Before I came to Cooper, I spent a year working as a family physician in a community health center in Washington, DC. Because I was a fellow and would only be there a year, the plan was that I wouldn't be building my own patient panel, but rather providing "walk-in" care. But even in my urgent care role, I started to see some familiar faces who preferred to get their primary care in our same-day clinic. Without trying, I had started to develop my own little patient panel.

My fellowship year passed by in a flash. It felt like one day I was triple-checking the very first prescriptions I had written as an attending, and the next I was saying goodbye to my unintentional continuity care patients. My last few days in clinic were more devastating than I had imagined. Visit after visit, I had to tell my patients I was leaving, and visit after visit, I felt like I was letting them down.

"Why do you white doctors always leave?" more than one patient asked. They had a point. Most of the doctors there were young white women, drawn by the idealism of caring for vulnerable patients and the promise of debt forgiveness on their medical school loans. But even in my short year there, I saw doctors depart. They were burned out by trying to provide meaningful primary care to 30 patients a day, unsettled by the substandard care our patients of color had received throughout their lives, so overwhelmed by the needs of their patients they had no time or energy to take care of themselves.

I had good reason to leave, of course. My fellowship was ending, and I had longstanding plans to move back to Philadelphia. But I knew I was participating in a health care system that was systematically racist. Our patients were mostly people of color, publicly insured or uninsured, and many of the academic health systems and private practice physicians in DC wouldn't see them. So they came to us. My colleagues were smart and caring, but the system wasn't designed to work for our patients: 10-minute appointments, fractured care, limited tools to address the social determinants of health. And as I said goodbye to my patients, entire clinic afternoons where I disappointed patient after patient with the news that I was leaving, I realized that I, too, played a role.

As the editor of the Center for Humanism newsletter and a member of our executive committee, it is with both pride and sadness that I introduce our Summer/Fall 2020 issue. In partnership with the Office of Diversity and Community Affairs, we have solicited a wide range of moving, frustrating, inspiring, enraging, and hopeful stories about racism and anti-racism from Cooper and CMSRU. This work was spurred by nationwide protests in support of the Black Lives Matter movement as well as reflections from within our own community about how to combat racism. We hope that these stories spark change within you and within our community.

This is the beginning of a conversation, not the end. Thank you to our authors for their thoughtfulness and vulnerability.

Warmly,

Mara Gordon, MD

Assistant Professor of Family Medicine

Associate Professor of Medicine

Breathing:

I was probably 10 or 11 years old. I was in Jamaica with our family, running and playing with several of my cousins. Somehow we all ended entangled in a pile on the ground, with several of our group landing on top of my cousin Lilly. I rolled away, laughing, until I saw her face: tears running, nose running, and panic in her eyes. She stared directly at me. Her arms were pinned beneath her, and something was wrong. I noticed her straining to pull air into her lungs. I started screaming at my cousins: "Get up! Get off! She can’t breathe! Help her!" I had to lie down until my panic subsided. Lilly came into my room, and held my hand.

Blink:

It was my first week on my Internal Medicine rotation as a third year medical student in Boston. One of the patients assigned to me was Mary, and I checked on her often. One afternoon, I was sitting at her bedside, talking, when her smile faded; she stared at me, then slumped, eyes still open. I stared back for 4 or 5 seconds, holding my own breath, and noticed that her lips had started to turn blue. I jumped up, knocked over the chair, and ran out of her room, yelling for help: She’s not breathing! She was just talking to me and now she’s not breathing!" A nearby resident fixed me with a stare, peppering me with questions about Mary’s clinical history, but I was shaking and could not catch my breath or organize my thoughts to answer. The floor nurse stepped up next to me, grabbed my hand, squeezed once, and started calmly relaying the patient’s age, status, and medications. I was wracked with mortification at my public and private inadequacies; the implications replaying in my mind. I had seen her last breath. I was the last person she had seen. I was not able to help her. I hadn’t known what to do.

