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Macmillan Childrens Publishing Group

Black Man in a White Coat

A Doctor's Reflections on Race and Medicine

Damon Tweedy, M.D.

Picador

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Chapter 1
People Like Us


It was a hot late-summer morning, a month into my first year as a Duke medical student. The classroom of 100 students buzzed with energy. After a few weeks of tedious lectures that seemed no different than the science classes we’d taken in college, our professor had just finished the first half of a presentation on the case history of a young boy with a rare childhood disease. A short film had brought the complex scientific pathways in our textbook to life in the words and actions of the boy and his parents. After the video, the professor talked about promising therapies for this disorder. Finally, we were getting glimpses of the clinical knowledge that we’d come to medical school to learn. I could hardly wait for the next segment.

But that wasn’t the only reason that I suddenly felt better. My first few weeks at Duke had been an exercise in expanding insecurity as I learned more about my classmates. As one of a handful of black students, I naturally stood out, but race was just part of the story. In those early days, it seemed that all of my classmates came from professional, well-to-do families. My mom never entered a college lecture hall; my dad did not finish high school. While my brother, Bryan, had been the trailblazer of our immediate family in graduating from college, medical school was a different league. The majority of my classmates graduated from high-prestige schools like Duke, Harvard, Yale, or Stanford. I’d gone to the University of Maryland-Baltimore County (UMBC), a young school with a comparatively limited national profile. Could I hack it at Duke? Determined to use this fear as a buoy rather than a dead weight that could sink me, I spent as many hours studying in that first month at Duke as I had my entire senior year of college.

The effort paid off. Our midterm scores had just come back, and to my immense relief I had done well, firmly within the top half of the class on each exam. As I stood to stretch during the break before the professor resumed his lecture, I was finally starting to feel comfortable, or at least what qualified as such for a first-year medical student.

The mid-class break offered time to use the bathroom, grab coffee, or simply remain in place and gossip. I preferred to move about, as the lecture hall, with its folding seats, dim lighting, and sticky flooring, had the uncomfortable ambiance of an old movie theatre. On my way out, I chatted with a few people and listened as one group discussed plans to camp out for Duke Men’s basketball tickets. Contrary to the stereotype of narrow-minded science misfits, most of my classmates seemed just the opposite: social, with wide-ranging interests and a desire not to spend all of their time locked in the library.

As I re-entered the lecture hall, Dr. Gale, our professor, headed in my direction. Ordinarily, he didn’t socialize much with us, so I expected him to walk past without acknowledgment. Instead, he stopped beside me.
“Are you here to fix the lights?” he asked.

The sounds of the classroom seemed to vanish. So did my peripheral vision. Calm down, I told myself, maybe he was talking to someone else and only seemed to be looking at me. I glanced behind me. Nobody there. A few classmates were within hearing distance, but they seemed too engaged in conversation to notice us.
I looked at Dr. Gale in disbelief. Still, my instinct was to find another explanation. Maybe with all the background noise, I had misheard him.

“Did . . . did you ask me about fixing the lights?” I said.

“Yes,” he replied, irritation creeping into his voice. “You can see how dim it is over on that side of the room,” he said, gesturing with his index finger. “I called about this last week.”

Reflexively, I stroked my chin and looked down at my clothing to check if I seemed out of place. Clean-shaven, and dressed in a polo shirt and khaki slacks, I thought that I’d done a decent job of looking the part of preppy first-year medical student. Obviously I had failed.

“No,” I said, stumbling to come up with a reply. “I don’t have anything to do with that.”

He frowned. “Then what are you doing here in my class?”

My mouth went dry. Why had he intentionally singled me out as the maintenance man? Race seemed the only logical answer. I tried to summon an attitude of 1960s-era Black Power defiance, but what came out sounded like 1990s diffidence. “I’m a student . . . in your class.”

“Oh . . . ” he said.

Dr. Gale looked away, then walked off without another word. I staggered to my seat, sitting through the second part of his lecture like a robot, tuning out his voice. What had started out as a promising day was spoiled.

During lunch a few hours later, I replayed the encounter to three black classmates, as we sat out of range from others in the cafeteria. I’m not sure what I was looking for, other than the chance to vent to people who might understand what I was feeling. Their response surprised me: Two of them burst out laughing.

“That’s messed up,” Robert said, almost choking on his hamburger.

“At least he thought you were a skilled worker,” Stan said, as the two laughed harder. “He could have asked you to pick up his trash or shine his shoes in front of the entire class.”

“That’s not funny,” Marsha said, glaring at them.

“What else are you going to do but laugh about it?” Stan shot back.

