'Has Anyone Asked About That Pin?'

One of the white senior residents on my pediatrics rotation always wore a pin on the key chain around his neck, whether he was dressed in business casual attire or scrubs. The pin read, “Black Lives Matter.”

That was toward the end of my clinical year, and he was the first resident I met who wore symbols in support of racial justice. I was thrilled, but I held back the urge to ask until my last day on this service. “Has anyone asked or made any comments about your Black Lives Matter pin?” Only a few, he responded. One had frowned when they realized what the pin meant. A second had asked if he’d considered the potentially negative impact of such symbols.

He told me he felt strongly about wearing his pin. He believed that the pin is a potential way for black patients and their families to feel that he cared and was aware of injustices they face in and out of the hospital -- a way to counter the potential assumption that black patients do not get adequate care. The pin might ease tensions and contribute to building a strong therapeutic relationship.

He referred to evidence showing that black people do not receive the same quality of care. For example, a recent study in a pediatric emergency department showed that black children are less likely to be treated for sepsis compared to white children, even though sepsis is a diagnosis based on objective data including but not limited to fever, low blood pressure and elevated breathing rate. Similarly, a prior study found that black children with appendicitis were less likely to receive any pain medication for moderate pain or to receive any opioids for severe pain compared to white children.

Certainly, I’m aware that being a white male senior resident granted him a great deal of social capital as he navigated the hospital. What if I, a black male medical student, wore a Black Lives Matter pin? Would it ruffle too many feathers? Black men in majority-white spaces deal with persistent negative stereotyping and are constantly attempting to appear nonthreatening. For me, wearing a Black Lives Matter pin could invite more interactions that would require me to make such calculations.

I’ve seen classmates have their feathers ruffled by antiracist displays before. During my first year of medical school, several of my classmates, mostly people of color, attended a Black Lives Matter rally on the main Yale University campus, donning their white coats. (I didn’t because of a clinical commitment.) The rally was in response to the police killings of Terence Crutcher and Keith Lamont Scott. Indelible in my mind is the memory of a classmate’s indignation, which led to a bioethics discussion with faculty arguing both sides of “Should medical students/physicians bring their activism about racial justice into the profession?”

That discussion felt egregious for a few reasons. Physicians have long stood against gun violence and advocated for sensible gun laws. #ThisIsMyLane recently became a popular physician-led hashtag campaign for sensible gun laws. Such skepticism when it came to black men as victims of police-inflicted gun violence signaled to me that whether my life as a black man truly mattered to my colleagues was a question of intellectual gymnastics in the form of a bioethics debate.

Fast-forwarding to my clinical years again, I am grateful that a senior resident showed visible, explicit support for Black Lives Matter. In a quiet but powerful way, he set an example for the rest of the team and, at the same time, showed me he was an ally, a co-conspirator. “Wow, you get it,” I thought.

His wearing a Black Lives Matter pin went beyond its impact on one-on-one patient encounters, for he was potentially creating comfort for black peers and juniors like myself, as well as other black hospital staff he might encounter.

Most black people I’ve met in the hospital are custodial/nonclinical staff, performing tasks such as patient transport, cleaning patients’ rooms and changing their linen. They don’t directly interact with clinical teams, but they see us in passing. Some team members acknowledge them. Others don’t. Whether or not we do, the workers acknowledge us, the clinical team members. The hierarchy means they have to. We are often in their way; we fill the trash cans they empty; we summon them to transport patients to their next procedures. What they see when they look at us can dictate how they acknowledge us. Some greet us with a smile, while others simply yell, “Excuse me!” when we’re in their way.

My resident’s Black Lives Matter pin might signal something to any passing custodial staff member: a kind of acknowledgment of the plight that they face outside the hospital, braving the racial plunder that takes shape in innumerable ways. For example, a recent study focused on economic vulnerability among U.S. female health-care workers showed that black women health-care workers are overrepresented among those earning a wage of less than $15 per hour. Or consider the barriers black workers face within the hospital, feeling invisible vis-à-vis colleagues higher up the hierarchy. They are consistently devalued.

In her book Flatlining: Race, Work, and Healthcare in the New Economy, sociologist Adia Harvey Wingfield (who has contributed opinion pieces to Inside Higher Ed) describes the experience of black hospital technicians who experience discrimination from those with greater authority, including their managers, nurses and physicians. That discrimination includes being assigned additional tasks relative to their white peers as well as assumptions of their incompetence.

To be sure, I have heard other people suggest that wearing political symbols in support of one group could offend members of another and even garner indignation. I get it. That perhaps is why I haven’t mustered the courage to put such a pin on my white coat or my key chain -- I want to avoid the potential confrontation with a colleague or patient. I, of course cannot peel the dark hue off my skin like one might take a pin off in certain circumstances, and my presence itself might conjure the same confrontations.

I know my resident’s primary intended audience, when he put that pin on his key chain years ago, was his patients. But as a team member, I, too, felt it as a positive signal. Given the racialized climate that black hospital patients, staff and trainees must navigate in and outside the hospital, I feel strongly that there is value in white physicians explicitly championing racial justice in the workplace.