Susan BornsteinI would like to apologize. In Jewish tradition, the time between Rosh Hashana, the New Year, and Yom Kippur, the Day of Atonement, is set aside to reflect on the thoughts and deeds of the past year. On Rosh Hashana, it is written, and on Yom Kippur it is sealed. It is the time to look back and repent for one’s transgressions. However, the theology is specific on how this must be done. It is permissible to ask God for forgiveness for sins we have committed against God, but, in similar fashion to AA’s 12-step program, we must make amends directly with those living persons whom our words or actions may have harmed. Given the vagaries of memory in general, and mine given the duration and passage of time, and the number of opportunities to have committed offense, it is impossible for me to contact the referenced individuals directly. I hope that this appeal will reach at least some of them.
This year, with the unmasking of past and current police brutality directed at minority, primarily Black, members of our society, and the accompanying long overdue examination of our nation’s racist policies and actions, I have been motivated to examine and take responsibility for my own behavior. Specifically, for a long time I have been aware , at an abstract level, that racial discrimination existed in healthcare, and consciously tried to avoid this in my interactions with my patients, my colleagues, my staff, and the hospital personnel. However, I have no idea if I was successful because I never tried to find out. When I complimented a Black patient’s finger waves, intricate plaits, or fanciful weaves, by saying that I pined for hair like hers, that it always looked beautiful, and stayed in place for weeks at a time, it was meant as praise, as well as an attempt to connect, to establish rapport. Plus, I had the “monumental” inconvenience of having to wash and style my hair every day! On reflection, could the comment have been construed by its recipient as meaning that I only wanted to have her hair, but not the totality of what being a Black woman represents? While it may or may not have reflected that particular Black patient’s lived experience, the patient whose hair was only a part of her whole, the reality is that many Black women experience (on average) less wealth, more obstacles to higher education, covert and overt discrimination, redlining, suspicion, fear, and poorer health compared to white women, compared to me. I certainly did not covet those things which made life harder, and I failed to recognize that it was impossible to have the hair without all the rest. I hope that my remark on my patients’ hair was received with the positive intent with which it was offered, but it is entirely possible that it was not. I do not know, because I did not ask. If I had, I might have learned something that would have prevented me from volunteering a thoughtless, or worse, insulting, comment in a subsequent encounter. I might have learned more about racism in America, about how I could be anti-racist.
It is well known that doctors have even less time to spend with their patients than ever before, given the escalating pressure to meet productivity goals and the demands of the electronic health record, which takes attention away from the patient in front of us. In my zeal to meet my patients’ medical needs, did I overlook their psychological and interpersonal ones? Was I inadvertently dismissive of a team member’s contribution, was my hurried tone disrespectful? Despite my efforts, did I fail to meet my own (sometimes unrealistically) high standards? Simply failing to recognize that something I said or did was perceived as racist, or demeaning, or offensive does not excuse it. The sins of omission are no less egregious than the sins of commission. I will try do better. I apologize and ask for forgiveness. Ashamnu.
With gratitude and acknowledgement to Ibram Kendi, Ijeouma Oluo, and Robin DiAngelo, whose words have expanded my consciousness and have made vital, illuminative contributions to our national understanding of racism and the false and destructive categorization of race.