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To Medical Student Activists on the Anniversary of the White Coat Die-In

One year ago, on December 10, 2014, over 3,000 medical students participated in the National White Coat Die-In. We knelt to the ground, rested our backs on concrete and tile, looked up at the ceiling and contemplated what it meant to be a citizen. We embraced a deafening silence pregnant with the implications of erasure. Our bodies, cloaked in the privilege of a white coat, painted a complicated image of advocacy and appropriation.

We asked people to consider: what bodies are recognized as fully human?

We hoped to convey a denial of complicity with a system that had allowed for the non-indictments of individuals responsible for the needless death of black people. We wanted to demonstrate solidarity with the broader mission to identify systemic racism as a national public health issue.

Last year, on the day before the action, I sat at this desk, in this chair, on this laptop writing “A Reflection on the White Coat Die-In.”

A lot has changed since then.

A lot has not.

For one, my coat is no longer a clean, monotonous bone white. It is scarred with stains and creases — badges acquired more likely as a result of carelessness, stray pens and fabrics that leave kisses of errant dyes than any sensational clinical encounter. Nonetheless, each won by experience.

Other things have changed. It feels like there is higher energy — that there are more organizations and coalitions fighting this fight, more student-doctors with a commitment to social justice at the center of their professional and personal mission. There are louder voices, more panels and discussions, increased letters to the administration and letters to the editor. There are new sessions on bias, more conversation of structures, additional attention towards inequality and injustice.

But some things have not changed. The conversations are still hard and uncomfortable. Change is still slow. Efforts are easily dismissed. There is still anger, hurt, trauma and pain.

The change closest to home: I am burned out. This work feels heavier than it did a year ago — it takes more energy from me than it did last year, gives me less energy than it did last year. I am so tired of watching beautiful, vibrant people feel downtrodden and uncared for in spaces that promised them so much more.

More frequently, I wish I did not care.

More frequently, I think, “I do not want to do this anymore.”

I find myself much less patient towards people who “don’t get it.” I am less likely to engage, less willing to meet people where they are. I am struggling with a deep and ugly shame — a growing resentment toward people who are able to walk away from continued engagement with inequality. I am troubled that my efforts and work towards fighting for goodness have, in some ways, birthed this odious echo of superiority. I am ashamed of feeling exhausted when my body is safe and secure in a position of remarkable privilege. I am forever not enough.

It does not feel good.

I am caught between a challenge to practice more amity, more love and more patience, all the while reminding myself, and others, that there a very serious importance to self-care, to learning how to say no. There is also something to be said about laboring to teach people when they have the resources and ability to find answers themselves.

In the midst of fatigue and a flurry of organizing, manuscripts, op-eds, deadlines, and attempts to seek people in higher positions of power, I have to remind myself that the endeavor to fight inequality has to be predicated on a love — a more radical sort of love — that denies achievement as a primary driver. As Alok Vaid-Menon says in one of my favorite TEDTalks, “Success, is about self promotion, not putting change into motion.” It is a healthy reminder to deny the pressures that frame triumph within personal accomplishment. This work, at a more basic core, needs to attempt to strip away notions of individualism and be more fully couched in community.

Medical school asks us to prove ourselves in ways that can be identified on a resume linked only to one name. We are in a pre-professional school. We are not in a radical space. Working within these walls has, in some ways, challenged our idealism with reality, practicality and strategy. I often feel the disappointment that comes with asking for what we think may be achievable, as opposed to demanding what we need. We are taken further away from community spaces, pushed closer to board rooms and conference centers. The projects we rally around are those that are publishable and recognized rather than those that have a better chance of building the collaborative, sustainable, long-term movements that combat transience. I wonder if we were duped, perhaps even by ourselves. I wonder if, instead of pursuing publications and presentations, we would make much more progress simply by making more time to meet strangers, break bread, shake hands, slow down.

I am weary of the complicated line between fighting to end inequality in our local communities, and fighting for our own professional development. What does it mean to commodify progress? To perform activism and attach it tightly to ownership?

