Note: All names and identifying details in this essay have been changed to protect the privacy of individuals.
“We are doctors, not politicians,” Dr. P. said during a medical school orientation lecture on professional responsibility.
His words were hard for me to reconcile with, because I have always been the kind of person who wears his politics on his sleeve. And, more fundamentally, it was my frustration with divisive politics and its bearings on health care outcomes that made me switch careers from finance to medicine in the first place.
So it came as no surprise when, a few weeks later, he noticed the rainbow pin on my hospital lanyard and said, “Be careful with that. You might alienate some of your patients.”
Unfortunately, he was right.
Two months after classes started, each student was assigned a clinical site where we would learn how to take a patient’s medical history. My placement was in an emergency room, which excited and terrified me at the same time.
When “an easy case” arrived, Dr. B. — my supervising physician — said, “Tom, why don’t you start taking the history and I’ll join you in a few minutes?” I did as I was told and walked over to Room 3.
The patient was in his late 50s, a Brooklyn local and an emergency room regular. He was breathing heavily and pursing his lips — a sign that’s often characteristic of chronic obstructive pulmonary disease. I introduced myself as the medical student and asked, “Do you have any questions before we get started?”
He was silent at first. But after a few minutes of belabored breathing, he blurted out, “Papi, that’s just wrong. That thing you got on your ID, that’s not biblical.”
I tried to deflect the remark and start the interview. But he wouldn’t budge. When I asked, “What brings you in today?” he replied, “Do you think that’s natural?”
More than being frustrated, I was embarrassed ― I felt a sense of shame so deep, it seemed to be coursing through my veins. Saying yes would surely lead to an argument. Saying no would be lying to myself. So I mumbled something about not being well-versed in the Bible and apologized profusely for offending him. And yet, despite his shallow breathing, he went on to accuse me of being yet another “brainwashed liberal” and asked, point-blank, “Do you really think President Trump contacted Ukraine?”
I had never experienced that much political anger funneled toward me firsthand. While a big part of me wanted to engage in the dialogue, doing so would have certainly exacerbated the situation. I also felt a jolt of nervousness as the thought dawned on me that the nature of the circumstances and my inability to establish a rapport with the patient would likely hurt my end-of-rotation evaluation. Nonetheless, I excused myself from Room 3 and requested Dr. B to join in.
When I left the emergency room that evening, I felt defeated. And by the time I got back home, I promised my husband that I would throw the pin away. While he was sympathetic toward my decision and understood why I wanted to do that, he encouraged me to think about the reason I chose to wear it in the first place.
I wanted an explicit symbol over the bridge of my chest for every person to feel welcomed and loved, where their queerness could be celebrated and discussed, not pushed aside to the periphery.
It wasn’t because I wanted to self-identify my sexual orientation among a crowd of medical professionals — although that might’ve been part of it. It was because I was committed to establishing a safe environment for patients who felt particularly vulnerable about their sexual identities. I wanted an explicit symbol over the bridge of my chest for every person to feel welcomed and loved, where their queerness could be celebrated and discussed, and not be pushed aside to the periphery.
I grew up in India hiding my queerness because, in addition to homosexuality being illegal in my country, I knew that my parents would be ashamed. And when I tried to bring it up with my pediatrician, he admonished me for being “careless.” I was told that I was “inconsiderate” for putting unnecessary stress on my family, and I was assured that it was a phase that most teenagers went through and that I would surely outgrow. “Don’t tell your parents anything yet” was his advice. “You certainly don’t want to give them a heart attack.”
But I did almost give my mother a heart attack when she unexpectedly returned home early one evening to find me in my sister’s dress, wearing gold filigree bangles, my face caked in makeup. I wanted to be a bride so badly then that I’d even stolen some of my mother’s sindoor — a vermilion red powder that Hindu women wear as a symbol of marriage — and traced a line along where my hair parted.
“What’s going on?” my mother asked, with a look of horror in her eyes.
“Oh nothing. Just dress rehearsing my character for a school play.”
I sensed her immediate relief. My lie felt like a believable explanation to what had been years of periodic cross-dressing. I quickly returned her bangles, the play never happened, and we never once talked about that day ever again.
I always just assumed that it was my pediatrician’s Hindu conservatism that led to his repudiation of my sexuality. Or perhaps it was an Indian thing — or a “third world” thing — for the doctor to chide the patient for having fairy fantasies. The America I knew from Hollywood movies seemed so liberal, so welcoming. And the New York I’d constructed from novels that featured the Stonewall riots felt so positively celebratory. That “first-world” children in urban America could face similar episodes of stigma and violence never once occurred to me as a real possibility until I started shadowing a doctor at an LGBTQ+ clinic.
The narratives I encountered there were heartbreaking. Elana’s father in Clinton, Mississippi, had poured boiling water down her back when she came out as transgender. Tony’s uncle beat him up and threw him out of the house when his browser history suggested that he’d been watching gay porn. And Liliana, from Macon, Alabama, was repeatedly pricked with insulin syringes as punishment for being lesbian. Even worse ― and completely unforgivable to me ― was the fact that these patients’ pediatricians had all sided with their parents to punish the “anomaly” of their queerness. And their experiences with New York doctors, after they ran away from home, continued to be alienating.