Blink:

I was in my basic life support training class. We were practicing the Heimlich maneuver. The instructor "set the scene," and described the sudden onset of silence, bulging eyes, hands to the throat. He intoned, "The most common problem is that the rescuer does not generate enough pressure to compress the diaphragm to dislodge the object impeding air flow." As part of the simulation, he asked the class to shout and yell, "She can’t breathe, she can’t breathe!" at the rescuer. It was my turn; as my peers shouted at me, I had flashbacks to Lilly and Mary, and my heart started pounding. I grasped the mannikin and used the thrust we had just learned with so much force that the object flew out of her mouth, but, her head also flew off the rubber body. There was shocked silence for a few beats, then snorts and laughter. The instructor kept an especially close eye on me throughout the rest of the class. That was ok. I did what I had to do.

Blink:

I am now a third year resident in Internal Medicine. Summoned to the bedside of a man who is deteriorating clinically, I see a medical student, frozen, wide-eyed, standing off to the side. As I listen to all the information coming at me, I also hear him stammering, "I was just talking to him an hour ago." I reach toward the student and motion him closer to listen and be part of the team. I take the hand of the patient. In a voice pitched to claim authority as team leader, and yet purposefully calm and steady, I order medication, ask the team to reposition him, scan to monitors displaying his pulse, respiratory rate, and oximeter readings from the monitors, note his accessory muscle use, the level of his neck veins, diaphoresis and the look of panic in his eyes. We stare at each other. The emotional space contracts to just the two of us, doctor and patient, which is what I want. I introduce myself and I squeeze his hand and tell him that I know that he is having trouble breathing. I tell him that we are going to help him. I know exactly what to do.

Blink:

I was on a bus from NYC back to Boston, after a rare weekend off. We left Port Authority, and were rumbling through the Bronx, when I pick up faint sounds of wheezing many rows forward. I focused my attention, and sat up in my seat. I saw several people gathered near the front, as the bus pulled over to the side of the road. "Oh geez," I thought, something bad was happening. I made my way to the front. A young woman was fidgeting near the front of the bus. She had significant expiratory wheezing which was worsening. My heart rate picked up as I did a mental inventory of what I had at my disposal to help her -– not much. I approached and announced that I was a physician; her panic-filled eyes locked on mine. The emotional space contracted. She told me that she had asthma, and did not have her inhaler. I used my own elastic hair tie to pull her heavy hair back, for comfort. While waiting for the police and the ambulance to arrive, her breathing deteriorated. The patient was trundled onto a stretcher in a seated position, an IV, nebulizer, oxygen were started, but she tightened her grip on my hand, still staring into my eyes, as if I was personally coaching every tortured breath. "Come on in, doc," the EMT pleaded."We gotta take off and she’s calmer with her holding your hand". The two police officers were very friendly and offered to take me to back to Port Authority after the hospital so I could catch another bus. I knew what I should do. I grabbed my wallet and jumped in.

Blink:

Later, I found myself driving into NYC in the back of a police cruiser. The officers had to check in on arrival in a different precinct, so took me into the station with them. I walked between the two men up to a raised platform where the desk captain was writing something down. He looked up and stared at me as I approached. What he saw was clearly reflected in his expression: a young black woman with long crazy curly hair (I had given my hair tie away), dressed casually, with dirt and mud stained knees (from kneeling on a bus floor then at the side of a highway), with no bag or luggage, walking in between two policemen. He glared at me and without looking at my escorts said "Where did you pick this one up? Does she speak English?" Everything changed in a heartbeat. I no longer felt safe. I no longer felt powerful. I wanted to run away from him. I held my breath. I began trembling. I wanted to say something so that he would look more closely at me. I was a physician, completing Fellowships in Genetics and Molecular Immunology at Harvard, thank you very much. I spoke perfect English. I was standing there because I responded to the distress of a patient. But, in that place, at that time, none of that mattered. He had perfected a stare of authority and dominance, and he was using it effectively. I felt that I was in danger. I did not know what was safe to do. I put on a neutral face. I kept my body still. I concentrated on my breathing.

