When I was six, a set of strawberry hair ties foiled my endeavor for independence.
My mother had a way of twisting the plastic ornaments at the end of her operation so they sat together like two friends on a bus, neat and obedient at the crown of my head. Despite my assertions, (“I can do it myself!”) I could never align their orbits. Battling sore arms and wounded pride, I would fight and tug and adjust over and over again only to have those plastic strawberries protrude crooked and askew. I could not endure their unruly defiance, and so I would bitterly concede, stomp petulantly down the stairs and stand, silently seething, until my mother obliged me with the turn of her wrist.
For years, those plastic strawberries mocked me from inside the mirror, jutting out from opposite sides of my plait like unsolicited pink barnacles. They are seared into my memory as an early symbol of defeat, juvenile kryptonite disguised as ornamental fruit.
When I knocked on the door of exam room 22 earlier this year as a new and eager clerkship student, the only thoughts swimming in my head were a recitation of the asthma step-up algorithm, the fifteen-minute time limit my preceptor had awarded for my initial patient assessment, and the discomfort of business casual clothes in the heat of a New England summer. I was not thinking of defeat.
And yet, from across the room, the first detail I noticed about the little Black girl sitting in front of me was the set of pink strawberries that clung kindly to the top of her ponytail, perched quietly like a second set of curious eyes. Two friends on a bus. She regarded me with the starlight of her own gaze as the familiar query fled across my tongue: “What brings you into the clinic today?”
She paused before replying.
“I can’t breathe.”
Within the confines of exam room 22, she recites the last words that escaped from Eric Garner’s throat minutes before he died outside, surrounded by people, in the sticky heat of a New York summer.
When we breathe comfortably, our diaphragm does the work of respiration. In the absence of fear, trauma, or pathology, it alone is enough. It is not until we are gasping for more air that we ask other parts of our body for help. It is not until we are desperate that we summon neighboring muscles to help us bridge the distance between inhale and exhale. In medicine, we call it recruitment.
My teacher tells me to look closely and observe. “Watch her shoulders,” she says.
In front of me, the little girl heaves to open her chest higher to the sky.
For the rest of the week, all I can think about is the tragic poeticism of her shoulders and the burden that has been placed upon them. I think of the plastic strawberries, wonder if she learned that elusive twist of the wrist or if she too stood wordless and indignant in front of her mother. I think of the statistic that Black children are 500 percent more likely to die from their asthma than their white counterparts. I think of defeat.
The third year of medical school has been about making the facts we learn come to life, backing cognitive understanding with tangible experience. It has been a year of humanizing, of adding consequence. This year, the correct diagnosis no longer means choosing the right multiple-choice answer, adding an extra point to your score. It assigns illness, endows gravity, changes a life.
I put the accordion tube of an albuterol nebulizer in the mouth of a six-year-old Black girl who wears the familiar strawberry hair ornaments of my childhood. It helped her breathe. She reminded me of myself.
Just as she made the long-known racial disparities of pediatric asthma palpable, my patient experiences throughout the year have concretized the significance of the oft-quoted statistic: Every year, almost 100,000 Black men, women, and children die because their mortality rates do not equal their white equivalents.
There is a small room in the ward where I spent my inpatient medicine rotation that is reserved for family meetings. Tucked at the end of the hallway, it is sparsely adorned, boasts only neutral hues and an occasional plastic flower next to a box of tan tissues. Not infrequently, it is crowded with the distress of an entire family, else choking on the quiet misery of a single aching spouse. They wait for the doctor to arrive, clutching crumpled handkerchiefs and each other.
One day, I ask a woman waiting in the room if there is anything I can get her. She requests a coffee, straining her voice to insert an addendum. “Extra hot, if you can,” she whispers.
Extra hot. It is a phrase familiar to my tongue, one that I flung across coffee counters and to unsuspecting baristas when I was in middle school. Even before I was able to introduce my own name without mumbling, I could assert this demand with confidence.