I think we have to begin to conceptualize reward, reason and incentive in different ways. I have become, and have to be, more conscious of how destructive the notion of individual achievement can be to meaningful progress — how our society’s emphasis on personal recognition and merit holds back opportunities to grow anti-oppression efforts. This work is about showing up and standing up for the people you share your space with. This work is a call for community building, a call to have love for other people at the center, forefront and foundation of its efforts. A love that is able to fight against a system that measures success along individual achievement, profit, and recognition. A love that — slowly, painfully, and despite how valuable they are in working towards our own dreams and aspirations — tries not to climb to a higher rung of a slanted social ladder, but to bring the entire system closer to the ground (or indeed, construct a whole new system all together).

This work is about fighting to attain power, only to give it away.

I understand this is hard. It hurts to give away power when it took so much effort to mine. Activism is not a lucrative tradition — I know many sacrifices have already been made.  It is difficult, and I am hesitant, to ask people in this activist community to be more selfless — to practice the politics of rejecting ownership of and giving away their hard won returns. I do not expect it to be easy. I expect myself to falter many times. I wonder if this essay itself only reifies the problem stated.

This reflection is imperfect. I wish I had more time to make it beautiful. I wish I were not spontaneously writing this at five in the morning. I wish I had more time to roll the words across my mind, edit, rephrase, reconsider — there is a lot I am trying to convey that is hard to articulate on paper, that can be easily misconstrued, that is complicated and nuanced in a way I am struggling to fully express in these paragraphs. I wish I knew more clearly what I was trying to say, was able to provide solutions instead of serving a jumble of internal demons and dilemmas.

As time passes and things change, it has been ever more important to remind myself why I am here, why I do this.

Here is what hasn’t changed: The people in my communities are amazing, brilliant, energetic and validating. I have been lucky enough to be connected with people across the nation who are working tirelessly for better resources for their peers, for more knowledge to combat an intellectual ignorance that resides in medical curricula, for programs and attention and recognition of the needs of their local communities, for their schools, for this profession, and for their patients.

Here is what hasn’t changed: When everything feels futile, I feel worthless, and this work feels aimless, and I wonder if I was wrong this whole time, being connected with the people in my community seems like enough.

So I end with a challenge to hold myself more accountable to the idea that this labor must be predicated on love, to remember that sometimes, failure as we know it can be the greatest triumph. I end by sending energy and warmth and gratitude to the people who have struggled tirelessly and often thanklessly to better their communities. I am indebted to the people around me who have served as teachers, allies, and friends; who keep me humble merely by demonstrating to me so clearly what grace, strength and passion are.

In no particular order: To the working groups I am a part of, to my friends, to Alpert Medical School and Brown University, to my family, to Providence — to my communities — I am going to continue to fight for, with, and by you.

See you next year.

Jennifer Tsai Jennifer Tsai (12 Posts)

Writer-in-Training and in-Training Staff Member

Warren Alpert Medical School of Brown University

The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.

I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!

  • Annie Young

    This hits very close to home. Thank you so much for being honest and sharing this piece – it is good to know we are not alone in what we are feeling.

  • Yanni Chang

    Thank you for writing about your thoughts and sharing them with us. I saw everything that I have been thinking about reflected in your words. You are not alone. We are not alone.

  • J. L. Johnson

    As I medical student in Philadelphia, I am ashamed and disgusted by people who think and act like you, Ms. Tsai. Your work isn’t about rights and people. It’s an elaborate exercise in narcissism disguised as “advocacy”. You’re not even MDs yet, and your egos are already through the roof. Fundamental rights are not a goddamn medical issue. They’re a fundamental rights issue. The fight for equality under the law belongs to everyone. The medical profession is no more special in this fight than anyone else’s profession. You people parading around like your opinion matters more because you’re wearing white coats is repulsive. Get off your goddamn pedestals and extract your heads from your respective asses. Take a look at what you really stand for. Based on the fact that my Facebook wall is overrun with self-righteous, self-congratulatory pictures and posts of you guys playing dress-up in public spaces instead of actually doing anything meaningful and system-changing, you should have the self-awareness to realize that you’re motivated by the cameras, not the people whose rights are being transgressed. Your essay is simply a prose-form selfie of a self-absorbed med student.

