me to do anything at all.
“Ma’am, we do this all the time,” he said, sighing. The sigh telegraphed to me that this man, this older, taller, heavier white cop, felt I was both missing a critical point and wasting his time.
“Oh, do you all have a court order for us to examine this man against his will?” I asked, implying that this must surely be the missing piece of information.
“No, but he’s under arrest for a crime.”
“I do understand what you’re saying, but it is against the law to force a medical examination on a competent adult human being. If you don’t have a court order, I would be breaking the law to do further medical evaluation on this man against his will. So, if Mr. Thomas does not want a medical examination, there will be no medical examination, because this is his right and this is the law in the entire United States of America.”
Officer Quigley, the charge nurse, and the resident all stared at me. Then they began to explain to me that other physicians had forced such exams on patients.
“I’m sorry to hear that,” I told them. “I’m sorry to hear that there are doctors who will break the law for this reason. I am not one of those physicians.”
Lauren turned around and went back to her desk.
Carl, whose face communicated total disbelief, asked, “So we’re just gonna let him go, with no triage or anything? Because he wouldn’t even let me triage him.”
I turned back to the patient. “Mr. Thomas, is it okay to just take some quick vital signs on you? Just a couple of things like your blood pressure and heart rate? I promise it won’t even take two minutes. As long as your vitals are okay, we’ll get you right out of here.”
“I’m not putting on that gown.” He scowled.
“You don’t need to change for this at all.”
“Okay, go ’head.”
“Thank you.”
I turned to Carl. “Excellent. I already got the history, so triage is done. He refuses any examination, which is his prerogative, so I’ll start on his discharge papers now. Just give a yell with those vitals when you get them.”
I turned away from the triage area, the dumbfounded police officers, and the annoyed charge nurse. I overheard nurses on both sides of the department debating the ethics of my letting the prisoner go. I heard them telling stories of how it was common hospital practice to make an intervention; of how just the other day Dr. Brisbane, another ER doctor, had placed an NG tube up the nose of a patient, down the back of his throat, and into his stomach to pump gallons of GoLYTELY, the fluid used in a colonoscopy prep, into his gut until his stool ran clear, to remove the alleged drugs from his system. This was the first I’d heard of this frankly horrifying malpractice. Because attending physicians in the ER tend to work in parallel to each other, with their sole focus on expediting the care of their individual patients, the only time I got wind of what my colleagues were up to was during sign-out or through rumor.
This work just got harder. While practicing medicine was feeling increasingly crucial personally, between the hospital bureaucracy and the colleagues who brought their limited perspectives to work—they were, after all, only human—the prospect of it being a sustainable career path for me was diminishing.
As I listened to the war stories of heroic medical efforts on unwilling captives, Maria, a feisty Latina transplant from the Bronx, chimed in. “Yeah, well, Dr. Harper is correct. You cannot force an examination on anyone just because the police or family member or any third party happens to request it. We need to treat people like human beings. I’m tired of people treating certain people like animals.”
I wanted to stand up and second everything Maria had just said, but I already had, in my management of the case. Besides, I needed a rest from standing, knowing that just seconds after I finished wrapping up Dominic’s case, I’d have to stand up again. For those few moments, I typed. To the extent it was possible, I’d stay out of the line of gossip. I leaned toward Lauren, who was positioned at the computer station just in front of mine. “Don’t worry about this case. I’ll write him up. Just move on to the next patient. Nothing for you to do here, since I already took care of it.”
Lauren looked at me with her typical antagonism. “Are you sure? I can write it up. I’m actually waiting for a callback from Hospital Ethics. I told them the whole case because I don’t think he can refuse an exam and medical interventions. We really need the Ethics Board in on this one if you’re going to let him go. I’ve worked with Dr. Linden and Dr. Jacobson on similar cases, and we just tell the prisoners what we are going to do. They don’t have a choice. I don’t understand what you’re doing.” Her tone was more indictment than question. It was the tone she used to assert that she knew more than I did, and for reasons she would never have dared articulate.
It was the very fact that Lauren felt comfortable assuming greater inherent wisdom on the part of the white, male physicians Linden and Jacobson that might have horrified her to examine in herself. For these same reasons—their white privilege—she would have followed their instruction anywhere, even if they directed her to literally break the law. While she wouldn’t have spoken the words, her tone communicated one of the ubiquitous microaggressions faced by people of color and the content of her words showed how such a microaggression is inextricably linked to the gross aggression that follows.
Although I had been having issues with Lauren over the past sixteen months we had worked together, it occurred to me that, in this moment, she was being entirely honest. Yes, there was her typical peevish passive-aggressive tone, but I saw now that she genuinely didn’t understand. I knew her only within the confines of work, so I couldn’t pretend to know why she hadn’t considered these issues more deeply. Certainly, there was a type of privilege in it. Willingly or not, Lauren had donned the cloak of white male privilege, and it fit snugly over her own skin. After all, this is the only way oppression can function: It requires the buy-in of a certain percentage of those it actively oppresses in order to pit those groups of subjugated people against one another.