“He’s right,” Robert chimed in while on the verge of a laughter-induced coughing spasm.

Marsha started to say something about reporting the incident or confronting the professor, but her militancy evaporated as Stan and Rob started quoting the comedian Chris Rock. I don’t recall the specific joke, but it made me smile and calmed me down enough that I could eat my lunch. Racial insults – big and small – were a part our lives and sometimes humor was the best way to deal with it.

Yet the good feelings didn’t last. The afternoon lectures gave way to a different course, and with it, another professor. I could not concentrate at all. “Are you here to fix the lights?” played over in my mind as I stared at the overhead fluorescent fixtures. Over the years, I had been mistaken many times for a potential criminal, hired help when I was a paying customer, and most favorably, as a six-foot-six budding professional basketball player. But it’s one thing to be insulted by a stranger you’ll never see again, and something altogether worse for your professor – who assigns grades that dictate your future – to cast you in such a limiting way.

Trying to reason with myself, I rationalized that at Duke, Dr. Gale saw many more black maintenance men than black students in his class. And I also firmly believed that there’s no shame in blue-collar work. My dad spent thirty-five years as a meat cutter at a grocery store while my maternal grandmother, worked her life as a housekeeper, or in the parlance of her times, a cleaning lady. What disturbed me was Dr. Gale’s assumption that I had no business in his class unless I arrived in some service capacity. Sensitive as I already was about my place at Duke, this incident stabbed at the core of my insecurity. With one question, Dr. Gale had shattered my brittle confidence and my tenuous feeling of belonging at Duke.

**********
In a colorblind world, Duke might well have rejected me; at the very least, its admission committee would not have offered me a full-tuition scholarship to its medical school.

This troubling revelation occurred to me less than an hour into my first day on campus. The Duke Med Class of 2000 had gathered for the first time, crowded into an old lecture hall that was in its last year of use. It was a typical North Carolina humid August day, with the temperature already approaching 85 degrees by mid-morning. Inside, an antiquated but powerful air conditioner chilled the room to the mid-60s. Our eyes focused on the speaker who stood at a small lectern. An anesthesiologist by trade, she had short graying hair and spoke in a monotone that could put you to sleep without medicine. Nonetheless, the room crackled with tension. Our medical lives were about to begin.

“Congratulations,” she led off. “I’m proud to say this is the most accomplished class we’ve ever had during my time at Duke.”

Nervous laughter filled the room. On a scale of cutthroat competitiveness, future doctors are worse than Olympic hopefuls. Pre-meds arrive with better grades than those who attend law, business or other graduate programs, and this is no coincidence. Although most schools deny it, getting into medical school is, to a large extent, about numbers. In keeping with our numerical obsessions, we craved our first glimpse of how we measured up against each other.

She began with our college grade point averages. “The mean was 3.7 on the standard 4.0 scale,” she said, leafing through papers that defined our lives as data.

My GPA was higher, but I discounted this edge since I had attended a less prestigious college than almost everyone around me. That realization had sunk in months earlier, during my admission interview at Yale. “I’m not sure the grades from your undergraduate college reflect what you’ll face here and beyond,” an elderly surgeon told me, his faced lined with worry as he viewed my transcript. And with that swipe of his verbal scalpel, he cut my straight-A transcript down to what seemed a B-minus average.

Next up were our scores on the MCAT, the medical school equivalent of the SAT. “The average combined score was 34,” our Duke professor announced.

I’d scored a few points below this class average. Based on percentile rankings that she went on to explain, my result was still as good as, or better than, those of a third of my classmates, but that did nothing to prevent my empty stomach from twisting into a painful knot. While admissions committees do consider other factors, I’m fairly certain that my community service record, leadership skills and interview performance all rated average at best. These were not the talents that made Duke offer me a full-tuition scholarship.

Things got worse as she boasted about the number of students from various prestigious colleges. “Twenty-five percent of the incoming class has an undergraduate degree from Duke.”

Another quarter came from the Ivy League, most either Harvard or Yale. Of the remainder, the vast majority hailed from other elite private colleges, such as Stanford and Johns Hopkins, or highly regarded state schools such as the University of Virginia or the nearby UNC-Chapel Hill. While I had considered many of those schools four years earlier and been accepted to several, I attended the lesser-known University of Maryland-Baltimore County. At the time, it felt like the perfect choice, as it offered a full scholarship, the opportunity for playing-time on a Division I basketball team, and was only a 45-minute drive to my parents’ home. But now at Duke Med, I felt like a scrawny thirteen-year-old on a basketball court with grown men.

