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When Alternate Universes Collide: Facing Racial Battle Fatigue as a Black Medical Student


When I started medical school last August, I arrived on campus excited to fulfill my childhood dream of becoming a doctor, eager to learn more about the body and its mysteries, and more than a bit nervous. “Medical school,” the physicians in my life told me, “is no joke.” But “everyone survives” they assured me. While I clung to this promise as I made my way through the year, I did so perhaps for different reasons than I first imagined.

As I expected, much of medical school education is based on memorization and is buzzword-heavy. I, like my classmates, have learned to make numerous associations during my preclinical studies: pituitary tumor, sella turcica, bitemporal hemianopsia; Crohn’s disease, transmural inflammation, skip lesions; decompensated cirrhosis, ascites, portal hypertension. So on and so forth, ad nauseam.

But for those of us keeping a close eye on the news, it seems that we are making additional associations — ones unrelated to medicine — as the lives of black men, women and children in America are lost to systemic racism, police brutality and other forms of injustice. Throughout the year, I found myself memorizing the stories of black people whose names have become hashtags:

Mike Brown — Ferguson, shot by police.

Eric Garner — Staten Island, died in a police chokehold.

Tamir Rice — Cleveland, shot by police.

Tanisha Anderson — Cleveland, excessive force on arrest leading to death.

Walter Scott — North Charleston, shot by police.

Freddie Gray — Baltimore, spinal cord injury after being taken on a “rough ride” by police.

Brandon Tate-Brown — In my very own city, Philadelphia, shot by police.

And most recently, the Charleston Nine: Cynthia Graham Hurd, Susie Jackson, Ethel Lee Lance, Clementa Pinckney, Tywanza Sanders, Daniel Simmons, Depayne Middleton-Doctor, Sharonda Coleman-Singleton, Myra Thompson — Charleston, massacred in church by a white supremacist.

For black medical students learning these names and stories, honoring these men, women and children’s memories, and coming face-to-face with the reality that we still live in a racist society can be just as, if not more, taxing as learning the material in our formal curriculum. I cannot pretend that my experience is universal among black students, but based on conversations with my black friends, I know that my experience is hardly unique. The stress of being in medical school is, in and of itself, a challenge for everyone. Not only do we have to find our way in a new city, on a new campus and among new peers, but we also have to manage a high-volume, fast-paced workload, all while trying to find a balance with our non-medical school lives.

But being a black medical student at a time when instances of police brutality against black individuals are making headlines regularly is a different, more intense kind of stress. It is the stress of having to live in what seems like alternate universes: the “medical school bubble” and the “real world.” In the former, reality is lectures and small groups, physiology and pathology; in the latter, reality is racism and structural violence, tragedy and loss.

I am in a constant state of mourning, and it is exhausting. The loss of black life in the “real world” is an acute reminder that our lives are still threatened by racism. Hearing stories of real people who look like me, my family members and friends being brutalized by police and trapped by the oppression of systemic racism often leaves me oscillating between feelings of anger, profound sadness and numbness.

It takes extra energy to force myself to stop thinking about the fact that one of my cousins could have just as easily been Mike Brown.

It takes extra effort to avoid watching videos of a police officer in McKinney, Texas, pinning teenager Dajerria Becton to the ground because I know that watching would absolutely drain me of the mental energy that I need to study.

It takes work not to freak out when I am reminded that not even the privilege that comes with my education can save me, as was the case with Martese Johnson, an undergraduate at the University of Virginia who was beaten during an arrest.

It takes extra effort to avoid footage of his bloody arrest, as well as that of Eric Garner’s final plea of “I can’t breathe,” and that of Walter Scott’s death as eight shots rang out from the officer’s gun.

It takes a conscious effort to walk away from my work for a bit because I need a mental health day, and it takes emotional strength to realize that taking the time to take care for myself is just as valuable as using that time to study, especially if I already know that that time “studying” will be spent staring at the wall, either with my mind racing with worry or with my entire being feeling numb.

It is also exhausting to have to constantly defend affirmations of black life to people who respond to cries of “Black lives matter!” with, “Don’t you mean all lives matter?” It is tiring to explain that talking about “black on black crime” is a cheap way to divert the conversation away from real discussions about racism and violence against black bodies while also avoiding issues of segregation and poverty that underlie those statistics. It is frustrating to hear people use coded language when talking about black people, to only see black bodies in the media when they are being brutalized, to see the news only covering protests when “thugs” are being “violent” and “destructive.”

All of this exhaustion can be collectively described as “racial battle fatigue.” Although this term was initially used to describe the experiences of black professors teaching white students, its definition can be applied more broadly. Racial battle fatigue, Dr. William A. Smith writes,

is a response to the distressing mental/emotional conditions that result from facing racism daily (e.g. racial slights, recurrent indignities and irritations, unfair treatments, including contentious classrooms, and potential threats or dangers under tough to violent and even life-threatening conditions) […] A growing body of literature suggests that stress-related disease result from the fact that African Americans have to keep activated a physiological response, originally evolved for responding to acute physical emergencies, but now ‘switched on’ constantly to cope with chronic racial microaggressions/macroaggressions.

And for those of us already dealing with depression, anxiety or some other mental health problem, racial battle fatigue is an additional stressor on top of the pressures of academic life.