A close-up of the author’s rainbow, Black Lives Matter and pronoun pins.
They needed visible signs of love and support and tangible acceptance of their sexual and gender identity vulnerabilities — something I intimately understood from my own experiences growing up. They needed gentle reassurance that they weren’t freak shows or purposeless in the present with no hope for a future. And it was that sense of invitation and reassurance that the clinic provided, not only through the care providers’ words but also through their actions.
There were pamphlets along every wall of the clinic with rainbow flags and transgender stickers. The doctor I worked with wore a pin that stated the pronouns he used and a rainbow button to create an air of respect and inclusion from the moment a patient saw him. The differences that these symbols made were not just occasional blips caught by the wayside. Not a single day went by without patients giving positive comments on them. And I vowed to myself that when I started medical school, I would also wear those pins.
As I combed through this emotional experience that night after I left the ER, my husband’s nudge quickly rejuvenated me. And in hindsight, I’m grateful that I decided to keep wearing the pin for the rest of my clinical rotation. That following week, a patient I’ll call Mr. K. felt comfortable disclosing his HIV status to me — a critical piece of health information he didn’t share with Dr. B. or any of the other medical residents who had evaluated him for blood in his urine. He gestured at my rainbow pin, taking it as a sign that I would be understanding of his diagnosis. And the week after, a high school student who came in citing suicidal ideation ultimately disclosed that he was having sex for money without his parent’s knowledge, saying that my pin had provided reassurance that I wouldn’t judge him for his actions.
While the ER experience was an eye-opening rotation that I truly enjoyed, the following semester I was assigned to an HIV clinic, and it was there that I met Ms. Carter.
Ms. Carter was in her mid-60s, a retired teacher and a parent of three. She had come to the clinic for medical clearance before undergoing a repeat vaginoplasty. Even though she’d had gender reconstruction surgery the previous year, the excruciating pain of daily dilation had prevented her vagina from healing properly.
“It was as if my body had eaten up my womanhood,” she said to me in the clinic. The frustration and pain wreaked havoc on her self-confidence, and before long she became deeply depressed.
“My partner refused to talk to me because we couldn’t be intimate,” she recalled, tears clouding her eyes.
And one time, when she was having thoughts of self-harm, she walked over to the emergency room.
“It was awful. Not only was I having these awful thoughts, but in the ER, all these doctors were talking behind my back, making fun of me. I could hear one of them joke, ′Is she doing this surgery to keep her busy after retirement because she’s bored?’”
She said they also made derogatory comments about her being Black and being “reckless,” commenting that her “hips weren’t big enough to be a ‘real’ woman” and asking if this was how “Black people seek attention.”
I remember being so shocked that I asked, almost involuntarily, “They really said that?”
She gave me a wistful nod and said, “If you’re Black and transgender, your life just doesn’t matter.”
The comment struck such a nerve in me that I impulsively gave her a hug. I held her hand and said, “Your life matters, Ms. Carter. Your life matters.”
As much as the button serves the purpose of being a visible symbol of my stance, it is also a constant reminder to myself to be more compassionate, sympathetic and culturally humble, even more so when seeing patients.
Recently, as videos of anti-Black police brutality spread across the internet and the value of Black lives became, yet again, a political deliberation, I told myself that enough was enough and bought a Black Lives Matter button for my hospital lanyard.
It was the best 70 cents I’d ever spent.
Criticism ensued. A scientist at an adjacent laboratory from where I worked over the summer made it a point to clarify that such political gestures were why people didn’t trust science anymore. A nurse acquaintance told me, “You will change your mind when you find out that these patients rarely follow orders.” And a neighbor inquired, “Why must you make a statement out of everything?”
But I let the negative comments slide as I thought of Ms. Carter, who unfortunately passed away from COVID-19 a few months later. And I know there are many Ms. Carters out there who might feel the same sense of despondency as they think about their lives and reflect on their experiences navigating the health care system. As much as the button serves the purpose of being a visible symbol of my stance, it is also a constant reminder to myself to be more compassionate, sympathetic and culturally humble, even more so when seeing patients.
The history of medicine painfully illustrates its pivotal role in perpetuating racial disparities. For instance, the Tuskegee syphilis study — sponsored by the United States Public Health Service — is just one out of many examples of how Black lives have been devalued in the past.
And the ripple effect of these injustices lives with us till this day. COVID-19 mortality has disproportionately affected Black communities. Black children are three times more likely to die within a month of surgery than their white counterparts. And Black youth have more than three times the number of new HIV diagnoses than white youth in the United States.
But we still have time to turn this around and make a tangible difference in the lives of those who are most vulnerable. And something as simple as wearing a pin can serve as a reminder to prioritize diversity. Until we can speak through our actions to the Ms. Carters of the world that their lives matter, there’s a lot more work left to do.
Lala Tanmoy (Tom) Das is an MD-PhD student in the Weill Cornell/Rockefeller University/Memorial Sloan Kettering Tri-Institutional Program. He lives with his partner, Eric, in New York City.
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