by Darrien Jones, WFU JD Candidate ’22
I. BLACK BOY
Black Boy has grown up in Over The Rhine, a small stretch of a booming city, Cincinnati. Over the Rhine, or as people call it now, “OTR,” is the “place to be”, the crowd is the youngest it has ever been, the restaurants that now line the streets are all between four and five stars, and the bars that accompany them are known for their local cocktail mixes. The crime has fallen to a minimal level, down from its top 25 ranking in “America’s Most Dangerous Cities,” and you can park without worry as you go to the Reds or Bengals game. Yet, as you come back to your car, you know to go towards Mason or Liberty Township, two of the biggest suburbs where most of OTR’s weekend visitors come from. You would not dare go past “The Wall.” Now, The Wall is not to be confused with a physical wall or any type of fencing. The Wall is where the city’s gentrification has stopped, maybe for only a month or a year as they continue to push Black people out of the area, but for now it has stopped. The construction certainly hasn’t, but the evictions, for some time, have taken respite. The difference between “good OTR” and “bad OTR” is so stark. One minute you are driving past The Eagle and Taste of Belgium, two “staple” expensive restaurants in the city, and drunk white college students and young professionals on paddle pubs. The next minute, you are in a territory of homelessness, dilapidated and vacant buildings, graffiti everywhere, and trash unattended. It is a different city beyond The Wall, and this is where Black Boy lives.
Black Boy is fourteen, he lives with both of his parents, an anomaly in this area, and attends the local junior high school. His favorite sport is football, and in fact, it is one of the only activities that distracts him from being a “contributor” to his household. He contributes by working at the local “Corner Market” at the corner of 14th and West 3rd Street. He hates it. He hates how no one comes in, he hates how he is not allowed to have any of the food there even though no one buys it. He hates how he isn’t allowed to drive but has to take his bike every day to a local distributor and restock the store with almost exclusively cigarettes, that, which is the store’s “best seller.” He hates riding to good OTR because on that side of the wall, he does not recognize his city. He isn’t familiar with the perpetual happiness and glee that everyone beyond the wall has. He doesn’t understand how it looks like no one is actually working. And he hates driving by the new bar, Drip, which occupies the plot where his old apartment was located before it was demolished by the city to make room for more lucrative businesses and restaurants. One day, as Black Boy is riding his bike towards the “good OTR”, a driver hits him and flees the scene. With his bike rendered unusable, Black Boy, with so much adrenaline, runs home. Upon getting home and telling his parents what happened, he begins to spit up blood. As they clean his shirt and wipe off the dirt and the little pieces of trash from the road that were stuck to his body, they notice a deep laceration in the back of his head. Black Boy says that he feels dizzy and “kinda funny” and he throws up.
Though Black Boy’s parents knew that the local hospital would have wait times of up to two to three hours, they figured at least he would eventually be seen, so they go to Black Boy’s mother, who knows she has to take her son in, but she is wary to trust doctors since her own traumatic experience at the same hospital several years ago. Before Black Boy was born, she was supposed to have a daughter. During labor at this very hospital, she was in severe pain for hours. The doctors shrugged it off as though it were the usual labor pains that all mothers face, refusing to give her more than the standard low dose of pain medication and an epidural. When she tried to explain to them that none of those methods had worked, they had adamantly insisted that she “give it time” and that the baby would “be out before [she knew] it.” Unfortunately, the pain that she was describing was caused by a blood clot that was creating an extreme amount of pressure near her cervix. When the doctors finally figured this out, they needed to perform emergency surgery, or they risked losing both mother and baby. Despite knowing minimal information about the procedure, she opted into the surgery. However, in the process of alleviating the clot, the umbilical cord became wrapped around the baby’s neck, suffocating it and eventually killing it. Black Boy’s mother lost her first child, her daughter. Ever since, she has been convinced that if they had listened to her, if they had believed her calls about her pain, she would still have her daughter today. But she doesn’t. She only has Black Boy, and she is determined to protect him from the same doctors that killed her daughter.
II. BLACK STUDENT
Black Student grew up in a relatively well-off area. Mainly because both his parents were educated, his father and mother a PhD in mechanical engineering and a Juris Doctorate, respectively. He went to a private school for most of his life, but eventually transferred to a public school in his sophomore year of high school due to his father’s promotion within his job, which forced the family to move about four hours away. Black Student knew he wanted to be a doctor because he loved to help people and he loved science. He loved how science had an explanation for seemingly everything, how there are quantifiable solutions to real problems. He loved that could use these solutions for problems that impact people daily, especially those that looked like him.
