His white shirt, made brighter still by the contrast of his chocolate skin, quivered with every shallow exhale. His dark jeans were clean and fit perfectly, as if he had just been wearing them on a Diesel runway. His white trainers weren’t new, but they were certainly well cared for—bright, clean, polished. He couldn’t have been more than five foot nine and looked thin and frail under his fashionable attire.

The four officers who brought him in seemed like overkill—like rolling in military tanks to secure a small-town demonstration. At the same time, I can’t claim with absolute certainty that the show of force wasn’t indicated: I’ve seen a 125-pound man on PCP evince Herculean strength that required everyone in the emergency department to subdue him with injectable tranquilizers and physical restraints. I always felt bad watching a patient being wrestled to the floor, knowing that he could be injured, knowing that, heaven forbid, he could be killed, even though we were doing it for his protection and ours. Even when everyone has the best of intentions, things can go terribly wrong. Yes, the patient had chosen to take the PCP, necessitating that the authorities be called and he be brought to the ER, thereby involving us in the danger of his personal decisions. Although, in so many ways, we in the ER pay the price for a patient’s choices, it never feels okay when there is a complication. Because the stakes are so high, the moment we decide we have to go hands-on, the critical action is always contained in the question before: Is this truly necessary?

“You’re gonna have to make him do it,” one police officer said to Carl. “He has to be examined, so you’re just gonna have to make him comply.”

I shifted my chair to keep one ear and one eye on the commotion, eavesdropping as I clicked away at my computer. This section of the ER was circular, with the doctor’s station in the middle, so it was possible to keep an eye on most rooms. The situation didn’t appear to be defusing, so I knew I needed to wrap up my work and head to triage.

“What’s his name?” Carl asked.

“Dominic,” the same officer replied.

“Dominic, you’re gonna have to put on this gown and let us examine you,” Carl said firmly.

“I ain’t doin’ nuthin’. These cops are lying. I didn’t do nuthin’ and I don’t want to be examined. I don’t want to be here,” he exclaimed as drops of spittle flew from his mouth.

As if suddenly resigned, his face became a mask of calm, but that flying spittle told another story.

“Someone, please get the doctor,” an exasperated charge nurse entreated.

Hearing this, Lauren, the second-year resident who was my charge for that day, took five hurried steps over to the melee. Lauren’s steps were always hurried and overconfident. She was pale white, of average height, with a narrow nose and a frame as slender as her fine mousy blond hair, which fell limply in a taut ponytail at the nape of her neck. She would have been entirely nondescript if not for the salience of her habitual condescension. She, like me, had heard the drama unfold. I was the only attending physician on in my section and just wanted three precious minutes to finish up with the last five cases before delving into this quagmire.

I could practically hear Lauren put her hands on her hips as she asked, “What’s going on here? I’m Dr. Morgan. What seems to be the issue, officers? Carl?”

I took a deep breath, knowing that she would not be the one to resolve this situation. I just needed 170 more seconds to wrap up my work so I could smooth things over in triage. I also knew that I had to give Lauren a chance to at least attempt effective mediation. She was, after all, my trainee, and thus my obligation for the next nine hours, forty-seven minutes, and thirty-two seconds.

I took a deep breath for another reason: I wanted so badly, when I entered the triage area, to see black officers and a white prisoner, or at least one black officer and a nonblack prisoner—anything other than the stereotypical white cop/black prisoner scenario. But I had already surveyed the scene, so I already knew—I made myself take another breath—that in triage was the configuration of characters I least wanted to see.

We are not yet at a time in America when the attributed or perceived actions of a brown or black or queer or Muslim “wrongdoer” are considered singular. Instead, such accused are seen as emblematic of an entire demographic, one labeled guilty before charged. And yet, the overwhelming majority of spree killers from the most notable mass shootings in U.S. history are male and white. The crimes of each of these assailants are repeatedly viewed as individual acts indicative of one sad, tormented man’s mental state and not of his entire gender and certainly not of his race. This privilege of individual self-determination is purposefully not extended to all. Strangely but not coincidentally, these massacres do not lead to large-scale examinations of the state of “maleness” or “whiteness” in America—both topics that Americans most desperately need to examine.

