Life After May 25
Authors: Uri Ladabaum
Journal: Annals of Internal Medicine (2020)

On Being a Doctor1 December 2020Life After May 25FREEUri Ladabaum, MD, MSUri Ladabaum, MD, MSStanford University School of Medicine, Stanford, California (U.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4106 Audio Reading - “Life After May 25” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads “Life After May 25” by Uri Ladabaum, MD, MS Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail May 25 is my birthday. May 25 was George Floyd's death day.The choice of verb tenses is deliberate. I am alive—and I hope, and statistically can expect, to have future birthdays. George Floyd is dead. Murdered.Our nation is convulsing. Before May 25, the daily headlines were medical: COVID-19, COVID-19, COVID-19. Medicine has been shaken operationally and morally. The pain of the novel virus has been multiplied by the uneven distribution of death based on social determinants of health—glaring among them being Black in America. We were then buffeted by the events of May 25. Demonstrations of outrage about centuries of racism now highlight political divisions that themselves feed the pandemic fires.Health care is about life. If you have a copy of your application essay to professional school, I urge you to reread it. Somewhere in there is a version of “I want to be … in order to help others.” What is our duty as health care workers during this time of compounding national crises?Patients share with us their most intimate thoughts and feelings within minutes of meeting us. They trust us with their health and their life. At the barest minimum, we are bound to repay this trust by treating each individual with the highest level of respect and concern, and by delivering the best care that we possibly can. However, that can no longer be enough. COVID-19 has exposed the structural biases and inequities that continue to plague the United States in 2020, with health care disparities being very high on the list.My wife became an obstetrician–gynecologist because she could not understand how nature could be cruel enough to take the lives of so many young women at the very moment that they were giving birth to a new life. The disparities in maternal mortality between Black women and women of other races in the United States are shameful. A few months ago, before COVID-19 struck, a Black patient asked my wife if my wife could ensure that she and her baby would not be adversely affected by her being Black. That shook us.Reasonable people may disagree on the prescription for remedy. But it is now inescapable that our moral duty extends to fighting for universal access to high-quality health care, including preventive care, for everyone. In modern life, in a rich country, it is a human right.Those of us entrusted with the privilege of teaching and mentoring the next generations must go further than ever. Of course, overt prejudice cannot be tolerated, but there is so much more. We must ensure diversity and equal opportunity among our faculties, trainees, and students. We must identify and eliminate any impact of implicit bias. We must become role models like never before. The patient who says that he is “not comfortable” with our Black resident taking care of him needs to be confronted head-on. The small steps count as much as the big climbs.My father was an admirer of the United States. He was fortunate to arrange a job transfer by his company from Mexico to California in 1977. He was so happy that his sons enjoyed opportunities that would have been unimaginable in Mexico. My father died of congestive heart failure in 2018 at age 82. What would he, the eternal optimist and lover of the American ideal, think today? The best of modern cardiology and cardiac surgery gave my Papi two decades of additional life. A Black colleague recently told me that she lost her Daddy when he was 56 to heart disease complicating diabetes and hypertension. He did not have good access to health care. It is painful to face how my father, immigrant to this country by choice, saw his grandchildren thrive while my colleague's father, descendant of slaves, did not even meet his grandchildren, largely because of the color of their skin.What about life beyond medicine? Can we even begin to disentangle health, medicine, and life in general, or are they wrapped around each other like the snakes and the staff of the caduceus?We are all now wrestling with what it means to be a responsible citizen, a righteous human being. On June 1, one week after the murder of George Floyd, Anna Deavere Smith said that one thing notably different this time is “the composition of the people in the streets during the protests … It's not just Black people.” She credited education, particularly in colleges, for young people's increasing awareness of one another. We should let the young guide us.My own daughter, a member of the COVID-19 college graduating class of 2020, continually challenges me. “But what are you doing about it, Dad?” she asked as I ached and raged about the death of George Floyd, about the disgusting repetition of the same stories, about what is happening to our country.As I try to figure out what exactly I will do moving forward, it is clear that it is no longer enough to try to be a good person, to try to raise kind and just and responsible children, and to be comforted by exercising the right to vote. As a small initial step, I joined the June 4 Stanford Medicine March for Racial Justice, my first march ever. In between moving speeches by young colleagues, we knelt in silence for 8 minutes and 46 seconds, contemplating the eternally long—and simultaneously and inexplicably fleetingly short—time that this is for a life to be extinguished into death by asphyxia.For us as health care workers, our profession is a big part of our identity. Each of us is also so many other things. In the end, we are all simply human beings. However, evolution seems to have etched in us insidious predispositions to define, in our hearts and minds, groups that are “us” and groups that are “other.” Perhaps the only consolation is that evolution has also endowed us with the brains to overcome this.Limited to the vocabulary of White, Brown, and Black, I am White. But that is incomplete. I immigrated to the United States at the age of 12 from Mexico. Spanish was my first language. I am Jewish though not religious. My ancestors were picked out, over centuries, by how they looked and dressed. If my grandparents had not left Europe, they probably would have been killed by the Nazis. My wife's parents miraculously survived the Holocaust. As a boy, I felt that I was different, part of a minority. I tell myself that I have some understanding of what Black people face. I tell myself that I, too, might be discriminated against in some parts of America because I look “Semitic” or “Mediterranean or something” and not Anglo-Saxon. Yet, I can jog in my neighborhood without fear. I am not scared that I might die when a police officer pulls me over. I do not face racism in my daily life. My daughter has helped me understand what White privilege means. Melanin as a determinant of our possibilities in life. Melanin as a predictor of the risk for death. That must end at last, once and for all.How do we live after May 25? The hope since COVID-19 emerged has been that, in the not too distant future, we might “go back to normal.” After May 25, it is clearer than ever that the “normal” we yearn for must be radically different from the “normal” that so many of us accepted for far too long. Nothing we do will allow George Floyd, Eric Garner, or countless others who have died unjustly on hospital gurneys or sidewalks to take another breath. But I fervently hope that this time, finally, there is something different building across our nation.May we one day remember May 25 as a new birthday for America. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Stanford University School of Medicine, Stanford, California (U.L.)Corresponding Author: Uri Ladabaum, MD, MS, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor C-326, Redwood City, CA 94063-6341; e-mail, uri.[email protected]edu.This article was published at Annals.org on 4 August 2020. PreviousarticleNextarticle Advertisement Audio Reading - “Life After May 25” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads “Life After May 25” by Uri Ladabaum, MD, MS Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 1 December 2020Volume 173, Issue 11Page: 938-939KeywordsAfrican American peopleCOVID-19ForecastingHealth careHealth care providersMaternal mortalityMelaninPlaguePreventive medicineRacial and ethnic issues ePublished: 4 August 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...