Blink:

Last week: I sat in my Cancer Center office after a busy oncology clinic, staring in disbelief at a picture on my computer. I checked a news site, and froze, staring at a still shot that captured the face of a man in distress. I felt that we were staring at each other. There is another man kneeling on his neck. I clicked on the video link. A few minutes later, I sat back, shaking, taking shallow breaths, feeling so alone. My world shrank to just the face of this man, his labored breathing, his rasping words. He couldn’t breathe. I instinctively reached toward the screen to touch him. I wanted to flick that weight, that police officer off him. I wanted to scream at all of them to let him sit up. I wanted to give him oxygen, to project calm and comfort, to stay with him no matter what. I wanted to tell him in a calm voice of authority that I was there and that I would help him. I wanted to let him know and feel that I knew exactly what to do.

Instead, frozen in time and space, I watched a Black man suffer and die beneath the knee of a white man employed to protect him, not to kill him. How many people have watched George Floyd die?

So: here I am. Here we all are. I am a Black woman and mother of a young man who loves to engage in debate, and a young woman who speaks her mind at all times with unvarnished honesty and sometimes unvarnished language. They are at risk. Blackness is a risk factor. If you look like me or look like my children you have very little room for error. Even if you are privileged –- and our family is -– we are still at risk. It becomes a parental responsibility to counsel, teach, and sometimes beg these strong, capable persons to swallow their pride and their instincts and focus on survival, which can depend on where they are, who they are with, what they may or may not have done, and on the decisions of strangers. We beg them, should they find themselves in certain situations, to postpone the fight against racism, and to find another day, another hour, another forum, which constitutes a less dangerous space. To keep their bodies still. To concentrate on their breathing.

I am a Black female physician deeply attuned to the dignity and comfort of persons whose health is threatened. At all levels of our nation, state, community and health care system, we lack enough of the allies and resources that can consistently sustain a life of safety and health for underprivileged persons. I have watched disparities unfold as I read through the histories of my minority cancer patients, my minority patients with alcohol or opioid use disorders, my patients who do not speak English, who have no money, who cannot read, who have no transportation, who have no home. I try to do my best, every day. I have learned to make painful compromises.

That night, sitting in my office, I had to admit to myself that all of the years of training to save lives, comfort the person with illness while treating the illness, to navigate the competing priorities, to flow around the barriers beyond my immediate control -- that is far from enough. Racism threatens the life and steals the breath of everyone it touches.

I have been reflecting on a poem written one hundred years ago:

Why is this age worse than earlier ages?

In a stupor of grief and dread

have we not fingered the foulest wounds

and left them unhealed by our hands?

Anna Akhmatova, 1919

Associate Professor of Obstetrics and Gynecology

Associate Dean of Diversity and Community Affairs

It’s July 18th. A week ago, my youngest child graduated from high school. I’m sitting in the back seat of his new Volkswagen Tiguan as he prepares to drive me and his dad to Philadelphia. Although, he has been driving for over a year (even working as a delivery driver for a local restaurant), it will be his first time leaving New Jersey and his first time driving over a bridge. I’ll admit that I am a bit nervous but he is visibly excited: excited that we agreed to let him drive us, excited that he is in his own car (one that he earned for having a great school year), and excited just to get out of the house in the midst of the ongoing pandemic.

We pull out of our development and we notice that he has a wood cross draping from the rear view mirror. I instinctively mention that he might get pulled over by the police for a having a view obstruction. Then, almost in unison, my husband and I begin to recite “the talk."

It’s the talk that we’ve given many times over, to him and to his two brothers before him. It’s the talk that many Black parents have with their children. It’s the talk that begins like this: “You know what to do if you get pulled over by the police, right?”

And even if there is a nod in the affirmative, or a “Yes mom, I know," the instructions are given again anyway, just to drill it in. Just to keep him safe.

We tell him, “Keep your hands on the driving wheel at 2 and 10 o’clock and don’t move them. Look straight ahead, and don’t ask any questions”.

It’s a reality that cuts me to the core. It’s a reality that the majority of my colleagues do not have to think about because they are not raising Black boys. Now sitting in the back seat, I feel anger and frustration erupting, but I also feel guilt: guilt for raining on his parade, for interrupting his excitement to rant about things are not in his control, for forcing him to bear the cross that is not his to bear.

