About 25 years ago, while working at a large shelter for Boston Health Care for the Homeless, I was stuck with a used needle from a patient whose blood I had drawn. He was a man who had sex with men, so I went on prophylactic AZT until his test came back negative.
At the time, I gave some, but not enough, thought to what it means to risk the body in the service of mission. I thought about it more in the urgency of the social and medical morass we are in when Massachusetts General Hospital was deluged with patients infected with the novel coronavirus. I began feeling uneasy when I realized that I was safer than my colleagues who were in the thickest part of the COVID-19 fray, in the ICUs and emergency departments. I was usually in my office, providing virtual care safely.
When I was in higher-risk settings, like the specialized clinics set up to evaluate people with symptoms suggestive of COVID-19, I not only had the benefit of as much PPE as I needed, but also people whose job it was to observe me “donning and doffing” to assure optimal safety. My personal risk, despite my age and comorbidities, paled in comparison to those providing longer periods of face-to-face care for sicker people.
And my risk on average is probably much lower than that of the people who come to the hospital faithfully to support it: to clean, launder, maintain, provide security, feed patients and staff, and much more. They are disproportionately people of color, from communities with higher risk of infection and complications, and they may ride crowded public transportation to work. On top of that, they’re among the lowest paid. Every time I hear the 7 p.m. hoots and clanging of thanks for the heroes, I am frankly ashamed. I know I’m an impostor.
But it’s the protests against police brutality and racism that are giving me the most pause about what risks I should be willing to take to make a difference in the world.
Recently, someone I care about was injured as they participated in a demonstration protesting the murder of George Floyd. A projectile hit their head as they were on the front line, using their whiteness to defend others behind the line. What was I doing at the time? Preparing slides for a virtual talk I was slated to give to other doctors fulfilling their ongoing education requirements. What harm did I suffer? Some eye strain. As a police car burned a few blocks from my office, my white privilege, permitting me to work isolated, uninfected, and unharassed, felt like fuel for the conflagration.
I used to know what to do to have a life of purpose and meaning. I had faith that the good I do for individual patients, and for my colleagues taking care of theirs, amounted to effort well spent. It was not a stretch for me to practice gratitude at the end of each day, and to have a sense of coherent integration into the world. I had proceeded according to Oliver Wendell Holmes’ credo of “Jobism.” Holmes knew that we are not privy to the larger purpose of our work, so it may be best simply to strive for excellence.
Today I am uneasy about anything I do that leaves me comfortable. I am torn: I crave getting back to the job of taking care of patients, helping my teams and colleagues do the same, and supporting organizations to propel positive change. In these times, seeing people all around me undertake great personal risk makes me ask myself if sacrificing my time, treasure, and sweat is enough.
I wish I had a solution. I can advocate for leaders in my profession and society’s civic leaders to combat stigma, racism, and injustice in medicine and laws that put people at risk. The diseased social structures that COVID-19 has exposed cannot remain beyond the focus of ethical health care. I have been heartened by the commitment to justice coming from my colleagues and hospital leadership, and by our willingness to call out racism.
In the weeks since George Floyd’s murder, I sense a change. My co-workers and I have had many heartfelt discussions, and leaders of color at the hospital have shared personal e-mails and essays that are encouraging. We have an active chapter of White Coats for Black Lives, and there are chapters at other Massachusetts hospitals. Also encouraging is the growing trend I see of newly minted doctors choosing to train in areas with an eye toward social justice: addictions, homeless health care, rural health, and global health.
Perhaps the urgency of national and global crises means that just showing up to do a good job, as Oliver Wendell Holmes advocated, is not nearly enough. The selflessness of those who put themselves on the front lines in the streets emboldens us to commit to weaving anti-racism into our work, shining an honest light on our own practices and institutions.
May we carry their courage onward, each in our own way. We must refuse business as usual, and ensure that everything we do moves the fight forward. The hospital team I work on is seeing a surge of patients coping with addiction. Next week, we’ll focus on combating stigma — not only on molecules, neurotransmitters, or disease.
Exactly 57 years ago, Martin Luther King Jr. said, “If a man has not discovered something that he will die for, he isn’t fit to live.” Then, as now, social turmoil causes us to examine what we believe in and how we use the finite hours of each day.
Dr. Michael Bierer is a primary care physician and addictions specialist at Massachusetts General Hospital and is a fellow in the OpEd Project. Send comments to firstname.lastname@example.org.