Why had Duke accepted me, and offered a full scholarship as enticement? As I played through the scenarios, affirmative action appeared to me the likely answer. Seemingly dialed into my thoughts, the professor then turned to racial numbers:

“We have fourteen underrepresented minorities out of our total of one-hundred students,” she said as she smiled broadly, “which makes this our most diverse class ever.”

In academic circles, underrepresented minorities include blacks, Hispanics and Native Americans; Asians are excluded because they enroll at colleges and medical school in very high proportion compared to their numbers in the U.S. population. In our class, all but one of these fourteen minority students was black. Hispanic students tended to choose medical schools in a few large cities (New York) or states with large Hispanic populations (Texas, Florida and California). At the time, North Carolina, and the city of Durham, had few Hispanic residents. Native Americans simply make up a very small percentage of the underrepresented minority pool, so they have little impact on the total distribution.

I scanned the room. About half the black faces clustered in a center area near the front, with the rest scattered, as I was, around the lecture hall. I had met most of them months earlier, during a weekend that Duke had held for admitted black applicants. At the event, black medical students, resident doctors, and faculty all descended upon us to offer assurance that we would not be racially isolated at Duke. Along with the opportunity to meet and greet prominent members of the Duke community, current black students there organized informal gatherings that featured common African-American themes: barbeque at the local park, pickup basketball games, and a venture to a trendy nightclub. They did everything to show they wanted us badly.

Duke was not alone in its efforts to recruit black medical students. Johns Hopkins filled our recruitment weekend with similar engagements, and it had a few aces that Duke lacked. Levi Watkins, Jr., a black cardiac surgeon who implanted the first automatic defibrillator in a human, led the festivities. Our experience culminated with brunch at the estate of Ben Carson, the famed neurosurgeon then known best for separating conjoined twins. Even then, his story of triumph over childhood hardship had spawned a career unto itself with lucrative speaking engagements and bestselling books. In our eyes, he was the Michael Jordan or Denzel Washington of medicine. Seated in his elegant living room amongst black medical faculty, residents, and current Hopkins medical students, we heard the implicit message loud and clear: as admitted applicants, we’d been invited to join an exclusive community of which he was king. Friends of mine attended similar events at Harvard, Yale, and the University of Pennsylvania.

This preferential treatment from these elite schools stemmed from their perception of us as “the best black,” a term coined by Yale Law professor and novelist Stephen L. Carter. In the post-civil rights era, college and professional schools still sought to enroll the best white students as they always had, but they also began a new, urgent mission: to bring the top black students into their halls. According to Carter, this aim resulted in a distinct set of standards where academically successful blacks were not judged against whites (or Asians), but rather against one another. “There are black folks out there. Go and find the best of them,” Carter wrote, describing the mentality that he saw as pervasive across several areas of society. This approach to admissions explains why I got a full scholarship to Duke and was offered early acceptance to Johns Hopkins during my junior year of college.

Yet, even with these aggressive efforts, the numbers of black students and doctors are low overall. Blacks constitute about 13 percent of the general U.S. population but a much smaller proportion of the physician world. In the mid-1990s, blacks accounted for about seven percent of medical students; that percentage holds steady today. That figure includes three predominately black medical schools (Howard in Washington D.C, Meharry in Nashville, and Morehouse in Atlanta) that currently comprise about 20 percent of the black medical student population. Some schools have just a few black students. What might those numbers look like without affirmative action? Perhaps the past holds some answers.

Before the social and political upheaval of the 1960s, black doctors were a rarity – comprising less than two percent of all U.S. physicians. The vast majority of these doctors were educated at Howard and Meharry (Morehouse was not established until 1975) with the expectation that they would provide medical care to segregated black communities. Of the prestigious white schools that did admit blacks, none could be called progressive in that era. Johns Hopkins graduated its first black medical students in 1967. The University of Chicago had just one black student in its Class of 1968. Harvard enrolled just two black students that same year. Yet Duke, from its founding in 1930, has dealt with a racial climate in many ways more intense than its peer schools.

Among elite medical schools – those regarded among the top ten in terms of selectivity, national reputation, and placement of graduates in top clinical residency programs – Duke alone is located in the South. Like most southern hospitals and medical schools, it was fully segregated through the early 1960s until a constellation of events occurred. In 1964, the U.S. Supreme Court upheld a lower court ruling in a North Carolina case (Simkins v. Moses H. Cone Memorial Hospital) that struck down the separate-but-equal doctrine in hospitals. The subsequent Civil Rights Act of 1964 and enactment of Medicare in 1965 gave the federal government the leverage to force the hand of southern hospitals into integrating their facilities.