I stop talking and let him enjoy the ride. But in my silence, I secretly worry about what quick judgement might be made if he gets pulled over in this new vehicle while riding alone.

Later in the evening, I walk into my son’s room to say good night. He is at his computer with his headset on, talking in an animated voice as he directs fellow gaming participants into their positions. He is a personable, confident, and smart young man. I watch for awhile in amazement as he changes his voice to take on different gaming characters, often speaking in different languages, which he taught himself. I look around his room and see the scattered evidence of his many high school accomplishments: college acceptance letters, certificates from track and the debate team, pictures of him in lead roles on the theater stage, and a judge’s gavel awarded to him for best delegate at the Yale Model Congress. My feelings of guilt return as I think, “What a great kid. Why, in the year 2020, do I still have to tell my son -- the great debater -- to be silent?" I think about the implications of taking away his voice to insure his survival. It is shameful.

I don’t want my son to just survive. I want him to thrive. I will silence him no longer.

Professor of Obstetrics and Gynecology

Details have been changed.

Many minority individuals have experienced, over the years, an encounter, which can only be classified as racially motivated. I am sharing one of many such encounters.

Many years ago, Monica, a high school student, had a meeting with her counselor to discuss the college application process. Monica was 17 years old, a basketball phenomenon, had made all-state status two years in a row. She was constantly in the local newspapers –- almost every week -– in the sports pages.

During her meeting with her counselor, she was told that she should not apply to a four-year college, but rather to a community college for two years to better her grades, and then transfer to a four-year college. She was surprised at this recommendation. After she informed her parents, an uncle was asked to set up a meeting with Monica and her counselor. The counselor reiterated the same recommendations and added that, although Monica is a basketball star, her academic credentials were not strong enough for a four-year college at that time. She was advised to apply to a community college for 2 years to improve her grades then transfer to a 4 year college.

Her uncle asked the counselor to review Monica’s grades and let him know where Monica needs to improve. Upon the review, the room went silent. The counselor excused herself, left the room for approximately 20-30 minutes, only to return with the Vice Principal, who immediately started to apologize for the situation.

After further discussions with the basketball coach, this recommendation did not happen with any of the other senior players who were white. Monica had better grades than all of them.

The irony of this situation is that Monica was accepted into many four-year colleges. She majored in Engineering, and today has a Master’s Degree in Computer Science Engineering.

Thus, one must always strive to treat all people equally; not by what they do in their extracurricular activities, sports they play in or their race, but by their overall performance in all they do including their character and credentials as an individual.

Associate Professor of Medicine

Details have been changed to protect patient privacy.

Mrs. P, a 90 year old white woman who suffered from vascular dementia, was admitted to a nursing home where the direct caregivers were predominantly women of color. I was her doctor.

As her dementia progressed, Mrs. P had lost some of the filters which had previously regulated the appropriateness of her comments. During my visit with Mrs. P she told me that she didn’t want to have those “Black women” taking care of her.

I asked her to explain, and she said that these women wouldn’t like her because she was white. She was afraid that they would be mean to her or hurt her. I told her that I had worked with these women for many years and that they were caring and very good at their jobs. Sometimes I will introduce new caregivers to a patient with dementia as “my friends” to help the patient feel safe among strangers.

I told Mrs. P that I was saddened that she was judging these women by their color. These efforts did not help. Mrs. P’s ability to retain new information was limited and it seemed that her fears were deep.

I thought about how sad it was that years ago she learned, or someone taught her, to be afraid of people of color. She had never grown past that. It also made me wonder how many people are walking around with these unfounded fears and may not voice them until their filters are removed by an illness that causes dementia. Before Mrs. P’s memory loss progressed to this point, was she aware of these feelings or were they buried deep in her subconscious?

We should all look closely within ourselves, use an honest filter, find out if we hold any guarded prejudices towards people of color and take responsibility for learning how to grow past them.

How can we help identify bias in ourselves, point out biases demonstrated by others, and do the work needed to help create a kinder, more respectful and accepting community? Unlike those with dementia, we can learn.

Details have been changed to protect patient privacy.

“Fair warning –- the wife might be angry when you call. You know how they can get.”

