Editor’s note: This piece was originally submitted as an entry to the Progress Notes’ Diversity Essay Contest.
As a child, I was told “You can be anything you want to be if you put your mind to it. All you have to do is believe.” Fortunately, I was born into a supportive faith-filled family that encouraged me through prayer, presence and preparation. Although my parents tried to shield me from the injustices and disparities Black children incur in their “normal lives,” this little Black girl, now a mother, wife and attending physician, never imagined the disparities that she would see along her path to becoming a physician. I first saw these disparities in medicine in my pursuit of becoming a medical student.
As a child, it was impressed upon me by my father that I had to be “above and beyond normal” to be considered competitive in America. When I would bring report cards home, full of As, if they were below 95, I was told “You need to do better.” As a result, I graduated valedictorian of my high school while participating in many volunteer activities and leadership roles. In high school, I was initially told I should not seek to pursue pre-med as my major because “Just because you graduated No. 1 here does not mean you will be at the top of your class in college.” After being mentored in college to purse my career in being a physician, making good grades, testing well, being heavily involved in a pre-med program and applying to numerous schools in Texas, I was only accepted into one school. As a Black female, I knew that there were not only disparities in race but also gender. If the affirmative action numbers were met, most schools would pick a white male with less accolades over my application. It’s the reality I lived. Growing up as a Black child, I knew that all I needed was one shot. Thankfully my parents made sure I knew who I was and whose I was.
When I matriculated to medical school and ultimately through residency, I knew to keep my head down, work hard, be on time, be present and produce undeniable results to get to a position where I could make a difference in the Black community, specifically. When I would walk into the room of an African American patient, you could see them physically relax and burst at the seams with pride. In my community, Black physicians are still considered rare. It’s an enormous feat to accomplish and makes the difference in quality of care for our patients.
You see, we (as a Black community) have trust issues in medicine. Throughout our history we have experienced significant pain in regard to how we have been handled and mistreated in medicine. To grow up learning that African American men, with known syphilis, were allowed to go untreated for years so that they could be studied in the Tuskegee Experiment is piercing to the soul. Those men could have easily been my father, brother, husband or son. To learn that consent was not obtained to take cells from Henrietta Lacks to create an immortal cell line is betrayal. To personally be treated as less than or less educated as a patient because of my skin when going into labor for my second child was heartbreaking. Only after announcing that I was a physician did treatment improve. It should not take all of that! Unfortunately, there are many more stories throughout history that repeat these same patterns.
When addressing the pandemic and the lack of African American participants in the COVID vaccine, it should not have been surprising that my people were and are still hesitant to take the COVID vaccine. Heck, I was hesitant myself! Even after reading the science and interpretating results that showed it to be effective, there was still a part of me that did not feel comfortable. I was now in a position of influence in my community; a position that was frightening at best. At the beginning of the pandemic, my patients (who are predominately Black and brown) would ask me, “What do you think about this shot? Have you gotten it? Do you think I should get it?” Those questions carried a heavy weight as a Black physician. Being a part of a culture that has been abused and misused, I knew that it was my duty to be cautious and that I would have to lead by example. My initial response was “Wait until I have taken it myself.”
In December 2020, I took my first leap of faith and anxiously received my first vaccination. I analyzed every symptom, recorded each one and continued to pray hard! Literally two weeks after, that sneaky little virus crept into my house and infected my children’s caregiver, all three kids (including a breastfeeding infant) and my husband. It was a war zone I had to tackle on my own. I had to be physician, mommy, teacher, chef, maid and everything that everybody needed. My husband was the sickest and I could not ask anyone to be willing to come into my house to help me and potentially die. I prayed hard to the Lord to bring me through and cover me. I could not afford to get sick. He did just that! At the end of the 21 days of nursing my family back to health, I was able to get my second dose and realized that getting my first dose played a pivotal role in affording me the opportunity to protect myself and provided protective antibodies through breastmilk for my baby during a scary time. I could not have imagined what it would have been like if I had not received any of the vaccine’s protection. If I had become as sick as my husband, I don’t know how my family would have made it through that difficult experience.
As private as I am, I know that my experiences are not meant for just me. I must share them with the world as a living, breathing testimony that could help save lives in my community. Because of that, I tell my story to my patients. I tell the full, honest truth. They need to hear it. They need to know that their physician is not willing to experiment on them and that their physician is willing to be first on the line to protect them. They need a reminder that they are worth sacrificing for and should not be the sacrificial lamb.
As pioneers in medicine, it is important that we continue to make strides in diversifying medicine in all aspects. Acknowledging that disparities do exist in medicine is key and equipping patients to advocate for themselves is vitally important. Representation matters and plays a key role in improving public health. If we truly want to do no harm, we can no longer ignore or perpetuate the disparities that we have inherited.
By Dr. Carmella Caldwell, associate professor in the Department of Family and Community Medicine.