I thought about the powerful underlying assumptions that had made it so easy for the police to transport this patient to a hospital and for his sovereignty to be taken away. It could be related to his dealing drugs—though, we see all sorts of patients with drug-related issues, and they are not typically brought to the emergency department in chains. And there is certainly no expectation that we will simply accept that their bodies should be violated because of their alleged illegal drug use.
But for Dominic, it seemed somehow warranted, somehow a commonplace, that his rights as a patient should be tossed aside. I looked at him; his autonomy was so provisional. But then, had he ever had self-determination? Had he even been considered to have ownership of his black body? There was no medico-legal reason for a doctor or a hospital to usurp his decision-making capacity, and yet, for some people, it was expected. In the face of these truths, we are reminded that for many people, their bodies are not considered their own. For those whose bodies are viewed as suspect and threatening, those bodies, at the preference of a more privileged body, could be manipulated, even assaulted.
As I stood there in my white coat, I was reminded of Dr. J. Marion Sims, often referred to as the father of gynecology, who in the nineteenth century conducted experimental surgeries on enslaved women. The women, who had hopes of treatment from a purportedly competent physician, instead were pinned down on operating tables screaming in agony while he sliced into their pelvic regions without the benefit of anesthesia. Sims continued to torture enslaved women in these barbaric ways until he felt he’d perfected his techniques and felt comfortable performing them on white women, but in their case, with the humane addition of anesthesia.
I was reminded also of the Tuskegee syphilis experiment, in which for forty years, beginning in 1932, the U.S. Public Health Service recruited 600 black men, 399 of them with syphilis, ostensibly to offer them treatment for “bad blood.” The men with syphilis were intentionally denied treatment so that the U.S. government could study the progression of the disease over the course of their lives and then autopsy them after they had died. Not only were the men in the study not informed of their disease or treated for it, but steps were taken to prevent them from receiving treatment elsewhere; for example, STD clinics were provided with a list of study enrollee names so that they would be refused treatment should they have sought it. The long-running study was not put to an end until 1972, when public pressure led to a federal investigation that deemed the Tuskegee syphilis experiment unethical.
I was reminded, too, of Dr. Albert Kligman’s experiments on imprisoned men in Philadelphia from the 1950s to the 1970s. Kligman biopsied, burned, and deformed the bodies of prison inmates to study the effects of hundreds of experimental drugs. Men were subjected to such atrocities as inoculation with herpes, gonorrhea, and various carcinogens. Kligman went on to become a millionaire after co-developing the popular acne medication Retin-A via his studies on inmates, while many of his victims were left with chronic medical conditions that irrevocably damaged their organ systems.
While significant advances have been made in areas of racial equality, we still have miles to go. That day in the ER, Dominic was evidence.
“Lauren,” I asked, “do you know what ‘treating’ this patient would entail? We would be commanding him to have an examination he doesn’t want. We would have to restrain him in some way—physically and/or chemically. We would then put a needle in him to draw blood. We would force him to have an X-ray. If the X-ray didn’t show anything, and it probably wouldn’t, then we would force him to have a CT. We would have subjected this man to two studies of radiation to pacify law enforcement, who have no legal right to force anything on his body. Who would be legally responsible if there were an adverse event from these refused medical interventions? Not to mention who would be legally responsible for the physical assault that a forced examination would entail? You don’t even know if the police are telling the truth. Why is any of this acceptable? Furthermore, even if he did swallow drugs, he is an adult who is competent and sober, and who is medically and legally allowed to make his own decisions. We can’t force parents of children to allow immunizations that prevent epidemics of devastating pediatric disease; we can’t force a hemorrhaging Jehovah’s Witness to accept a blood transfusion; we can’t force someone having a heart attack to go for a life-saving cardiac catheterization if he refuses it. You know all these things. We have all had these very cases and simply signed the patients out against medical advice. Why would this be different, even if there is a potential life threat?”
Lauren stared at me in silence, her posture perfect. She gently chewed her lower lip.
I heard the clerk call out, “Anyone waiting for Hospital Ethics?”
Lauren waved vigorously at the clerk to send the call to her phone.
I watched and waited while she was on the phone. She didn’t say much, just a series of “ohs” and “ahs.” Then: “I see . . . really? Okay, well, thank you for your help.”
I sat still at my computer, attempting to breathe in for a count of three and out for a count of six (or something like it), to dampen the disgust as my anger mounted—anger that my resident, my privileged, highly educated white female resident, had felt comfortable being so disrespectful as to dismiss my judgment on this matter; that she had felt she had the right to invoke what she deemed a higher authority: older white doctors who’d done the police’s bidding in the past or whatever voice happened to be on the other end of the line from Hospital Ethics.