It was an offhand, seemingly harmless comment and I didn’t ask who exactly “they” were that the attending had referred to. It was the height of the coronavirus pandemic and I had volunteered to help make phone calls to families to keep them updated on their loved one’s hospital course.

I dialed the number in the chart and, sure enough, was met with a hello from a strong voice tinged with obvious anger. I explained that I was calling with updates on her husband who had been hospitalized with Covid-19.

When she heard about the improvements in his health, she responded with an enthusiastic, “Praise the Lord.” The anger had vanished, and I took the opportunity to apologize for everything that she must be going through.

Her voice cracked. She explained how she had been so frustrated because she had been calling the hospital for updates constantly, but no one had been getting back to her. She explained that not only was her husband hospitalized with Covid-19, her mother and brother were too. She was overwhelmed and she was scared.

This virus had hit the African American and other minority communities especially hard, highlighting the many cracks that exist in our healthcare system. While institutionalized racism requires a much bigger solution, we need to also work on the interpersonal and implicit biases that undoubtedly exist in all of us. It is not uncommon for such comments about a group of people to be made nonchalantly but they carry substantial consequences of perpetuating biases every time we fail to acknowledge them. I have heard such things not infrequently and often said by the kindest people I know - possibly because some biases have become so ingrained over time that they seem to exist as a fact rather than a point of view.

Over the past few months, it has become more apparent that being kind does not equate to being against racism. To be against racism, it is necessary that we all play an active role in changing our own viewpoints or that of others.

When I spoke with the attending again, I made sure he knew what a pleasant woman she was and what she was actually going through. He sympathized, “If I was in her place, I would be angry too.”

Assistant Professor of Medicine

Identifying details have been changed to protect patient privacy.

As an academic hospitalist, I recently took care of a young Black woman who came to the hospital for a life-threatening consequence of not taking prescribed medication for a chronic medical problem. Familiar to the hospitalist service with over ten hospitalizations in about six months for that same reason, she has a history of bipolar disorder for which she declines to take medication. On her previous hospitalization ten days prior, I and the multidisciplinary team at Cooper University Hospital attempted to do what we could for her. Although we were successful in obtaining additional resources for her, here she was again.

These situations can be frustrating for care providers. They occur with such shocking frequency that, many times, we, as health care workers, dismiss these patients as “frequent fliers.” The assumption is that all we can do has already been done. But it has not. Individually or collectively.

Looking beyond the quick snapshots of a patient's life seen during each hospitalization, the reality is that these patients — these “frequent fliers” — are disproportionately Black and have typically been failed by multiple societal systems. The pervasiveness of the failures in the societal care of Black Americans is astonishing.

Blacks are twice as likely to have no health insurance as compared to whites, one of many factors contributing to the fact that they have a higher rate of chronic medical conditions and mortality. Due to residential segregation, Blacks are more likely to live in more densely populated areas with less access to grocery stores and health care resources. As compared with non-Hispanic Whites, only about one third of Black Americans can access mental health services, such as prescription medications and outpatient treatment, when they need it, but they have higher rates of utilizing inpatient services. Adding to that, Black people with mental health conditions like schizophrenia and bipolar disorder are incarcerated at a higher rate than people of other races.

Racism in America is more than interpersonal: It is systemic and it threatens the lives of Black people. The language we use and the assumptions it carries can perpetuate and complement those racist systems.

Despite all of this, I remain optimistic. Not only do I deeply believe in the humanistic mission of medicine but I also have the good fortune of being surrounded by attending physicians, fellows, residents, students, nurses, social workers, therapists, and other colleagues who share my values and work every day to care for patients no matter their race, ethnicity, sex, gender, sexual orientation, or socioeconomic status.

These shared values can fuel our collaborative efforts across the entirety of the health care spectrum, with community groups, both public and private, to be effective and innovative in supporting the victims of systemic racism and in changing those broken systems. Black lives matter and we can make our society show it.

Details have been changed.

One day, X, a pleasant and earnest Black student, approached me after class. I was working as an instructor in a pipeline program at Rutgers University designed to help students of color pursue careers in health care. The student looked visibly troubled, so I gently asked him whether there was something on his mind.

