Walter Scott and a Pediatrician’s Conscience

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The recent killing of Walter Scott was another brutal reminder of the home African-Americans wake to daily. Their America, is one where your father might not come home at night, because his brake light went out and that cost him his life. It’s a place where petty crimes are penalized by life sentences, doled out on the streets by the very men and women charged with their protection. But too often, they don’t find protection. And black men and boys are left lying there, without aid or comfort, in a pool of their own blood, for all to see the boundaries of permissible police conduct.

For there is no crime too small for which black fathers and sons may face imminent death. For some, death may merely be a traffic ticket away. And for others, no crime is even necessary. Simply disobeying social expectations, or committing crimes against the social order, can threaten an African-American’s life, if one encounters the wrong officer or wrong neighbor, wearing the wrong hoodie or playing with the wrong toy. For them, their public presence can be a justifiable cause for homicide and their assailant may not even face trial.

So as the death toll rises, the leading cause of death for black males aged 10-24 fails to shock anyone – it’s homicide. But you might be surprised to know that doctors are doing little to nothing about it.

In the wake of Sandy Hook, the response from physicians, and pediatricians in particular, was astounding. But as boys who could be my sons and men who could be my father, lie in the street, week after week, the medical profession is silent and I’m frankly appalled.

These deaths should weigh on every physician’s professional conscience. They rip into the very fabric of our degree and challenge the meaning of practices essential to modern medicine – harm reduction and disease prevention. If we, as a field, fail to even acknowledge the lives lost, let alone devise systematic interventions, at a certain point, we fail to honor the oath of our practice and to serve the core of our professional obligations.

Targeted police violence against African-Americans is a public health problem and it uniquely affects children. Yet to this date, there has been no public statement on behalf of the American Academy of Pediatrics, or any other professional medical association to my knowledge, recognizing the tragic deaths of African-American men and boys across this nation. So while my lone voice is hardly sufficient, I offer these words as a part of my professional responsibility to care for the lives of all my patients, big and small.

  • The toll police killings take on black families, including those not directly involved in the events of violence, matters and the chronic stress it generates may adversely affect family dynamics, community safety, and the mental and physical health of African-Americans of all ages.
  • Adolescents, both male and female, commonly participate in risk-taking behaviors as a part of their development as youth. Those same behaviors can have significant and lasting costs for African-Americans, as they may suffer higher rates of arrest, incarceration, and death.
  • Efforts should be taken on behalf of physicians caring for black families to discuss the toll police killings have on health. If there is concern for impending danger, appropriate referrals to local authorities and community organizations should be sought on behalf of the physician, nurse, or medical staff.
  • Preventative health screening guidelines for children and adults should include risks of gun violence, including police violence.
  • Training will be needed for physicians to appropriately discuss these concerns with families, screen youth for risk behaviors, and refer at-risk individuals to further services.
  • Funding for clinical interventions to address police killings should also support local organizations that work to decrease community violence.

Too many parents tuck their children into bed, only to worry that tomorrow, their curious 10-year-old may be the victim of police-related violence because the combination of a growth spurt and black skin threatened their life. Too many physicians either don’t know that, or don’t care. Because I’d have to imagine that if we knew and cared, we’d be doing something very different in medicine.

This is my plea for us to do something different. Silence is not okay. This is our responsibility, just as it is for all Americans to re-think what these deaths mean for our society. Because if this legacy of violence isn’t weighing on everyone’s conscience, we are all doing something wrong.

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Good Girl, Up Speak and Thinking In

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I have a confession.

It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.

As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise we are raising women to wear to navigate the complexities of race, gender, and politics in the classroom and the workplace.

So here goes…

I change my voice to make other people comfortable.

In general, I have a high-pitched voice. It’s genetic. My grandmother spoke in a higher register and I guess I’m following in her shrill footsteps. But my grandmother had style and when she squealed in laughter or sang the soprano out of a church hymn, it sounded like wind chimes in a summer breeze. Her piercing tone commanded authority and carried assurance. She was authentic and her voice was the instrument that ushered her power.

