Microaggression

From the 6/12/2020 newsletter


Microaggression

Bruce H. Campbell, MD



I hand out a short story to the fifteen residents and students. They follow along as one of them reads aloud:

“One last blow, and, blind as Samson, the black man undulates, rolling in a splayfooted circle. But he does not go down. The police are upon him then, pinning him, cuffing his wrists, kneeing him toward the van. Through the back window of the wagon – a netted panther.”

I am working to integrate narrative into medical education. On this early morning, the ENT residents and a few medical students concentrate – heads down, brows furrowed – as they take turns reading aloud “Brute” by Richard Selzer, a riveting first-person short fictional story first published in 1982 and republished in 1996. An exhausted young surgeon must repair the gash on a prisoner’s forehead in the middle of the night. Both the surgeon’s frustration and his admiration of the patient escalate as the roaringly drunk black man “spits and curses and rolls his head.” After one last, unheeded demand to “Hold still!” the surgeon calmly sews the man’s ears to the cart, wipes the blood from the man’s eyes, and grins victoriously down into his face, a demeaning gesture the surgeon profoundly regrets many, many years later.


The reading ends and everyone's eyes widen. The trainees are well on their way to becoming surgeons, and I watched them squirm as they read the story from the surgeon’s point of view. “So,” I ask the group, “what are your reactions?” After a pause, the discussion flows. Residents nod knowingly, recalling difficult, late night encounters with uncooperative, ungrateful people. “God,” says a resident close to completing her five-year training, “those situations are really frustrating. I know exactly how he feels.” Some of the students – having never been in the ER with a drunk – wonder aloud, “But what do you actually do?” and “Do you think this is a real story? Did this really happen?” I break off the discussion at the end of the hour. Several thank me as they file out. We have all been given something to contemplate.


A couple of days later, one of the senior residents, Tristan, and I are in the operating room. “Dr. Campbell,” he says, “Melissa was upset by the story.”


“Really?” Although Melissa is a junior resident, she should have already had similar encounters. “About the way the surgeon reacted?”


“Talk to her.”


Later that day, I track her down. “Melissa,” I ask, “do you want to talk?”


“Dr. Campbell.” Her gaze is steady and she speaks very evenly. “I was really disturbed when the writer portrayed the black man as an animal. It was awful.”


Oh, my goodness. Melissa has a mixed-race heritage. She is a gifted writer and a gentle soul.


“Tell me more.”


“I hated how the writer described the victim. I was upset. I called my parents to talk about it and they said I should talk to you. I wasn’t going to. I didn’t want to talk.”


“Sorry,” I reply. “Tristan ratted you out.”


We spend time talking through the reading and her reaction. Where I had always viewed the story through the surgeon’s eyes, she had immediately identified with the patient. “I apologize,” I say. “I have always seen the victim’s race as a placeholder.”


“Not for me,” she says.


As we talk, I think back. I have used “Brute” in teaching sessions before but cannot recall if other residents and students of color participated. If they did, were they upset, as well?


Without recognizing the harm, I have perpetuated a racist act of prejudice – a “microaggression” – a misstep that I commit more often than I realize. Melissa has reminded me that I am a late-career, white male surgeon who grew up in a certain time and place and bring my own preconceptions to every experience. Even as I continue to teach residents and students, I must remain open to what my trainees teach me, as well.


“I’ll find a different story next time,” I tell her. “Or maybe you can help me teach it in the future.”


She smiles. “I’ll think about that,” she says as she checks her pager. “Excuse me. I’ve gotta go to the ER.”


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The names have been changed.


Bruce H. Campbell, MD FACS is a Professor of Otolaryngology & Communication Sciences and is on the faculty of the Center for Bioethics & Medical Humanities at MCW. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He serves as editor of the Kern Transformational Times.