University of Toronto, Toronto, Canada (Spring 2016)
There is a fine line between prejudice and experience, and it is a line that grows all the more important for someone who is a doctor. In his memoir, Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine, Dr. Damon Tweedy ushers his readers through his years in the medical field as he evolves from a naive first-year medical student to an experienced practitioner and becomes increasingly aware of the socioeconomic and physiological implications of what it means to be black in America.
In Tweedy’s America, racism is abolished only in name and the intolerance of those in white hoods and robes are replaced with the subtler prejudices of those in white coats. In a book that is both accessible to its readers, yet informative about the realities of the medical system in America, Tweedy attempts to tackle the undeniable questions of race that exist in the field for an African-American doctor, but does so with enough examples of his own cowardice that the reader cannot help but feel a fondness for both the younger and older versions he depicts of himself.
Perhaps the most chilling and self-reflective aspects of the narrative are when Tweedy succumbs to the same prejudices imposed on many of his African-American patients by the other (white) doctors. In these instances, Tweedy begins to comprehend that racial disparities and prejudices are so deeply institutionalized and normalized in the medical world that even he, as an African-American doctor, is subject to their influence.
When Tweedy is a medical student, a young and heavily pregnant seventeen-year-old African-American girl named Leslie with complaints of painful vaginal bleeding is brought to the emergency room. Though Tweedy is supposed to care for Leslie, her refusal to answer questions about drug use, substance abuse, or even her own pregnancy frustrates the young medical student and eventually causes Tweedy’s supervisor to step in and interrogate the young girl by asking her “When is the last time you smoked crack?”
The interrogation leaves Tweedy feeling naked. Though the young doctor and younger patient are connected only by the common color of their skin, Tweedy cannot help but feel a certain vulnerability and exposure in the face of the supervisor’s actions. He cannot help but wonder if the patient’s race, her speech, or some combination had played a role in the supervisor’s decision to step in and ask the questions that he did.
When Leslie first came in, Tweedy held feelings of contempt and disapproval towards the young patient who, in his eyes, embodied the brunt of the prejudices and stereotypes of the black community. Likewise Carla, the on duty nurse, expressed similar scorn; she saw people like Leslie, crack-smoking pregnant women, as the true villains of society because of the effect of their addiction on their unborn babies. Just moments before delivering Leslie’s dead baby, jarred from having seen so many premature babies from drug-addicted mothers, Carla went as far as to callously ask the supervisor if she had talked to nineteen-year-old Leslie about having her tubes tied.
However, when the young patient miscarries her child, and her piercing cries echo throughout the hospital ward, both Tweedy and Carla’s hard judgment breaks down into an unquestionable compassion and human sympathy. Leslie is handed the corpse of her dead fetus, and as she uncontrollably sobs cries of apology again and again to the small body, Tweedy dolefully recalls that “raw pain consumed all the air in the room.”
This compassion only develops further as the staff learns about the young patient’s troubling background and upbringing: a heroin-addicted mother, a series of sexually abusive stepfathers, a dysfunctional foster home, and more recently, prostitution for money and drugs. “What chance did she have?” Tweedy thinks to himself. In one sense, Leslie has become yet another statistic—a mere one of the thousands whose childhoods had been struggle, a mere one of the thousands whose substance abuse had ruined their lives, and now a mere one of the thousands whose addictions had ruined another’s life.
But in another sense, Leslie’s childhood and therefore her seemingly inevitable adulthood, the image of Leslie as the brunt of what her surroundings predestined her to be, slowly begins to break down in the young doctor’s mind. It is understanding and empathy that re-shapes Leslie into an individual and— perhaps more importantly—a patient, to the young doctor. And it is this same empathy that Tweedy gradually sees as an essential component of the solution to the racial disparities and prejudices in the medical world.
In Black Man in a White Coat, as Tweedy develops from a naive medical student into an experienced practitioner and suffers each ambiguously racist encounter, the narrative slowly begins to expand beyond the confinements of a single individual’s life. By the its conclusion, Black Man in a White Coat has become a full-scale attempt to tackle the undeniable questions of race that exist in the medical field for an African-American doctor; it has become a plea for improvement, for action, for acknowledgement of the imperfect medical practice in America, and a humble proposal of a possible solution.
Tweedy often poses more questions than he answers. But it is important to understand that the intention in writing his memoir was not to provide a singular solution to the existing problems in the healthcare system, but rather to “contribute to a much needed public dialogue on improving the health of black people.” Tweedy humbly recognizes that he does not and cannot hold all the answers, but he does present what expertise he has to contribute to the discussions that he feels need to take place in the context of racial disparities present within the medical world.
In addition to the judgment Tweedy finds himself giving to others, he receives his own fair share, from both white and black patients. Most of the instances of racism that Tweedy experiences and witnesses are covert or perhaps too systematic to declare as obvious cases of racial prejudice (such as the encounter between his supervisor and Leslie). Others, however, are painfully straightforward. In one instance, a middle-aged white patient blatantly states to the hospital staff, “I don’t want a nigger doctor.” In another, a young black patient undermines Tweedy’s competence as a medical professor because Tweedy is an African-American. Both encounters, however, are gradually resolved. The respective patients eventually acknowledge and respect Tweedy as a doctor and as an individual. What brings both patients to this conclusion, and brings the memoir to its end, is what Tweedy sees as one of the fundamental solutions to racial prejudice in the medical system. In Tweedy’s prejudice towards Leslie and the prejudices he receives from his patients, he realizes that what is essential in eliminating racial inequality and socioeconomic disparity in the medical field is a personal and trusting connection between a patient and his doctor — and that is the humble suggestion that Tweedy concludes his book with. The key to coming closer to addressing the pressing issues at hand, according to Tweedy, appears to be empathy and a common humanness between doctor and patient.
Perhaps Tweedy’s humble suggestion is too simple. Or perhaps it is too idealistic and easier said than done. Or perhaps building a personal connection between patient and doctor can only do so much. But Dr. Tweedy, through his book, succeeds in ultimately accomplishing what it set forth to do: to “contribute to a much needed public dialogue on improving the health of black people.” And this, he does impeccably.
Tweedy, Damon. Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine. 1st ed. Picador, 2015.
Yeji Lee is a third-year English Literature student at the University of Toronto. Born in Seoul and raised between Canada and Korea, she is currently abroad in Paris on an exchange program at Sciences Po and will soon be returning to Canada for her final year.