I was reminded also of the Tuskegee syphilis experiment, in which for forty years, beginning in 1932, the U.S. Public Health Service recruited 600 black men, 399 of them with syphilis, ostensibly to offer them treatment for “bad blood.” The men with syphilis were intentionally denied treatment so that the U.S. government could study the progression of the disease over the course of their lives and then autopsy them after they had died. Not only were the men in the study not informed of their disease or treated for it, but steps were taken to prevent them from receiving treatment elsewhere; for example, STD clinics were provided with a list of study enrollee names so that they would be refused treatment should they have sought it. The long-running study was not put to an end until 1972, when public pressure led to a federal investigation that deemed the Tuskegee syphilis experiment unethical.

I was reminded, too, of Dr. Albert Kligman’s experiments on imprisoned men in Philadelphia from the 1950s to the 1970s. Kligman biopsied, burned, and deformed the bodies of prison inmates to study the effects of hundreds of experimental drugs. Men were subjected to such atrocities as inoculation with herpes, gonorrhea, and various carcinogens. Kligman went on to become a millionaire after co-developing the popular acne medication Retin-A via his studies on inmates, while many of his victims were left with chronic medical conditions that irrevocably damaged their organ systems.

While significant advances have been made in areas of racial equality, we still have miles to go. That day in the ER, Dominic was evidence.

“Lauren,” I asked, “do you know what ‘treating’ this patient would entail? We would be commanding him to have an examination he doesn’t want. We would have to restrain him in some way—physically and/or chemically. We would then put a needle in him to draw blood. We would force him to have an X-ray. If the X-ray didn’t show anything, and it probably wouldn’t, then we would force him to have a CT. We would have subjected this man to two studies of radiation to pacify law enforcement, who have no legal right to force anything on his body. Who would be legally responsible if there were an adverse event from these refused medical interventions? Not to mention who would be legally responsible for the physical assault that a forced examination would entail? You don’t even know if the police are telling the truth. Why is any of this acceptable? Furthermore, even if he did swallow drugs, he is an adult who is competent and sober, and who is medically and legally allowed to make his own decisions. We can’t force parents of children to allow immunizations that prevent epidemics of devastating pediatric disease; we can’t force a hemorrhaging Jehovah’s Witness to accept a blood transfusion; we can’t force someone having a heart attack to go for a life-saving cardiac catheterization if he refuses it. You know all these things. We have all had these very cases and simply signed the patients out against medical advice. Why would this be different, even if there is a potential life threat?”

Lauren stared at me in silence, her posture perfect. She gently chewed her lower lip.

I heard the clerk call out, “Anyone waiting for Hospital Ethics?”

Lauren waved vigorously at the clerk to send the call to her phone.

I watched and waited while she was on the phone. She didn’t say much, just a series of “ohs” and “ahs.” Then: “I see . . . really? Okay, well, thank you for your help.”

I sat still at my computer, attempting to breathe in for a count of three and out for a count of six (or something like it), to dampen the disgust as my anger mounted—anger that my resident, my privileged, highly educated white female resident, had felt comfortable being so disrespectful as to dismiss my judgment on this matter; that she had felt she had the right to invoke what she deemed a higher authority: older white doctors who’d done the police’s bidding in the past or whatever voice happened to be on the other end of the line from Hospital Ethics.

I looked down at my hands on the keyboard, my slender, dark brown hands, dry from constant washing and dousing with alcohol-based sanitizer between patients. As I noted the contrast of my dark wrists extending from the cuffs of my stark white coat, I was reminded of which costumes in America, even in the twenty-first century, are seen as legitimate and which are not.