My voice may be naturally high, but when I’m the only African-American or woman at the table, or when I hold a particularly contentious opinion, I go EVEN higher. Instead of wielding the power of my pitch, I ritually sacrifice my self-expression somewhere in the back of my throat and barter my pride for the perceived benefits of social normalcy. I phonetically transform what I physically cannot change, I am an educated black woman with an opinion.

My sister calls this guise “good girl, up speak.” It is the rising tone of voice I enter to placate others. I summon the “good girl” voice as a part of a physical transformation I have grown accustomed to, first in the classroom and now in the workplace. At some point, I have, consciously or unconsciously, accepted the misogynist edict that women, and women of color in particular, are to be seen and not heard. And I have learned that edict from other women.

Careful experience has taught me that speaking assertively may make males, and white males in particular, uncomfortable. Why else would intelligent women, in the media, in my classroom, and in my profession, soften their voice almost to the pleasant vacancy of a child, to communicate their thoughts? We’ve all seen it. So rather than fully challenge my male colleagues to engage in the mental and social exercise of trying to understand what my black, female body is communicating, I too make my words, however cutting, fall softly on their ears, lest they be offended by both my point of view and my tone of voice.

It is not so much playing dumb as it is playing docile. But what’s the difference when you are trying to be heard? In Harvard Business Review, Deborah Tannen, a sociolinguistic researcher, wrote a piece called The Power of Talk: Who Gets Heard and Why. In it she says, “Language is a learned social behavior.” As such, it is infused with the power dynamics that are socialized into each of us as children; dynamics that communicate competence and confidence, and dynamics that can translate into stereotyped gender roles. According to her, “Language negotiates relationships” and the way you address people and how you are addressed, reveals an unspoken social order that defines how we understand each other and how we value each other.

Lately, much has been made of the sociopolitical posturing (“leaning in,” if you will) women must undertake to exercise their power and influence. Yet our greatest instrument of power is our authentic voice. Any time we silence that voice, we miss the opportunity to value other women. For example, by assuming “good girl, up speak,” I validate the antiquated social order that decrees women, and women of color in particular, must infantilize their voice to be heard. Each time I do this, I implicitly encourage women around me to adopt similar positions of subordination to express their feelings. In so doing, I am complicit in the creation and maintenance of the very systems that oppress women in leadership and suppress female thought.

So instead of “leaning in,” the real exercise women may need is “thinking in” or creating a space to re-evaluate how our patterns of behavior undermine our authentic voice and contribute to our disenfranchisement as a group. One of those patterns of behavior is how we speak, another is how we conceptualize our role as leaders. If we continue to define ourselves between a 2-dimensional chasm of “should” and “should not” quandaries that pit domestic aspirations against professional salience, women will always lose. This rigid dichotomy ignores the important and dynamic roles women can fulfill over their lifetime and the opportunity we carry, either in our wombs or our briefcases (or backpacks, as the case may be), to shape the world in which we live with our authentic presence and voice.

When we, as women, strip away the guise, we can be more “I am woman. Hear me roar.” and less “I am woman. Don’t call me bossy.” Instead of being afraid of words, let’s own them. Let’s speak with the authority that our education, experience, and the roles we fulfill, provide us, be that sister, mother, student, physician, or CEO.

New feminism is about women, work, and the will to be authentic. And future generations will rely on us to use the tools at our disposal – the vote, free speech, globalization, and growing numbers of college graduates – to dismantle the structures that demand we conform to misogynist inventions of who we are. For modern American women, we don’t have to be the “good girl” to be the boss. As Deborah Tannen says, “The way we speak is who we are and who we want to be.” Our influence spans the home, office, clinic, and classroom, and who we can be and what we can be is defined by how we use our voice to empower other each other. At its best then, feminism is a collective notion that lifts each of us, despite our color or creed, to live authentically.

Update: This post is also being featured on Kevin.MD. Click here to check it out!

The Way

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But somehow I wonder if

Despite their silent exterior

Away from the purview of others

In a darkness all their own

They endure the painful pruning of transition

Of transformation

Old is new

And new is you

And butterflies bleed too.

There are those among us who are treading on unmarked ground, fresh soil devoid of the comfort of patterned steps heralding the way. We are straying from tradition and daring to redefine the boundaries of our professions as we venture in new directions. It is not just that we don’t fit the mould, but that in some ways, we reject the idea of moulds all together.