I looked down at my hands on the keyboard, my slender, dark brown hands, dry from constant washing and dousing with alcohol-based sanitizer between patients. As I noted the contrast of my dark wrists extending from the cuffs of my stark white coat, I was reminded of which costumes in America, even in the twenty-first century, are seen as legitimate and which are not.
I recalled the conversation with my department chairman that morning. I had sunk uncomfortably into the plush leather couch across from him. Part of me awaited congratulations upon my promotion to a new hospital position. The other part, the part that felt weighty and awkward sitting three inches deep on this sofa, anticipated the speech he would inevitably make. It was the same speech he’d had to make several times before, to the other women and black physicians who left before I had arrived at Andrew Johnson Hospital:
“Michele,” he said. “You know every time I try to make a change at this institution, I just can’t. I’m always blocked. You didn’t get the position. I’m sorry to say it. You’re qualified. I just can’t ever seem to get a black person or woman promoted here. That’s why they always leave! I’m so sorry, Michele. They’ve decided that even though you were the only applicant, and a super-qualified one at that, they’re just going to leave the position open. I’m so sorry. I hope you’ll hang in here with me anyway.”
His words had hung sadly between us. He had spoken with the heavy heart of a longtime liberal white man who would shake my hand, smile, close the door behind me, and then sit back down in his comfortable, secure chair. His effort was complete. His part was done. I was the one left to live with the limitations of that bigotry. I was the one left to get up and fight for Dominic and myself.
America still has so many more strides to make. I am evidence.
Lauren turned to me. “Well, the hospital ethicist says that she reviewed this case and even spoke to Legal about it. Turns out it’s true that we can’t force any evaluation on this patient. Well, good to know. I’m gonna go see this little kid with a cold.” She closed her computer screen and headed over to Room 5.
I typed an extremely brief note on Mr. Thomas and swiveled in my chair to let Carl know the papers for his discharge were ready. Then I waved good-bye to Mr. Thomas; he gave me a barely perceptible nod and then continued to stare into space. Officer Quigley grabbed the discharge papers from Carl and mumbled something about everything being so ridiculous. The officer swept his arm across the room in the direction of Mr. Thomas. “Go ’head,” he said, in a manner that decisively conveyed his utter contempt for what had just unfolded.
What we had just experienced had offered an opportunity for all of us to recognize that America bears not just scars, but many layers of racial wounds, both chronic and acute. In order to move beyond them, we need to look at them for what they are, diagnose them, treat them, heal them, and then take care not to pick at the scabs, reopening the old wounds and creating new ones. I know how hard it is to stand and look at tortured and infected flesh. I know because it’s part of my job, and therefore something I cannot choose to look away from: soft skin splitting, macerated by brutality and time, half-eaten by maggots spilling out the sides, noxious gases spurting from the extremity of our trespasses. We need to stand face-to-face with it, to look and feel and smell and taste what we do, so we can choose exactly how we want to be in this world.
Just as we needed to look at the body of Emmett Till, the fourteen-year-old black boy who was murdered in 1955 by two white men who had accused him of flirting with a white woman while visiting relatives in Mississippi. They kidnapped the child, beat him, gouged out his eyes, shot him in the head, tied a cotton gin fan around his neck with barbed wire, and then threw his mutilated body into the Tallahatchie River. His mother insisted on an open casket at his funeral, so all of America could see how the nation treated its children, how we treated each other, how we were in this world.
Dominic Thomas brought me back to the reason I had chosen to become a physician: Being a healer is the powerful gift of bearing witness in an authentic way that allows us to mindfully choose who we are. In this way, there is another path.
I choose to witness the tortured flesh. I support it in my hands and cleanse the wounds as gently as I can. I apply intention and salve to heal. I write about these moments so we always remember the power of our actions, so we always remember that beneath the most superficial layer of our skin, we are all the same. In that sameness is our common entitlement to respect, our human entitlement to love.
I hit Send on the email I was writing, packed up my stainless-steel water bottle, coffee mug, and uneaten granola bar, and tucked them all back into my lunch bag. I wanted to leave the day behind me.
Once home, I shed my scrubs and then showered, rinsing off the shift. Dressed in a robe, I propped my feet up on the ottoman, and my shoulders floated down to settle into the sofa. My boss had probably received and responded to my resignation letter by now. There was comfort in knowing that this was the end of the road here. My chair would give me the time I needed to line up another job before I left.
And so, I started the process of beginning again. I knew that there must be another place where, as a doctor, I could both practice medicine and climb the administrative ladder. After all, I was here to ascend. I was here to help as many people as I could . . . somehow.