Black Student grew up in a predominately white area, but that did not bother him as much as it might bother others who are similarly situated because he always performed well academically, lived in a decent place, and code-switching (a strategy often employed by black people in mostly white settings to blend in with the culture and vernacular) had become so second-nature for him that he was essentially a social chameleon. The only problem was Black Student really struggled with standardized testing. His GPA was comfortably at a 3.7 but his ACT was an average 23 and his SAT a dismal 900. Despite this, he went to a state school for undergrad, where he excelled in all his classes as a bio-chem major with a minor in social sciences. By his senior year, not much had changed. He still wanted to be a doctor, and though he was not quite sure what type or where, that did not matter. He wanted to be a doctor. After graduation he studied tirelessly for the MCAT for two months. He even hired a tutor to help. This was not going to be like the other standardized tests; he was determined to do well. That summer, he confidently walked into the testing center with his strategies playing over and over in his head. He was ready for any problem that required computations or analytical thinking as he had practiced relentlessly for any type of problem that would be on the exam. Six weeks later, he received his results. He didn’t do well. With his scores, he knew he wouldn’t get into a top 50 medical school. He thought he might get into a top 100 medical school because of his grades and his extracurriculars, but that was optimistic. Although he felt discouraged, he decided to apply everywhere he could to try to get into any school that would take him. This was his dream. Sadly, no medical school accepted him.
Of his group of friends from undergrad, three others wanted to go to medical school as well. They were all white, they all tested better than him, and they all were accepted to a medical school. Two of them went to top 50 schools, and the other still fell within the top 100. This was extremely discouraging to Black Student, and he decided not to pursue a career in health at all. While his parents still encouraged him to pursue a career in nursing, or even a physician’s assistant, he was so mentally exhausted from the initial rejection to medical school that he did not pursue a career in health whatsoever.
III. BLACK DOCTOR
Black Doctor went the University of Wisconsin for undergrad where he excelled as a double major in biology and chemistry. He also mentored young Black high school students from his hometown, Over The Rhine in Cincinnati, Ohio, and visited when he could to encourage them to stay in school. After taking the MCAT and doing very well on it, higher than most in his age bracket and demographic, he applied to eight medical schools. He was accepted to Johns Hopkins in Baltimore, Maryland and this was an opportunity he could not pass up. Medical school was hard. He hated it at times and loved it at others, and in between it all, he had mental breakdowns and existential crises about whether this was what “God really had in store” for him. But he did it. He finished. He graduated at 26 and got an offer for residency from his hometown hospital, University of Cincinnati Medical Center, where he would be working in their trauma unit.
Black Doctor loved it for the first year. Something new every day, experiencing exhilarating procedures that really tested and stretched him as a young doctor. His first trauma patient was a twenty-two-year-old college student from the University of Cincinnati who had drunkenly run into traffic and was struck by a car going 35 miles an hour. He sustained six clean breaks on three of his limbs, there was a deep laceration on the side of his head, and his kidney seemed to be severely bruised or worse from the impact. Two of the residents were flustered with the patient’s obstinate demeanor, but Black Doctor loved it. He smiled and laughed at the young man’s jokes and enjoyed the candor and conversation he had with the family. Most importantly, he enjoyed providing care to this student. Black Doctor was finally practicing and applying the skills and tools he spent years dreaming about. Black Doctor had many cases like this over the next two years, and he took them all in stride, smiling and laughing along the way, happy that he was making a difference in his own neighborhood.