I recalled the conversation with my department chairman that morning. I had sunk uncomfortably into the plush leather couch across from him. Part of me awaited congratulations upon my promotion to a new hospital position. The other part, the part that felt weighty and awkward sitting three inches deep on this sofa, anticipated the speech he would inevitably make. It was the same speech he’d had to make several times before, to the other women and black physicians who left before I had arrived at Andrew Johnson Hospital:

“Michele,” he said. “You know every time I try to make a change at this institution, I just can’t. I’m always blocked. You didn’t get the position. I’m sorry to say it. You’re qualified. I just can’t ever seem to get a black person or woman promoted here. That’s why they always leave! I’m so sorry, Michele. They’ve decided that even though you were the only applicant, and a super-qualified one at that, they’re just going to leave the position open. I’m so sorry. I hope you’ll hang in here with me anyway.”

His words had hung sadly between us. He had spoken with the heavy heart of a longtime liberal white man who would shake my hand, smile, close the door behind me, and then sit back down in his comfortable, secure chair. His effort was complete. His part was done. I was the one left to live with the limitations of that bigotry. I was the one left to get up and fight for Dominic and myself.

America still has so many more strides to make. I am evidence.

Lauren turned to me. “Well, the hospital ethicist says that she reviewed this case and even spoke to Legal about it. Turns out it’s true that we can’t force any evaluation on this patient. Well, good to know. I’m gonna go see this little kid with a cold.” She closed her computer screen and headed over to Room 5.

I typed an extremely brief note on Mr. Thomas and swiveled in my chair to let Carl know the papers for his discharge were ready. Then I waved good-bye to Mr. Thomas; he gave me a barely perceptible nod and then continued to stare into space. Officer Quigley grabbed the discharge papers from Carl and mumbled something about everything being so ridiculous. The officer swept his arm across the room in the direction of Mr. Thomas. “Go ’head,” he said, in a manner that decisively conveyed his utter contempt for what had just unfolded.

What we had just experienced had offered an opportunity for all of us to recognize that America bears not just scars, but many layers of racial wounds, both chronic and acute. In order to move beyond them, we need to look at them for what they are, diagnose them, treat them, heal them, and then take care not to pick at the scabs, reopening the old wounds and creating new ones. I know how hard it is to stand and look at tortured and infected flesh. I know because it’s part of my job, and therefore something I cannot choose to look away from: soft skin splitting, macerated by brutality and time, half-eaten by maggots spilling out the sides, noxious gases spurting from the extremity of our trespasses. We need to stand face-to-face with it, to look and feel and smell and taste what we do, so we can choose exactly how we want to be in this world.

Just as we needed to look at the body of Emmett Till, the fourteen-year-old black boy who was murdered in 1955 by two white men who had accused him of flirting with a white woman while visiting relatives in Mississippi. They kidnapped the child, beat him, gouged out his eyes, shot him in the head, tied a cotton gin fan around his neck with barbed wire, and then threw his mutilated body into the Tallahatchie River. His mother insisted on an open casket at his funeral, so all of America could see how the nation treated its children, how we treated each other, how we were in this world.

Dominic Thomas brought me back to the reason I had chosen to become a physician: Being a healer is the powerful gift of bearing witness in an authentic way that allows us to mindfully choose who we are. In this way, there is another path.

I choose to witness the tortured flesh. I support it in my hands and cleanse the wounds as gently as I can. I apply intention and salve to heal. I write about these moments so we always remember the power of our actions, so we always remember that beneath the most superficial layer of our skin, we are all the same. In that sameness is our common entitlement to respect, our human entitlement to love.

I hit Send on the email I was writing, packed up my stainless-steel water bottle, coffee mug, and uneaten granola bar, and tucked them all back into my lunch bag. I wanted to leave the day behind me.

Once home, I shed my scrubs and then showered, rinsing off the shift. Dressed in a robe, I propped my feet up on the ottoman, and my shoulders floated down to settle into the sofa. My boss had probably received and responded to my resignation letter by now. There was comfort in knowing that this was the end of the road here. My chair would give me the time I needed to line up another job before I left.

And so, I started the process of beginning again. I knew that there must be another place where, as a doctor, I could both practice medicine and climb the administrative ladder. After all, I was here to ascend. I was here to help as many people as I could . . . somehow.

SIX

    Jeremiah: Cradle and All