When I started medical school, I expected my hardest conversations to be the ones I had with my patients. Surprisingly, I found this not to be the case. The conversations physicians have with patients are difficult because we strive to champion their humanity whilst embodying a constant reminder of their mortality. I have made my peace with this reality, but I am unable to find a peaceful conclusion to the exhausting conversations I have with a famous dead man. I don’t suppose that Thomas Jefferson ever really meant to enter a conversation with me — an African-American female medical student — some 200 years after he wrote his Notes on the State of Virginia. The vast majority of people I have encountered assume that we stop having conversations when we die, and yet passages from Notes on the State of Virginia, something I have not read since my sophomore year of college, seemed relevant more often than not in the past year.
Early in the school year, a Facebook post made on our med school class group became racially charged. Emotions escalated enough that the deans called a class meeting. One student vehemently insisted that the she thought the response of the Black students to the Facebook post was unforgivably “primal.” The word slipped from her lips and suddenly there was Thomas Jefferson making his presence known through my classmate: “their [Blacks’] existence appears to participate more of sensation than reflection.” I fell back in my chair helplessly and watched as the Black students of our class were painted as aggressive and thoughtless. Overemotional. Unable to reach the intellectual summit that would allow us to view the Facebook comment through its intended post-racial lens.
In the days that followed two factions emerged: Those who believed the Facebook comment was racist, and those who believed it was not. Although no chance existed that the opinions of a class of 150 medical students fit squarely into these two factions, everyone was forced to choose a side. If a student did not openly come out on one side or the other assumptions were made based on the student’s race and what little could be gleaned about their political leanings only a few weeks into class. Even now, almost a full year later, talking about race in our class feels a bit like participating in trench warfare. Each side knows the other is abuzz with hidden activity. Aside from the occasional maelstrom of aggression when someone dares to poke their head above the trenches for a glimpse of the other side, All [is] Quiet on the Western Front. Over the course of the school year, neither side gained nor lost any amount of ground worth writing home about. I watched the war drag on and found myself again haunted by Thomas Jefferson’s projection of what would happen if Blacks and Whites ever tried to live together in a free American society: “Deep rooted prejudices entertained by the whites; ten thousand recollections, by the blacks, of the injuries they [Blacks] have sustained; new provocations; the real distinctions which nature has made; and many other circumstances, will divide us [Blacks and Whites] into parties, and produce convulsions which will probably never end but in the extermination of the one or the other race.” I surveyed the state of my class, wishing desperately for an intelligent retort for President Jefferson’s bleak prophecy. I could think of nothing and remained silent.
The eerie silence alone might have been bearable, but it also had a maddening quality. The risk inherent in answering a question incorrectly in medically school keeps many students silent. Better to keep quiet than shatter the illusion that we all understand all the material, all the time. For the first few weeks of class I refused to answer questions in class even when I was rather sure that I had the right answer. The risk of shattering the illusion, even when the risk was small, seemed intolerable to me. On the day that I finally felt comfortable enough to take the risk my elbow lifted slightly and then froze. There he was again whispering in my ear: “…it appears to me, that in memory they [Blacks] are equal to whites; in reason much inferior…” My eyes scanned the room. I was the only Black student present. The risk of proving Thomas Jefferson right was too great. My had fell into my lap and I remained silent. Another student, a White male, confidently gave the answer without even raising his hand. He gave exactly the answer I’d had in my head. I did not envy the praise he got from the professor for providing the correct answer, I envied the fact that he did not have to enter a vicious debate with a dead man by answering the question.
I thought I was safe in lecture. Traditionally, the only one who speaks is the lecturer. But during our renal unit, slide after slide of research concluded that Blacks had higher rates of renal failure. There Thomas was again: “they [Blacks] secrete less by the kidneys…” What was more likely, I wondered: That, in addition to being a founding father of the United States, Thomas Jefferson also could have been a brilliant nephrologist if time permitted? Or that somehow one of Thomas Jefferson’s justifications of slavery seeped its way into the results of research done centuries after his death? I honestly do not know which option seems more fantastical, nor do I know which option bodes better for the future of race relations in our nation. But there was the connection, and I knew I was not the only one to see it. At our very own medical institution an African-American primary care doctor retrained as a nephrologist after donating a kidney and realizing the racial biases in the way that donated kidneys are allocated. Even though this conversation raged on internally during the rest of the lecture, I dared not raise my hand and have my question interpreted as primal. Even though I was in an interminable conversation during the first year of medical school, I paradoxically was also often silent.
A thousand such conversations occurred in my head as I passed through all the milestones and rites of passage of the first year of medical school. I won’t retell them all to you. But I will share one more of our chats with you. I sit here, attempting to explain in words what my first year of medical school was like in brown skin that at one time would have meant that I donned shackles instead of a stethoscope, and even now Thomas is here. Our third president insists: “…in imagination they [Blacks] are dull, tasteless, and anomalous … never yet could I find that a Black had uttered a thought above the level of plain narration.” Thomas Jefferson has said his piece and this time I won’t attempt to say anything back. This time I won’t stay silent either. This time, I’ll write.
Writer-in-Training
University if California San Francisco
Shakkaura Kemet, MPH, is a member of the Class of 2021 at University of California San Francisco. She completed her Bachelor’s degree at Harvard University in Human Developmental and Regenerative Biology with a minor in African American Studies in 2015. She then went on to complete a Master's of Public Health at Yale University where she focused on social determinants of health, with a particular focus on women's health. She is currently a second year medical student at UCSF School of Medicine where she is co-president of SNMA, teaches a course to first- and second-year medical students about integrating advocacy work into one's medical career, and helps to design and implement quality improvement projects with the OB/Gyn healthcare providers at San Francisco General Hospital targeted at closing health care disparities in maternal care. Her areas of interest for research and practice include women's health, maternal health, health disparities by race and socioeconomic status, and medical education.