One day, a patient came into the trauma unit with a compound fracture and a likely concussion due to a car accident she was in. She was white, mid-forties, and a mother. She was distressed and confused about why the ambulance rushed her “here, and not the hospital I regularly go to in Mason”. Black Doctor and the other residents tried to explain to her that due to the risk of internal bleeding it was best EMTs got her to the nearest trauma center, and since the accident happened less than five miles away in OTR, this trauma center was the best one for quick examination and testing. This woman expressed her worries about her standard of care, about how she “knew [they] were not running all the tests they should be running.” And finally, she pointed at Black Doctor, paused, laughed, and said, “You especially do not look like you know what you’re doing.” Black Doctor chuckled because he thought it was a joke, perhaps a result of the morphine drip they were pushing. He said, “I promise you ma’am we are doing all we can and more to ensure you are taken care of. We’ve seen a lot of these, and a lot worse, and everyone walks out of here on their own two feet, just give us some time.” Sharply, she replied, “No, no I don’t- I don’t like you talking down to me and I’d like to talk to whoever your supervisor is.” Black Doctor, not wanting a conflict, and mindful that the patient’s blood pressure was rising, went to go get his supervisor, who later advised him to drop this patient and wait for another trauma patient to come in. Little did any of the doctors know that this woman’s husband was on the board of directors for University of Cincinnati Health, and shortly after her release she filed a complaint alleging, “The Black doctor, was short with me, ignored my requests for needed testing, and laughed in my face as I expressed my concerns.” Black Doctor’s supervisor knew this was not true. He knew that Black Doctor was doing his job, as he always had, and there was no foul play. Yet, Black Doctor was not placed on the trauma unit again for at least two weeks with no explanation. He was relegated to brief inpatient check-ups the day after they were admitted, a task usually assigned to first year residents that requires little working knowledge of trauma care.
Black Doctor understood the placement and understood how there are situations that are “just out of your control.” He refused to let this incident diminish any of the work in the trauma unit, after all, he would surely go back in some time. If anything, he would be the best intake resident in the entire hospital. Several months passed and unfortunately, the temporary reassignment was starting to feel like a full-time placement. In fact, another class of residents came in the hospital and all they knew of Black Doctor was that he was now a fourth-year resident at the hospital, working in a position suited only for first-year residents and Physician Assistants.
Black Doctor heard the whispers about his incompetence, about his lack of drive and motivation which kept him from advancing. Once, he even overheard amongst the gossiping of fellow residents, “There’s a reason why he’s the only Black one left here…and maybe not for long”. The line was met with a few chuckles from the surrounding residents as they moved down the hall into their respective assigned rooms. This began to bother Black Doctor. They didn’t know why he was there, they didn’t know that he had been the most active doctor in the trauma unit for two and a half years before they arrived, or that he was still respected by his peers around him. They didn’t know any of that. He knew that all they saw was a black man in healthcare, doing a relatively remedial task, and because they knew nothing else about him, they assigned mediocrity, incompetence, and inability to his blackness.
Black Doctor decided to bring this up with his supervisor, the same one who had “temporarily” relegated him from the trauma unit. He expressed his concerns with his new assignment and about the way the other residents were talking about him. Being the only black doctor in the trauma unit and just one of six in the entire hospital, he felt extremely uncomfortable, and he was at his wits end. His supervisor nodded, said “I understand, but that is just how things go sometimes, I can definitely see about bringing you back up to the trauma floor, but there isn’t really anything I can do about the residents talking…ya know…these things happen, people talk, you can’t let it bother you…” Black Doctor thanked his supervisor for listening and for considering bringing him back to the trauma unit. But as he walked away, he could not shake a certain three words, “… these things happen”. He asked himself, “what does that mean, ‘these things happen’? Black doctors being relegated from top positions to remedial tasks? Black doctors being subject to racial scrutiny and being excluded and ostracized simply because they are Black and one person had an issue with that? People questioning your competence, your work ethic, your pedigree, when they know nothing else other than the color of your skin? These things happen?” Black Doctor went home and wrestled with the thought of getting back on the unit to prove everyone wrong. However, also working in the same unit where no one defended him, no one vouched for him. Even his own supervisor brushed off the insults that were underlined with racial tones and excused them as “things that happen” was a situation, he felt, was beyond remedy. The latter part of those thoughts persisted and penetrated through any past feeling of happiness or any future thought of joy.
He decided to quit. The next morning, Black Doctor went to his supervisor, he told him once more about his feelings, about the treatment towards him and ended his resignation with, “these things may happen, but they will not happen to me again,” and he walked out of University of Cincinnati Medical Center for the last time.
Later that same day, at the hospital, a young boy was admitted. He had been hit by a car in a hit-and-run in OTR. The front of his shirt was a little bloody, which was due to him spitting up blood as his parents explained. The boy drifted in and out of consciousness, and every moment of lucidity was met with delirium, undoubtedly related to the deep laceration in the back of his head. The doctors’ main goal was to keep him awake because they feared he might drift into a coma if he let his eyes close. The parents, worried, asked what the next steps should be, if admission was an option, if images needed to be taken, if surgery was necessary. They would do anything to help their son. The residents’, having not seen a case like this in their time there, scrambled and were not exactly sure how to approach the case. This resulted in a cacophony of suggestions to the parents in medical terms which may as well have been in another language. The residents were struggling in relaying both the severity and the urgency that was needed for consent to do certain procedures, but the parents were simply not going to allow any procedure, invasive or non-invasive, to be done without trusting that it would actually benefit the health of their boy. They wouldn’t even let them put an I.V. in the boy, who was now sweating through his clothes, they would not let the resident’s take their son back for a CAT scan of his head. So far, the parents only let the doctors take the boy’s blood pressure which was now decreasing rapidly. Something needed to be done, and quickly.