    • Jennifer Tsai

      Hi J.L Johnson,

      I think you’re touching on a lot of important points and
      considerations. I think a lot of people participating struggle with some of the
      same things you say. For example, in the first paragraph, I write that “Our
      bodies, cloaked in the privilege of a white coat, painted a complicated image
      of advocacy and appropriation.”

      It is true that there is some level of appropriation here – largely, again, because of privilege. I think that’s why I feel very strongly that the publicity that is garnered simply because of our privilege, needs to be funneled back into communities, and not remain sequestered in the institutions of privilege we reside in (medicine, medical school). In this sense and to some capacity, you are correct about being motivated by cameras. In the end, however, the people in front of the camera ultimately need to be the people who are most affected by the inequality we aim to push back against. Again, “This work is about fighting to attain power, only to give it away.” Again, I often “am weary of the complicated line between fighting to end inequality in our local communities, and fighting for our own professional development.” Again, what does it mean “to perform activism and attach it tightly to ownership?”

      I think you’re hitting on a very
      important tension – what is the responsibility of a doctor, and do they have an
      obligation to advocate for broader concepts of health? For some, and me, this
      is a resounding yes. This is not to say, as you suggest, that doctors have any
      “claim” over other professions in the fight for fundamental equal rights.
      However, this is to say that for many people who aim to enter a profession that
      aims to address health and patient suffering, racism is indeed a public health
      issue that deserves the notice of healthcare providers. It affects health, it
      produces suffering, and therefore it mandates a response. Again, you are right:
      we are hoping for attention.

      Activism, advocacy and allyship are
      all very complicated, difficult processes. Somehow, white coats have the
      ability to garner more attention because of their social authority. I agree
      with you that this may not be deserved –our training as it stands does not
      prepare us to be arbiters of social issues. So then the question becomes, how
      do we negotiate the tension of having this power, and the reality that we can
      use it to give more power to other people, all the while being conscious of the
      fact that the power we may possess (even as you said, as medical students, not even doctors) is something given to us mistakenly. Medical authority is a dangerous thing that I have
      found important to critique – I think you will find that many people fighting
      inequality also have it in their minds to actively evaluate the unjustified
      strength of medical authority. So then, how do we participate as citizens, as
      medical students, as advocates — separately, and also all at once?

      To another point, these systemic
      issues are incredibly overwhelming. The line “I am forever not enough” refers
      to this – how little it seems we can do as medical students inundated by student
      responsibilities and exams. But
      then—when do we take the moment to congratulate our own work? When is it okay
      to celebrate small triumphs, while knowing they are far from enough? We cannot
      expect to attack these systems all at once, all on our own. So sometimes, we
      start with where we are. We start with gaining the attention of our
      administration, with adding a one hour conversation on structural competency,
      with having discussions with our professors, with questioning our own practices
      in the clinic. We start by attempting to amplify, in whatever tiny ways we can,
      the call against inequality.

      I think there are lot of people
      “playing dress up” who are conscious of your critique and are really struggling
      with it. I trust them enough to trust that they have thought this through, held
      themselves accountable, and in the end have reasons that justify, bolster, and
      inform the importance of what they are doing, even as they consider your points. Maybe you’re right – perhaps we
      are not harsh enough on ourselves. But at the same time, perhaps you are too
      harsh on these people yourself.

      It is true
      that we cannot indiscriminately accept actions propelled by good intention.
      However, trust that there is good intention in these efforts. These people, we,
      are trying. We are not perfect, but we are trying. We are stumbling, often
      unsure, often unsuccessful, but we are trying.

      Thank you
      for your critique, and for propelling dialogue. Please feel free to email me if
      you would like to speak further.

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