It could not be delayed any longer. I stood up and removed my gray fleece and put on my long white coat. At that time in my career, I always had my white coat with me. In truth, I used it more to hold a collection of medical references and my favorite pen light, which had pupil measurements on its side, than to show everyone that I was a doctor. In fact, I almost never wore it. I found it cumbersome to run around an ER wearing a long coat with full pockets. And indeed, it became a liability in the department: just another item I had to protect from blood, vomit, and bedbugs. But apart from what I could stash in its pockets, there were times when it was a useful costume. Sometimes I had to explain to a family member that her courageous mother had just passed away, or ask another if his father’s end-of-life wishes included cardiopulmonary resuscitation. The coat was my garment of choice for such conversations. It was a uniform that signaled expertise, authority, confidence. And now here was another scenario in which I had found it came in handy.

As I approached, Lauren was looking directly at the patient and saying, “Sir, you are going to have to do what we say. You did something that is dangerous and life threatening. Now you are under arrest. You must get in this gown, and then we will examine you.” No invitation, no question. Simply her interpretation of the events and a directive to comply.

No one moved.

Suited up, I approached the stalemate. I looked at the patient’s face. He was turned away, looking at nothing in the far corner of the room. His chin was tilted upward, his jaw tight, his brow glistening with the first signs of perspiration. His breathing was rapid and shallow.

I clasped my hands in front of my chest. “Hello, sir,” I said softly. He lowered his head to look at me. I was anywhere from twelve to four inches shorter than everyone else in the area. He and I were at least ten shades darker than everyone else in the triage room. “Sir, what’s your name?”

His jaw loosened just enough for him to say, “Dominic.”

“Yes. And your last name?” I asked.

“Thomas. Dominic Thomas.”

“Hello, Mr. Thomas. I’m Dr. Harper. I’m the doctor in charge here, so I just have to ask you a couple questions. I’m sure they’re the same ones everyone else has asked you. Please just bear with me. Can I first ask you why you’re in the emergency department today?”

“I don’t know. I didn’t do nuthin’,” he said, his voice rising. I saw his neck and shoulders begin to tense and his arms extend behind him. Nearly shouting, he continued, “They arrested me and brought me here for nuthin’.”

Officer Quigley, one of the four large white officers standing around the patient, spoke up. “Dominic here is under arrest for drugs. We raided the house and saw him swallow bags of drugs when he was trying to flee the scene. That’s why he’s here. We need you to examine him and get the bags out.”

Turning back to Dominic, I asked, “Mr. Thomas, did you swallow bags of drugs?”

He sucked his teeth and then replied, “No! They don’t know what they talkin’ ’bout!”

I looked back at the officer who’d spoken. He rolled his eyes and looked away.

“Mr. Thomas, of course I have to make sure you understand that if you or anyone swallowed bags of drugs, it is really dangerous. The bags could cause a blockage in your bowels. Even worse, they could leak and cause all sorts of things like heart attack, an inability to breathe, pain, and even death.”

“I got it, miss, but I didn’t do it, so it’s not an issue.”

“Okay, can I just ask you a couple more questions? It’ll be fast.”

“Yeah.”

“Do you have any medical problems?”

“No.”

“Do you take any medications?”

“No.”

“Are you allergic to anything?”

“No.”

“Any surgeries?”

“No.”

“Any alcohol or drugs today?”

“No.”

“And my last question. Mr. Thomas, would you like us to examine you today?”

“No. I wanna get outta here.”

“Okay, then we will discharge you.”

At this, the officers bristled. Officer Quigley exclaimed, “We brought him here for an examination. You have to examine him. That’s the procedure.”