You see, the issue with Black Boy’s parents, is that they didn’t trust “no one” in the medical system. They were unfamiliar with the medical system, and they could only go off what they heard and what they “knew”. What they have heard consists of doctors ignoring patient needs, and that white doctors refuse to spend any meaningful amount of time with most Black patients. What they knew is that there is a history of white doctors performing unnecessary tests and procedures on black patients. They knew that there is a history of nonconsensual examinations done over time in the name of “health and science”. They knew that these were young white residents, and they knew that they were not going to lose another child in this hospital. But as both parties wrestled with medicine and history, respectively, Black Boy was losing time. He needed tests, and the residents knew that, and although the parents knew that too, they couldn’t get past the wall of mistrust. As the parents and the residents were at arms over what to do with Black Boy, his heart rate began to climb rapidly. When the residents took the sheets off him, they noticed significant discoloration and bruising along his back and running down the left side of his torso caused by internal bleeding. He was not responding to any of their questions, and when they tried to provide stimulation to his hands and feet, there was no reflex. His body temperature reached 106.3. The nurses were scrambling to get him ice packs, the supervising doctor arrived and pleaded with the parents to allow Black Boy into surgery to find the sources of his internal bleeding and effectively suture the wounds. Amongst the chaos and decision making, the beeps on the heart monitor became more frequent. The intermittent beeping then became one long sound, like an alarm bell. As he flatlined, the residents suggested using an automated external defibrillator to shock him back. But everyone knew, as Black Boy lay lifeless and limp, that he was gone.
Precious time was wasted wrestling with history, wrestling with medical methods, ignoring signals, and refusing to get the right people in the room. And who suffered? None of them, none of them except Black Boy. Rightfully, people should be mad at the residents who refused to pay attention. Rightfully, people should be mad at the parents who couldn’t shake the ghosts of their past for the sake of their son. Yet, people cannot forget that just the day before, Black Doctor was there. Black Doctor could have related to those fears of the parents, and he could have assured them that certain tests and procedures were safe. He had the most experience of anyone on the floor aside from the supervisor who showed up too late, and he would’ve been able to diagnose the signs earlier than the new residents. He could have made a difference. Instead, after being crippled and ultimately defeated by the weight of racism and inaction from his peers he quit, and he was not there. Instead, Black Student never made it that far because of one test that disproportionately affects Black test takers.
So, perhaps we shouldn’t blame the parents who were scared, nor should we blame the residents and the doctors that were trying to help but couldn’t efficiently do so. Perhaps, we should blame a system that repeatedly allows people like Black Doctor to leave. We should blame a system that refused to let Black student into medical school because of one metric. We should blame a system that has pushed black families into areas of deep poverty and social neglect and has created dangerous environments for children like Black Boy. All they needed was one, one black doctor and this boy’s life could have been saved. But he wasn’t there. This is a reality Black Americans face all too often. We are asking for Black medical professionals to fail, furthermore, we are failing to give Black people access to any professional spaces because of the systemic racist barriers that exist. Those failures start with situations like Black Boy’s.
I think that it is time to make a change. I propose we create a more robust tenant’s rights system so that gentrification no longer has a death grip on minority communities. I propose we expand access to reproductive health care and maternity leave, so Black mothers can identify critical health issues before labor. I propose we put less emphasis on the MCAT and other standardized tests that disproportionately effect Black students’ ability to attend top tier schools. I propose that we revamp medical institutions with more representative staffs to combat the fatigue that young, black professionals face defending their own credentials and competence. Yes, these are broad suggestions, but we have to start somewhere or like I illustrated, Black people will continue to die. And if not, death, they will deal with a substantially lower standard of health than their white counterparts. We need advocates and champions at every part of the pipeline to create change, and help rewrite the stories of Black Boy, Black Student, and Black Doctor.
Photo Credit: Katya Rekina/Shutterstock