Let’s Talk About Racism and Be Ready to Get It Wrong
by Adina Kalet, MD, MPH
“Would you like me to cut it too short or too long?” I asked the surgery resident in my head, an ironic, exaggerated smile on my face. “How would you like me to get it wrong this time?” I murmured defiantly, out loud to no one, as I walked home late at night replaying the endless surgery clerkship day in my head.
What had actually happened? I was scrubbed in the OR, standing at the head of the patient, wedged next to the anesthesiologist (who was leering down my scrub shirt), holding the heavy steel retractor lifting the patient’s liver (don’t ask), so that the chief resident had an unobstructed surgical field to remove the gall bladder. I imagined him – but could not see – carefully dividing tissue planes, isolating the common bile duct, tying off small bleeding vessels. Once the gallbladder was “delivered,” plopped into the kidney shaped metal bowl, and examined thoroughly (none of which I could see), the chief instructed me to release so he could remove the retractor. Then he stripped off his gloves and left the OR. Without a word, the lower ranked resident stepped into place and the scrub nurse firmly slapped the needle holder, suture in place, into his hand, and he began stitching the surgical wound closed.
I stood with my hands above my waist, not daring to contaminate the field, looking longingly at the needle and thread. Taking pity, the nurse – the only other woman in the room besides the sleeping patient – handed me scissors. How did she know I love to sew? The resident tied the sutures. With each stitch, he growled, “Cut!” I fumbled. “Too short!” “Longer next time!” “Cut!” “Shorter next time!” He never made eye contact or said “please” or “thanks” as he barked at me.
I should have been more assertive even in the face of withering criticism or ridicule in the OR, I would have learned more, had fewer regrets and felt better about myself. At the time, though, it seemed clear that if I wanted to avoid being judged and considered wrong the only choice, was to be passive and “just go along” with what was the dominant culture in the small part of the world.
That is how I am feeling now.
Now, don’t get me wrong. I am not endorsing humiliation and its resultant silence as a generic pedagogy. It was a weird and wrong-headed way to teach surgery, but it turns out to have been a damn important life lesson.
We learn more if we are willing to make mistakes repeatedly. We might slip and say things that hurt someone else’s feelings or reveal our own implicit bias, arrogance, or ignorance. No matter. These days call for white people who hope to be allies for our Black neighbors to be willing to speak up and continually learn from being wrong as we become accomplices for change.
Educating Ourselves
As Black writers and intellectuals like Rachel Cargle and Ijeoma Oluo have pointed out, it is not the role of Black people to stop what they are doing and lend a compassionate ear to the confessions of white Americans seeking to clear our consciences or air our own inner conflicts about complicity. It is wrong for well-meaning white people to call our Black friends as witnesses to our growing self-awareness. It is not fair to ask every Black friend to help us unlearn racism and become “anti-racist.” While we look to our Black colleagues for guidance, the impetus for those conversations and educational imperatives is our responsibility. In these pages Drs. Bruce Campbell, Megan L. Schultz and Kathlyn E. Fletcher provide their thoughts as starters for conversations among nonURM physicians.
How do we take responsibility? The events of the recent days make it abundantly clear that it is time for us to get comfortable with being uncomfortable. To move forward and be part of the needed transformation, we each need to understand how we play a part in the perpetuation of “white supremacy,” and in privilege – the “Brightness of Whiteness” – as described by Jane Lazarre. We must acknowledge and understand the history of the political and social construction and nature of whiteness. What we don’t need are the platitudes of what my father called a “benevolent monarchy” that arepatronizing and paternalistic. We must learn what has come before, how racism affects every aspect of our Black neighbors’ lives, and what we can do to make certain that the world bends toward justice.
How do we learn? Creative Black artists have long worked to share their experiences with the larger society in ways that offer windows into worlds we, as white people, cannot otherwise hope to experience. Think of fiction and nonfiction books (for example, Beloved, Between the World and Me, So You Want to Talk About Race), movies (for example, 13th, Just Mercy, Selma), podcasts (for example, NPR’s Code Switch or Scene on Radio), music, art, photography, and especially comedy (Trevor Noah is my favorite newscaster these days). In this issue, Dr. Loren Nunley provides more recommendations. Reading and listening generously – and then engaging in conversation – helps us unravel how racism is taught and how we might unlearn it. Like the M3 on the surgical service, we begin as clumsy, unfocused, and inarticulate novices. We don’t even know what questions to ask. This discomfort is hard for adults, but by being open to learning and developing new, reciprocal relationships, we might move beyond neophyte.
Expert clinicians develop skills to navigate difficult conversations. We ask about intimate life details, we delve into patients’ deepest fears and desires, and we share the best and worst news possible. These can be hard and ambiguous tasks. We can be uncomfortable. So, why can’t we talk about race, interpersonal and structural racism, and discrimination in medical education?
Under the leadership of Dr. Greer Jordan, MCW’s Chief Diversity and Inclusion Officer, and Dr. Libby Ellinas, the director of the MCW Center for the Advancement of Women in Science and Medicine, the Kern Institute is working to organize a series of facilitated conversations for the white members of our community. Facilitators have been selected. The discussion questions will keep these conversations trustworthy, honest, and respectful but, at the same time, will push these groups to do the hard work of unlearning and then relearning. Emerging themes will be quickly collated to craft the next round of conversations. Actions will emerge from this work. We will stumble and get it wrong before we learn how to get it right.
In this work, we are not asking for permission from everyone, but we strive to create trusting and deep partnerships as we move forward to make change. Human effort and compassion will power this work.
Symbolism to Action
As a sign of institutional commitment to change, President Raymond has had the hallway portraits of MCW’s previous deans taken down, to be replaced eventually with a better, more contextualized representation of our history, our present, and our future. This act will mean different things to different people, but it hopefully signals a real commitment to creating an educational and community space where no one feels left out, unseen, or unheard. There is hard work to be done.
Dr. Greer Jordan once told me that she has never met anyone at MCW that didn’t mean well. At the Kern Institute, we hope that our work will push MCW and the wider community far beyond merely “meaning well” to a new reality where we usher in real, lasting justice and change. We can no longer act like passive M3s on the surgical service watching someone else do the work. We must prepare ourselves for our places on the front lines.
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.
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