“My mom likes her coffee extra hot.”
The Styrofoam squeaks as it passes from my hands to hers. Despite the eddy of asphalt grounds, the woman accepts. Sips. I think it helped her breathe.
She reminded me of my mother.
This year, on the third year of collective action by White Coats for Black Lives, I think of the moment I watched a surgeon release the last shred of tendon connecting a man’s leg to his body, that moment a 50-year-old man lost his second leg to diabetes. I recall the thoughtful countenance of a woman and the fungating breast cancer that ate a hole through her chest, purpling a twisted crater across her skin like a blackberry serpent. I remember the man whose eyes burst a stunning highlighter yellow as he roved back and forth across the hallway, remember when the hepatitis made it impossible for him to get out of bed alone, remember the day the sound of his trailing IV pole disappeared from my mornings altogether.
This year, on the third year of collective action by White Coats for Black Lives, I am left thinking about that little waiting room, and all the others like it, that have sucked in the grief of 100,000 needless deaths.
On the Labor and Delivery floor, as women concave their bodies, curl their spines in response to the waves of labor, they are told at the end of their push to take a deep breath, dive right back in. It is a command that seeks efficiency to maximize the capacity of progress – building momentum covers more ground than a concert of hiccupping pulses. Push, take a deep breath, dive right back in.
Again.
The tired grief of racial injustice continues to stretch across our bodies of knowledge and the bodies of our patients. The risk of failing to act is too vast and too violent to ignore. In the next years, if business continues as usual, if nothing changes and we remain the same, many more people will coat the inside of little waiting rooms with layers of misery, inoculating the neutral wall paint with their desolation. Many more people will suffer. More already have.
I do not mean to imply that we must live perpetually aflame, always inhabiting that fervid and singing breath of space that exists before fire catches a gas-lit stove. We owe it to ourselves to take a deep breath. I do believe that silence is never neutral. That we cannot sit in static passivity in the face of a great and ever-growing threat. As we are exposed to more injustice, bigotry, and grief, we must remember that these are not novel inequalities. We do not bear greater witness because racism is new, but because its violence has reached new visibility. It is the same dragon, with greater permission.
It does not serve us to shy away from the unpleasant evidence of inequity, to shift our gaze from the wreckage.
Push, take a deep breath, dive right back in.
Today, on the third year anniversary of collective action by White Coats for Black Lives, I hope the flame of your conviction is burning brighter, renewed by a sense of urgency and fervor. I hope that your action, whatever it is, is buoyed and emboldened by a professional responsibility to advocate for others, fight for healthy living, seek remedy to injustice. I hope you continue to push to turn pain into power, to create hope for others and yourself.
In the coffee shop near my home, a brown baby wound in powder-green fabric is parked next to my knee. She discards her breath in rhythm, steeps her cheek in a slender plot of drool.
I watch her shoulders.
I think of waiting rooms.
I take a deep breath,
Dive right back in.
Editor’s Note: This piece is part of a series of reflections by Jennifer Tsai. Her previous pieces appeared in on in-Training in 2015 and 2016.
White Coats for Black Lives is a medical student-run organization born out of the National White Coat Die-in demonstrations that took place on December 10, 2014. The organization seeks to safeguard the lives and well-being of patients through the elimination of racism. You can subscribe to its listserv for more information here.
Protect Our Patients is a grassroots campaign of over 4,800 future health care professionals who oppose repeal of the Affordable Care Act and, instead, demand a bipartisan effort to improve it. It engages in local and national legislative advocacy to remind Congress that for our patients, this is an issue of life and death. While it is led by medical students, the campaign welcomes all health professionals and trainees. You can join their email list by signing their petition, join their Facebook group for updates, and email them at protectourpatientscampaign@gmail.com to get connected with a student who’s leading efforts at your school, or to become a school leader.
Image source: White Coats 4 Black Lives Protest on 12/10/2014 at Harvard Medical School by Chidi Akusobi.
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!