After a sizable delay, X responded with a sharp response: “I feel so embarrassed.” With his emotions brewing and tears percolating in his eyes, I gently replied, “If you want to chat about it, I’m here for you.”

After what seemed to be some internal dialogue going through his head, he reluctantly revealed to me his issue. It was that on his first day shadowing a physician, a critical moment in the development in one's pursuit as a health care provider, he was informed by the physician that he looked “unprofessional” for sporting cornrows.

I was deeply mystified. I could not make sense of how a health care professional could have so much chutzpah and be so insensitive towards such a student in a such a vulnerable time. I did not have a coherent piece of advice, but except to simply provide whatever encouragement I could at that moment.

He went on to explain to me, while fighting back the inertia of his intense feelings, that he doesn’t wear this hairstyle because it’s fashionable; he wears it because it has a historical meaning to him, which provides reservoir of pride for his unique heritage. He noted that cornrows are not only a cultural tradition traced back thousand’s years ago but that cornrows were utilized as an escape map from slavery in the south. This new insight to me was bone-chilling. I had no clue about this myself. This moment for me was an inception point because I realized that people of color experience moments like this time and time again, and that this rust that accumulates in their minds from moments like these are hinged on people like the doctor and me making intentional efforts to understand and learn.

But with the resurgence of anti-racist activism this summer, I’m optimistic that we can grow together as healthcare workers and as a society as long as we are scanning the frontiers of the future and not the fountainheads of the past. Let us all attempt to not only make a concerted effort in understanding the nuances of how the body works but also the cultural and racial forces the body is under. Let us, Cooper, be a beacon of progress and forge a blueprint that other schools can adopt. Let us, Cooper, be on the cutting edge of the intersection of health, race, and community. Why? Because flourishing should be everyone’s birthright, and no one should in the shackles in the backdrop of society.

Co-CEOs of Cooper University Health Care

After months of a devastating pandemic that brought many of us together to battle an enemy that has killed tens of thousands of our fellow Americans, our nation, once again, is now gripped by a whirlwind of protest, frustration, and division over racial issues. It is not an understatement to say our nation is struggling with extraordinary challenges it has not faced in more than a century.

For many of us in the health care community, who are dedicated to serving others, the discord and division over race in our nation is particularly disheartening. Racism and hatred has no place in America and definitely will not be tolerated at Cooper University Health Care. We do, however, see this as an opportunity to move issues related to diversity, equity and inclusion forward in ways that have not been done in the past.

For years, Cooper employees have been at the forefront of treating the underserved in our society and working to understand and remove disparities in health care. Our mission to serve, to heal, and to educate is one that knows no discrimination.

As we look to the future, our team at Cooper can continue to lead and contribute to meaningful change here and in the communities we serve. While much of our work will be related to eliminating disparities in health care, our team’s expertise, commitment, and compassion may be useful in working to eliminate injustice more broadly.

In fact, our Board of Trustees is asking that we develop a formal structure to foster discussion and action to promote diversity and eliminate injustice and discrimination. Further, we want to ensure that everyone believes their ideas and contributions are heard and valued at Cooper. Research data overwhelmingly demonstrates the value generated to organizations that cultivate more diverse and inclusive teams.

To start this work, we are partnering with Dr. Jocelyn Mitchell-Williams, who is the Chief Diversity Officer at CMSRU. She has agreed to bring her expertise to Cooper in a similar capacity to assist us in this effort. We are also currently searching for a Cooper dyad partner to join Jocelyn in this very important work.

Additionally, we will be convening a Diversity, Equity and Inclusion Leadership Council made up of a broad group of Cooper team members empowered to develop strategies to further enhance our appreciation of diversity in our workplace environment and coordinate with the various groups that have already formed and are forming within the institution. Ultimately, we hope to cultivate a more compassionate and productive culture at Cooper where every employee, who is committed to our mission, understands they are valued, that they are accepted for who they are, and that they can grow and succeed here.

Want to get involved with the Center for Humanism? Do you have feedback on any of these essays and want to write a letter to the editor? Have ideas for our next edition?

Contact us at centerforhumanism@rowan.edu