I Don’t Want to Know More

When people ask me about my intern year, I have a few seconds to pick my response. Sometimes, I buy a little time by pretending to ponder deeply. But really, I’m just thinking about which version to choose. Should I choose the comfortable answer? “It’s tiring, but I’m learning a lot.” Then, we would discuss the long work hours or the transition from a student making observations to a doctor signing orders. Or, should I choose the real answer? “Actually, what makes intern year so tough is being a Black woman in medicine and learning more and more about the systemic issues of racism against people who look like me.” Then, I would mention how difficult it is to focus on work after my physician father and autistic brother are stopped by the police for the hundredth time, in our own neighborhood. I would tell them how sad I felt during my neurology rotation, because it made me remember my uncle, who had a brain aneurysm, and how he was neglected in his long-term care facility before passing away. But, if I choose this answer, nine times out of ten, that same person who inquired about my intern year will become silent. That wasn’t the answer they were prepared for, and they have no advice. So, most of the time, I go with the vague, status quo answer of “I’m learning so much.” And I am.

I am learning how to diagnose appendicitis, as I research how Black and Latinx children, when compared to their White counterparts, are systematically under-treated for their pain. I am learning how to treat young children with toxic lead levels, likely to affect their cognition and development, as I explore how environmental racism has intentionally placed African Americans in places with higher lead content with a housing system that barely holds landlords accountable. Most importantly, I am learning that I know more than many of my colleagues about the racial inequities plaguing the medical system. I don’t want to know more.

As the new intern on rounds, I find ways to bring up systemic racism in the medical system, but I have to be calculated. I have to be careful. Will this attending give me a bad evaluation or make my days harder because I brought up racism? It wouldn’t be the first time. After I bring up a relevant clinical topic affected by racism, I may receive an awkward thanks or even a smile, but then, we move on. Where is the quizzing on the ins and outs of medical inequities, like we are quizzed on the diagnostic criteria of Kawasaki Disease? How can we give patient-centered care, if we aren’t educated on an issue which our patients are at the center of?

I want my attendings to quiz me on the pathophysiology of a genetic disease seen in less than 1% of the population. I also want them to teach me about racism in the medical system which affects more than 30% of the population. I want my senior residents to take time during rounds to break down the biological mechanisms behind each medication we prescribe. I also want them to teach how medical experimentation has led to low levels of trust and adherence in minority patients. And on a personal level, I want to be sure that if I were lying on a hospital bed about to give birth, that my colleagues would protect me, taking into account the rising rate of Black women dying from preventable childbirth-related illnesses due to racism and medical neglect. But, how can they do this if they don’t even know about these inequities?

Sometimes, public health experts are invited to noon conference to educate us about disparities, like how Black women breastfeed less than White women, due to lack of education and poverty. I hang on their every word, waiting for the part where they explain how formula companies systematically targeted Black women and experimented on Black children. I expect them to explain how slave-owners robbed Black women of the right to breastfeed their own children, and how even today, most mainstream advertisements lack positive images of Black women breastfeeding. But that information, that essential historical context, doesn’t come. Instead, the same narrative is circulated, the same plethora of ways in which they are helping poor, Black women breastfeed. I raised my hand, asking “How are your breastfeeding initiatives helping to rectify institutionalized racism today?” They frowned, crinkling their forehead in confusion, and replied, “I don’t know about that.” At that moment, I realized that I actually knew more. At that moment I realized, I don’t want to know more.