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Urology Blues

By Ugo A. Ezenkwele, A&S '93, SPH '97 (MA), Med '98
Illustration by Michael Morgenstern

It began as a good day. The sun was just peeking over the buildings, and already I could feel the cool breeze of early fall as it made its way through the house. Just the day before, I had learned that I had received honors for my performance in my internal medicine clerkship, one of the most important and difficult clinical requirements in medical school. Months of hard work had finally paid off. My last major hurdle was the surgery clerkship; after that, the worst of medical school would be over. Just last month, I had obtained a degree in public health, ensuring that when I graduated from medical school I would become one of those professionals whose name is followed by an alphabet soup of letters. Imagine that! A status symbol of knowledge and hard work, those letters would entitle me to respect from my patients and colleagues.

My surgery clerkship was starting today. I got out of bed, ate a quick breakfast, and donned my short white coat, which displayed my lowly student status to all those in the field of medicine. I left the house, gave a high five to my buddy two doors down, and dashed to the corner to catch my bus. I was on my way.

At the hospital, as I sat among my fellow students waiting for our ambulatory surgery assignments, we talked anxiously about the long days and nights that we expected over the next couple of months. After what seemed like an eternity, the surgery course director arrived. I was paired up with another student, a fellow from Kansas, to work in the outpatient urology clinic.

Brad was tall and clean-cut, with blue eyes and blond hair — the quintessential all-American male. He had confided in me more than once that he had never known or interacted with any African Americans before he entered medical school. Brad came from a very small town where everyone knew one another. His high school and college experiences had taken place among people with similar backgrounds, interests, and phenotypic makeup. In fact, he often told the story of how, just before he left for medical school, his town had welcomed its first Asian, a Chinese-American woman from San Francisco. She had recently married his uncle and had become the yardstick by which all other Asians were measured. Brad recounted with glee how the townsfolk nicknamed her "Connie Chung," after the news personality, much to her chagrin.

Brad's father and grandfather were alumni of our medical school, and he was following a long family tradition. My father was an herbalist and a naturopath, a career he had learned from his father in Africa and then brought with him to the United States. He had a day job as an economist in order to sustain his family and practiced his brand of medicine on the side.

As I stood there thinking about my upcoming partnership with Brad, I wondered what it would be like to be paired with someone with whom I seemed to have nothing in common. I had noticed that with other medical students who were different from me, our only conversation would involve medicine or gossip — or perhaps nothing at all — and I worried that Brad and I would fall into that pattern. I knew that my best chance for doing well in surgery would involve having a partner whom I could trust. Success in medical school necessitated bonding with your classmates to carry you through the tough times.

On arriving at the urology clinic, Brad and I were told that we would shadow a urologist who was world-renowned for his work with the prostate gland. He was a faculty member in the urology department and was cited as one of the top urologists in the world. His list of patients — which included kings, princes, presidents, and CEOs — read like a Who's Who in America and Europe.

Meticulous and precise, Dr. Urology introduced us to his world. He instructed us on our professional appearance and decorum. Our white coats were to be dry-cleaned and starched, not machine- or hand-washed. Our pockets were to contain nothing more than a pen, and our identification badges were to be openly displayed on our lapels — left side only. We were to go into the rooms, introduce ourselves to the patients, obtain pertinent information using templates he had already devised, and present this material to him. He would then enter each room with us, talk to the patient, corroborate our information, grill us on our findings, test us to make sure we had done the necessary readings, and devise a plan of action.

Once we understood our roles, it was time to perform our duties. Two charts were waiting in the patient bins. I grabbed the first one, and my colleague took the other. We went our separate ways.

I entered the patient's room with a bit of apprehension. I wanted to make a good first impression on both my first urology patient and Dr. Urology. The patient was Caucasian, a short and heavyset man. I could see that he was sizing me up.