For me, social justice medicine is the new direction. It is the practice of clinical medicine in a thoughtful way that creates and sustains health equity. It requires community engagement, civic participation, political advocacy, apt use of new media and technology, and interdisciplinary collaboration with local organizations and community leaders. It is essential to build a more just, equal, and free society and so far, it doesn’t really exist.

6 months ago, at the end of my pediatric residency, I took a position as a community pediatrician and have been eagerly piecing together a career in the practice of social justice medicine ever since. Sometimes, in moments of uncertainty, when my mind is quiet enough to admit my fears, I find myself in the throes of a great transition, worried I have no idea what I’m doing or where I’m going.

In medical school, I took a class called Let Your Life Speak. It was based on a vocational guide by the same title, and it helped medical students identify our gifts and consider potential careers. In the book, author Parker J. Palmer presents the idea of “way” or the path on which each of us walk toward our purpose. I’ve been looking for my “way” since college and as my blog header articulates, it is an ongoing journey. Recently, I found some clarity.

In any hierarchical assent, “way” seems to form in front of you, with each opportunity striding towards the next. But the truth is, that “way” was already there, worn by the feet of others, and ending at a predetermined destination. Sometimes paths are created as “way” closes behind you. When opportunity doesn’t knock, it quietly closes the door, making new, unseen paths available.

To stretch the confines of what it means to be a doctor, I have to stretch my understanding of how to get there. In doing so, it has become clear that “way” is not linear and does not have directionality. It is the iterative process of curiosity, experiment, discovery, and failure that builds the experiences necessary to create an unconventional career. Although the cyclical process of preparation, pruning, and readiness may be difficult, the product will be beautiful and uniquely yours.

But somehow I wonder if

Despite their silent exterior

Away from the purview of others

In a darkness all their own

They endure the painful pruning of transition

Of transformation

Old is new

And new is you

And butterflies bleed too.

Single Working Female

I have recently noticed a trend in my social circle and wonder if this is a broader phenomenon.

Single working women have increasingly fewer single working female friends.

After we finish our marathon of training in business, law, medicine, education, or whatever makes our hearts sing (or pays our hearts’ bills), single working women emerge simultaneously more educated and more isolated. And I’m not just talking about professional isolation where “good ole boy” traditions (or discriminatory favoritism) leave young women outside the complicated social dynamic of the workplace. I’m talking about looking up at the end of a long journey to meaningful employment and finding less and less women around to relate to (or to share your professional aspirations and watch movies in your pajamas on a Saturday night).

What happened to all my girlfriends? To the brilliant young women I studied and grew up alongside?

Well, they moved. And so did I.

I mean, it makes sense. Without the consideration of marriage or children, many of us move to our nation’s epicenters to start a budding career and social life. We bloom, finally stepping out of a truncated adolescence into the spoils education and employment offer (mostly stimulating conversation over moderately priced dinner and drinks). And more importantly, we change. Eager to finally contribute to the world, we are ready to embrace opportunities and without a reason not to (namely family constraints) we are doing just that; despite the consequence, which lately for me, has been more social isolation. Adept at multitasking in a world where social and professional responsibilities can overlap, we sometimes over-commit in the workplace to seem eager and approachable while under-committing in our personal lives to remain flexible and focused. We are walking the thin line Sheryl Sandburg encouraged us to lean across (where being ambitious can be confused for being a bitch, but by acknowledging the tight rope of gender politics in the work place we are freed to succeed, or something like that) and sometimes it is a lonely trek.

So what’s a girl to do? How can we stay connected despite the miles between us and how can we meet new wonderful women along the way?

Maybe we should start a friend exchange, where we share the amazing people who have made our life better with our sisters across the country, posting online profiles or something for women looking for other supportive gals. Or maybe it’s just early in my professional life (I’ve been working approximately 2 weeks now!) and now that I finally have time to be more social, I actually have to work at it a little bit. Maybe I am not trying hard enough and everyone else is somewhere having a great time without me. Or maybe I just miss all my amazing friends who moved away.

In other news, anybody up for dinner and a movie this week?