COMMENTARY

'These Are Not Things I'm Getting Paid For'

Milton Little, MD, as told to Usha Lee McFarling

September 09, 2020

Being told the operating room has already been cleaned. Being questioned by patients about where you went to medical school. Being asked for ID every time you enter your own hospital. Being told you don't look like a doctor. In a series of conversations with Medscape, Black physicians talk about racism they've faced in their training and their clinical work, the change they'd like to see, and how they're coping during this period of both pandemic and racial upheaval.

Dr Milton Little (Cedars-Sinai Medical Center)

People often ask me whether I've ever experienced racism personally, as if racism is some theoretical thing in history books and on the news. I've had direct experiences, like grade school kids calling me the n-word, but it's the daily, small interactions that build up over time and drain me emotionally. I've treated patients who have swastika tattoos or confederate flag tattoos all over their bodies. I've had patients openly tell me they want a different surgeon or resident because I was Black. I've had so many patients mistake me for transportation in the hospital when I'm wearing scrubs that I no longer wear them unless I'm in the OR. I've had patients ask me if I'm good at breakdancing, just randomly out of nowhere. When that kind of thing happens in front of my white colleagues, it's often the first time they've experienced racism so up close and personal. Just the other day, a patient told me he remembered that I was his surgeon because I was the same color as his "chocolate" lab.

I wear a shirt and tie every day because I want people to know who I am when I walk into their room. It helps people understand: This person is not a resident, this person is not the orderly or the nurse's assistant. It's easier for me to wear the shirt and tie than to have to have that conversation repeatedly.

When I have patients who seem surprised or upset when I walk into the room, I never try to convince them or force them to have surgery with me. I don't want people second-guessing me because of the way I look or because of their own misconceptions. I had one patient, a young Asian guy, who said after his surgery, "When I first met you, I felt comfortable, but in the back of my mind were the things my parents had always said about Black people being less qualified or less smart. But now I'm glad I stayed with you." I guess I appreciate him feeling a connection with me so that he could say that, but the fact that these conversations are still happening today, with young people, shows racist feelings aren't reserved for old people.

After spending my first 10 years in public school, for high school I earned an academic scholarship to a boarding school in Rhode Island and moved there from LA. There, other students continuously asked if I was there on an athletic scholarship and what my life had been like "growing up in the ghetto." I ended up becoming student body vice president, became a three-sport varsity captain, and graduating cum laude. Despite that, and competitive SATs, the school's college counselor told me that I shouldn't apply to Harvard, Stanford, or other Ivy League schools because those schools were a reach. That's when my family started setting up my college visits. I did get into those "reach" schools and eventually chose to attend Stanford.

Thankfully, I grew up with a family who constantly reaffirmed my potential. My mother and two of my grandmothers were career teachers. My father raised money for non-profits. But my biggest influence was my grandfather, the first Black physician with his own medical practice in Ypsilanti, Michigan. He delivered most of the Black babies in town, until he was able to eventually deliver babies of all races. He got his master's in public health from the University of Michigan at a time when they would barely let him in the front door. In Ypsilanti, if you go to the car shop, the grocery store, the mall, you find people he treated everywhere.

When I interviewed for residency at the Hospital for Special Surgery in New York City, there were multiple Black residents in each class, there were Black chief residents, there were Black fellows, and there were Black attendings. The head of the residency interview committee was a Black man, Dr. Riley Williams, who was also the team doctor of the New Jersey Nets. The hospital, which is top ranked for orthopedics, made diversity a focus rather than an impediment. They chose people who were excellent regardless of their color. Many of my Black co-residents are now team doctors for professional teams, like the 76ers and the Lakers, accomplished surgeons and highly published researchers. The amount of diversity at that hospital was one of the reasons I ranked it so high.

My children are 8, 7, and 4 and they know so many of the names of people killed or hurt by the police: Tamir Rice, Philando Castile, Michael Brown, Breonna Taylor, Sandra Bland, George Floyd and now Jacob Blake. All of these things are on the news and all of these things are in the world and kids see these things. They ask thoughtful questions and we talk to them about it because my son has to know if he's pulled over by the police he should keep his hands on the dashboard, he should listen and follow all instructions, he should speak slowly and tell the officers what he's doing when he's reaching for his license and registration. He should get out of the car when they tell him to even if he doesn't have to. He should let them search the car even if he doesn't have to because if he says no, that is a sign of aggression, and if he shows a sign of aggression, he can be killed for something as simple as a broken taillight. He doesn't have the benefit of the doubt. So, we talk to them about it.

My kids understand Tamir Rice was a 12-year-old boy playing with a gun at a park and he was shot by a police officer who did not even have time to stop before he opened fire and shot this boy in the chest. For that reason, my children are not ever allowed to play with toy guns. Sometimes, my middle son can't sleep at night. He has nightmares about the police breaking through our door because they understand that the police broke into Breonna Taylor's home wrongfully and killed her while she was sleeping. They ask why did the officer not stop when George Floyd couldn't breathe? They ask why does this keep happening? And I don't have an answer because there is no answer.

This can be a heavy burden to carry each day. It is stressful and destroys your motivation. People of color built this country as unpaid labor, and then we fought for our freedom, and now we are still expected to keep fighting every day. I'm expected to be on diversity committees, I'm expected to do these interviews. These are not things I'm getting paid for. These are things that take up a lot of time, take up a lot of energy, and require the rehashing of a lot of painful and sad experiences. It takes a toll.

We really need people who are white, privileged, and who have never gone through these experiences to be on the front lines, because they get attention. We need institutions to hire the plethora of experts on diversity rather than placing the burden on their diverse employees. But we know we have to do this work because if we don't do it, it's either not going to get done, or someone is going to downplay the things that have to change. And so much has to change. There is no reason Black women should make so much less than everyone else in the workforce. There is no reason Black women should have a maternal fatality rate that is three times higher than that for white women. There is no reason only 1.4% of orthopedic surgeons should be Black.

In the end, I don't have all the answers, but I know I have to wake up and navigate this stuff every day and keep a shred of optimism because that's the only thing that helps me believe that my children will be safe in this world.

Milton T. Little, MD, 39, is an orthopedic surgeon and director of the orthopedic trauma fellowship program at Cedars-Sinai Medical Center in Los Angeles. He was born in Harlem and later moved to Los Angeles. He received his undergraduate degree from Stanford in 2003, his medical degree from the University of Michigan in 2008, and then went on to do his residency at the Hospital for Special Surgery in New York City and his fellowship at Harborview Medical Center in Seattle. He and his wife Erica are the parents of three young children.

Usha Lee McFarling is an American science reporter who has written for the Los Angeles Times, Boston Globe, STAT News, and the Knight Ridder Washington Bureau. In 2007, she won a Pulitzer Prize for Explanatory Reporting. Follow her on Profile @ushamcfarling.

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