While dealing with racial battle fatigue alone is tiring, I have found that it is more exhausting to compartmentalize, to act as if nothing in the “real world” matters when you are in “the bubble.” If there is one thing that I have learned in my first year of medical school, it is that it is inappropriate to express too much emotion, particularly emotions of vulnerability, in a professional setting. We are so trained to suppress negative feelings that, earlier this year, a photo of an ER doctor crying over the loss of a 19-year-old patient went viral because people were surprised to find that, “Wow! Doctors actually have feelings.” How terrible it is that we, as medical students and physicians, do not feel safe enough among our colleagues and within our work-spaces to express feelings of loss.

Back in August, I would never have guessed that not being allowed to acknowledge my racial battle fatigue, rather than struggling with the academic workload (although that definitely happened as well), would be the greatest challenge in my surviving the first year of medical school. Now, at the end of it, I find myself exhausted from compartmentalizing. Down the road, I hope to further cultivate my practice of different forms of self-care, from taking occasional mental health days to getting better at reaching out to friends and family when I am under the most pressure. But ultimately, my greater hope is that medical school culture shifts in such a way that I finally feel comfortable enough to ask for a minute to grieve.

For further reading or inquiry:

Smith, William. A. “Black Faculty Coping with Racial Battle Fatigue: The Campus Racial Climate in a Post-Civil Rights Era.” A Long Way to Go: Conversations about Race by African American Faculty and Graduate Students. Ed. Darrell Cleveland. New York: Peter Lang Publishing, 2004. Print.

Dorothy Charles Dorothy Charles (1 Posts)

Contributing Writer

Perelman School of Medicine at the University of Pennsylvania

Dorothy is a Class of 2018 medical student at the Perelman School of Medicine at the University of Pennsylvania. She currently channels her interest in intersectional feminism and social justice by organizing with the medical student activist group, White Coats for Black Lives. When she’s not studying or organizing, Dorothy can be found live-blogging/live-tweeting her favorite TV shows, eating froyo with friends, and playing the guitar (somewhat badly).

  • John Thompson

    You discredit yourself when you put Mike Brown – a grown young man who committed strong-armed robbery and then assaulted a police officer – with genuine victims (the Eric Garner case was particularly atrocious – and those officers should’ve been charged with murder). Also, I got a 3.99 GPA from an Ivy League school (Biochemistry major), scored a 41 on my MCAT, and worked countless internships (at good universities) and was rejected from UPenn Med School. I dare say that if I were black – as you are – rather than Asian, as I am, I would’ve been accepted. What, may I ask, are you qualifications? Stop bitching and be grateful that you’ve benefited from blatant racial discrimination against whites and Asians, you ungrateful twat.

    • psom

      My goodness, what sort of medical school could have rejected a candidate with your inimitable maturity and eloquence–fellow Asian at Penn Med with a sub-3.9 GPA and sub-40 MCAT

    • Morgan Oniel

      I just can not see how you were rejected with such a compassionate manner and rapport. Who wound not want a doctor who displays such a commitment to meeting a perceived failure with resilience and resolve to looks inward and better himself instead of harboring bitterness and casting blame. The fact that you see value in the life of Mike Brown even though you do not agree with a particular action of his is a testament to the mistake that UPenn made in preventing you from having power over human life. As evidenced by your comment above, you would have make and excellent and unbiased compassionate physician. You would not have contributed to the growing health disparities in communities of color partially due to doctors internalized biases and cultural ignorance. Your obvious respect for women would have made you and excellent addition to a multidisciplinary team. It is truly unfathomable that someone with the capacity for empathy displayed in the above article would be chosen for a life of service over you!

      • John Thompson

        Be as sarcastic as you like – that won’t change the facts of the Mike Brown case. Forensic evidence shows that he lunged at the police officer. I’m not exactly suffering, as I was able to get into Stanford – but I still find it absurd that Penn would reject a candidate with my academic track record. Continue to support race-based Affirmative Action if you like, but I choose not to support that which blatantly discriminates against me and my people.

        • Theodore J Limerick

          John it is simply amazing with all your accomplishments that Penn would simply not acknowledge you. What kind of institution would want a student who was self-centered, egotistical, and delusional about the world around him. To assume you would be accepted anywhere just because you were black is preposterous. Black physicians only make up 3.8% of all physicians in America. It is sad to see that there is one more physician to be, who had a mindset of racial biased and stigma even before you have even seen your first patient. Also, I love how people like you get big and bold on the internet and would dare to call a fellow colleague as aspiring doctors such a terrible word. That is extremely unprofessional. I would love to see the personal statement you wrote for medical school, because just from seeing the way you wrote to the author above you have no intention of practicing patient centered care with the decency and respect people deserve.

          • John Thompson

            What sort of institution would want me? Stanford.

          • Morgan Oniel

            That is unfortunate!

    • lol

      Dude, you have serious, I mean DSM V level issues. I think you need to first GROW UP and act like a mature adult. You’re the one who’s whining right now and making a fool out of yourself behind the anonymity of the internet. You sound extremely self-entitled. I pity Stanford for accepting you and the patients that have to meet someone so judgemental and ugly as you.

      -fellow asian from university of washington school of medicine

    • MDinTraining

      Are you even a real medical student? You kinda just sound like a professional troll.

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  • The Impostor

    So well written. I worry how Dorothy will do on the floors when the racism is one on one rather than distanced through media. Very happy her focus is on self care. She is exactly the kind of doc we need joining our community – deeply aware and affected, passionate. Kick ass Dorothy.

  • Abraham Khan

    Thanks for sharing your story