I smiled, stretched out my hand, and introduced myself. Arms folded, he glared at me, looked away, and cursed under his breath, "What the f — is this? Who the f— are you? I don't want to talk to you! I f—ing don't want any affirmative action working on me, let alone a nigger. What the hell is going on? I'm getting the f— out of here!" With that, he stormed past me through the door and down the hall, all the while swearing and mumbling something about the world being crazy to have let "niggers" into the medical field.

Years of education, more years of hard work, and numerous degrees had been rendered meaningless. I had done all the right things, volunteered at all the right places, passed all the right exams, represented my family well — and for what? I was floored. As I stood in the doorway, anger, frustration, guilt, and feelings of inadequacy and helplessness coursed through me in a matter of seconds. Years of education, more years of hard work, and numerous degrees had been rendered meaningless. I had done all the right things, volunteered at all the right places, passed all the right exams, represented my family well — and for what? To be called an "affirmative action" and a "nigger"? To have him suggest that I had no right to be here, merely because I'm African American? That there's no possible way any African American could have made it to medical school without affirmative action? That once in medical school all students don't have to fulfill the same requirements, no matter how they were admitted? I knew that he was wrong, but in the face of such blatant hostility, it was hard not to doubt myself just a little.

Then my emotions turned to anger. Why should I, simply because I'm a black man, have to defend myself to him, to myself, or to anyone else? Suddenly, I wanted to give that guy a piece of my mind. How dare he insult me! I was torn between wanting to educate him and knock him on his ass. I wanted him to know about all the accomplishments that people of color had managed to achieve in the face of adversity. I wanted him to know that I had to work twice as hard as my Caucasian classmates so that no one would ever judge me on the basis of my skin color. I wanted to say to him that I was better than he would ever be. I wanted to tell him how ignorant he was. I wanted to yell in his face that I wished he had prostate cancer.

I forced myself to calm down when I saw Dr. Urology coming down the hall toward me, followed by Brad. "What happened?" they asked. After I told them, Dr. Urology took me by the arm and steered me toward one of the empty patient rooms. He apologized for the patient and told me that I should not let this hinder me in any way. He assured me that he was not going to welcome that patient ever again into his office and that he would draft a letter to the dean of students about the entire experience. He apologized again, and I told him I was OK.

I wasn't really OK. Even though Dr. Urology had offered some comforting words, I was upset that the incident had happened at all. Now I felt even more different than I had before, and I didn't believe I could trust anyone enough to reveal my true feelings. I just wanted to make the whole thing go away. Brad remained quiet and avoided my eyes for the rest of the clinic. At the end of the day, as we walked back to the main medical campus, he confided to me that he was disgusted and upset. He knew about the black-white disparity in America, but he had never seen it firsthand. Back home, his peers and family members had joked about black people in a condescending manner, but he believed they were thinking about the "lazy" ones they had read about or seen on television who were sitting on their porches in the city doing nothing and accepting "free" handouts from the government. It hadn't occurred to him that someone could make similar judgments about me, a hard-working medical student at an elite medical school.

What I really wanted from Brad was automatic understanding and recognition of how I felt — a reaction I likely would have received from another person of color. But I realized that I could use this opportunity to educate Brad about what it's like to be a member of a minority group: to be followed by security guards while shopping in department stores; to be mistaken for an orderly instead of a doctor-in-training; to lack the same access to role models or mentors available to white students. As we talked that afternoon, Brad inadvertently educated me as well, because I had assumed that someone with his background would not be willing to learn about racial discrimination.

Despite what had happened earlier, I guess I could say that that day turned out well after all, but in a way I never would have anticipated. I think Brad and I each became more open to confronting our own racial stereotypes. I gained a new appreciation for Brad, a man with whom I at first believed I had nothing in common.

I still experience incidents of discrimination. Fortunately, because of what happened that day, I am now able to discuss them with my friends and colleagues. After these discussions, all the issues may not be resolved. But having a meaningful exchange of thoughts is an important step in the right direction.

Excerpted from What I Learned in Medical School: Personal Stories of Young Doctors, edited by Kevin M. Takakuwa, Nick Rubashkin, and Karen E. Herzig. Published by the University of California Press. ©2004 by the Regents of the University of California.

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