Dr. Jaspreet Loyal (Attending): Last year when I was covering the inpatient pediatric wards on a weekend, I asked one of the new interns if this was her “Black weekend.” It was my feeble attempt to empathize with her tough intern schedule. In the medical community, the term “Black weekend” is common phrase defined a five-day work week followed by a Saturday and Sunday shift. It has a very negative connotation. I recall the intern taking a deep breath as she gathered her thoughts to respond to my seemingly naïve yet deeply offensive and racist question. She said, “Dr. Loyal thank you for asking. I am in fact, working both days.” She sighed and there was a long pause. “I know you care a lot about residents and you will understand where I’m coming from. I just wanted to point out that using the word Black with the weekend associates the word Black with something very negative.” She courageously went on to give me the historical context of decades of injustice and racism towards members of the Black community. She shared how using that phrase was hurtful. She very respectfully suggested using alternative phrases and although embarrassed, I authentically thanked her for her courage in breaking the hierarchy to call out racism by an attending. We proceeded with rounds, but that very brief interaction opened my eyes to a deep-rooted unconscious bias that I, who considered myself an ally, had painfully never recognized before.
Dr. Jessica Malcolm (Resident): I first encountered the phrase “Black or white cloud” in medical school when I overheard residents using it to describe themselves. The term “Black cloud” is associated with the perceived experience of residents who believe they attract an unusually high number of patient admissions or difficult cases. While “white cloud” residents bear the opposite fate.1 During my training, it would always sting when well-intentioned clinicians would call me a “Black cloud” during my busier call days. For a long time, I struggled with vocalizing why. One day I was working a busy shift with Dr. Amanda Calhoun, who is my colleague and close friend. We overheard someone say, “you’re definitely a Black cloud.” I observed Dr. Calhoun kindly educate that individual about why that phrase was hurtful and racist. Later, Dr. Calhoun, Chris Elledge (her husband), and I sat together in a café and had a long discussion about the historical context of the phrase. Our conversation allowed me to reflect about why I, especially as Black physician, felt so much inner pain and turmoil whenever I heard that phrase being used.
Drs. Malcolm and Loyal: In nature, there is no such thing as a “Black cloud”. There are white appearing clouds on sunny days and gray appearing clouds on stormy ones. But that’s it. The same can be said about weekends of work. Why then do we use the phrases of “Black or white cloud” and “Black weekend” in medicine? It likely goes back to the racist foundation that the United States and medicine was initially built upon. Black people were perceived as being inferior to white people and, during the period of slavery, as property. Dr. James Marion Sims, who is sometimes referred to as the father of modern obstetrics and gynecology, often operated on Black slave women (including Lucy Sims, Anarcha, and Betsey) without anesthesia because he believed that they did not feel as much pain as white women despite their cries and screams.2,3 There are hundreds of years and many other accounts of the abuse, exploitation, and unethical medical studies performed on non-consenting Black people because they were perceived as different and inferior to white.3-5 This Black versus white ideology, made its way into medical jargon where Black things were labeled as bad and white labeled as good. This way of thinking is racist. Thankfully, we are making strides to remove the distorted way of thinking of the past. Our language should reflect that change.
It takes courage to call out a colleague or a member of the medical staff when you see or hear an offensive phrase that has been accepted in the medical community for decades. This is even harder when the offender is higher in the chain of command, such as an attending. We can only make real change if we say something when it happens to us or as an ally in the moment. There are many tools and tip sheets available to help with scripting, such as Interrupting Bias: Calling Out vs Calling In.6 One way to begin the conversation, as seen by the resident in our first example, is to tell the person you are educating that you assumed they had good intentions, despite their harmful impact. Another way to trigger awareness is through curiosity or even by sharing an example of when you personally fumbled and committed a veiled aggression without realizing it. Sometimes it takes seeing someone else speaking up to say something, like in our second example, and to empower an individual to not suffer in silence any longer.
A famous Chinese proverb states, “a journey of a thousand miles begins with a single step.” We challenge our medical community to acknowledge their own biases and those of others in our own institution. Speak up when you hear racist phrases and let’s transform this racist script together.
Dr. Jessica Malcolm is a second-year Yale Pediatric resident and Co-Recruitment Chair on the Yale Diversity Council. Dr. Jaspreet Loyal is a Pediatric Hospitalist and Division Chief for the Section of Pediatric Hospital Medicine at Yale.
1. Johnson C. Rethinking the “Black Cloud” of Medical Training. Available at https://www.stfm.org/familymedicine/vol49issue6/Johnson481. Accessed October 15, 2020.
2. Holland B. The “Father of Modern Gynecology” performed shocking experiments on slaves. Available at https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves. Accessed October 15, 2020.
3. Washington H. A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York, NY: Doubleday; 2006.
4. Roberts D.E. Killing the Black Body: Race, Reproduction, and The Meaning of Liberty. New York, NY: Pantheon Books; 2007.
5. Skloot R. The Immortal Life of Henrietta Lacks. New York, NY: Crown Publishers; 2010.
6. Seed the Way. Education for Justice and Equity. Interrupting Bias: Calling Out vs Calling In. Available at http://www.racialequityvtnea.org/wp-content/uploads/2018/09/Interrupting-Bias_-Calling-Out-vs.-Calling-In-REVISED-Aug-2018-1.pdf. Accessed September 26, 2020.
7. Bauder D. AP says is will capitalize Black but not white. Available at https://apnews.com/article/7e36c00c5af0436abc09e051261fff1f/ Accessed November 23, 2020.