At the time of these radical developments, you could count the number of black medical students and physicians at Duke literally on one hand. “During the late 1960s, they basically enrolled just one black student every year,” one black alumnus from that era told me.

On the undergraduate campus, black students were not admitted to Duke until 1963, and their numbers were only slightly higher than at the medical school. According to those who lived it, overt prejudice in those early years on campus was rampant. It was represented by senior university officials’ membership in a prominent local country club that excluded blacks. It also took the form of campus cross burnings and other racist acts. This combined racism – equal parts blatant and symbolic – fomented black student unrest that culminated in the 1969 non-violent protest and occupation of the school’s Allen Building, an episode largely credited with paving the way for Duke’s entry into the modern multicultural era.

Yet the stain of Duke’s racial legacy persists. In the late 1980s, well-known Harvard University professor Henry Louis Gates Jr. was briefly a professor at Duke. He didn’t stay long, feeling unwelcome, and later publicly referred to Duke as “the plantation.” More recently, Duke’s racial problems resurfaced in 2006 when three members of the near all-white men’s lacrosse team were arrested and charged with the alleged rape of a local black exotic dancer. The case dissolved after the charges were shown to be false, but the race, gender and class elements revived campus and community tensions while fueling decades-old stereotypes.
So while the days of cross burnings and swastikas are a distant memory, Duke still struggles with its legacy of racial discrimination. During my medical school interview at Harvard, I had lunch with Kevin, a senior from Princeton who was the only other black person in the group of thirty or so applicants. We were considering all the same schools save for Duke. I told him how much I had enjoyed my interview at Duke and how beautiful the campus was.

“It’s a great school,” he conceded, “and it would be great to live in a place where it is seventy degrees in November.” He then looked around to make sure that no one else was listening: “But you know how they don’t have a good track record with people like us.” I must have heard some variant of this comment a dozen times during that interview year. It was clear that many black students viewed Duke through a racially tinged lens.

A few years earlier, in an effort to combat this perception, the medical school decided to offer full-tuition scholarships to the handful of underrepresented minorities (primarily black) it saw as most desirable. Anyone who has known a medical student or recent graduate recognizes this award as the lottery ticket it is. With rare exceptions, the only way medical students can get someone else to pay for their education is to serve in the military or on some rural outpost for a handful of years after graduation and training. But Duke’s offer came with no strings attached. At its essence, the scholarship was a form of recruiting reparations, a practical way to entice blacks students who might otherwise be scared away by stories from Duke’s past.

And it worked. For me, the scholarship was the decisive factor in my choosing Duke and swaying me from Johns Hopkins, which offered more prestige, a slightly better track record of training and hiring black doctors, and proximity to my family. It also bumped Duke ahead of three Ivy League schools on my list. I later learned that the free ride propelled the other five recipients to Duke for similar reasons. Back then, the scholarship was valued at $100,000 over four years, but factoring in interest rates for an equivalent loan over many years, it was more like $175,000, or even more. A lot of money for a group of people like us who’d never had much.

So there it was: Not only was I admitted to Duke, when in a colorblind world I might not have been, but I had arrived with a full-tuition scholarship in hand. Depending on your perspective, affirmative action had done its job, giving a working-class black kid the chance for an elite education, or affirmative action had reared its ugly head, taking a slot from someone else more deserving while possibly setting me up for failure.

**********
In our initial week on campus, we accumulated all the trappings of first-year medical students: parking passes, ID badges, bulky textbooks. Classes started the following Monday. As I nestled into a spot in the middle of the lecture hall, nearly a week after I’d learned how I stacked up against my classmates, I saw three unfamiliar faces seated together a few rows in front of me. Two were black. Were it not for this, I probably would have overlooked them, assuming they were classmates whom I had not yet met or had simply forgotten in the chaos of shaking hundreds of sweaty palms the previous week during our orientation. However, the numbers of black students in my first-year class was small enough that I already had a mental catalog of their names and faces. These two – one man, one woman – were new to our select company.
During a short break between lectures, I leaned over to Greg, a native southerner who’d gone to college at the University of Florida. “Who are they?” I asked.

“I don’t know for sure,” he said, “but I have an idea. Let’s ask Angela. I bet she knows.”

We turned around and looked up at Angela, another black classmate, who sat a few rows behind us. She was from New York and had gone to Duke as an undergraduate, where she’d been an English major. The gregarious type, she already had her finger on the pulse of medical student gossip. Later that day, as the three of us walked along a semi-enclosed path to the medical school bookstore, we asked her about the unfamiliar faces.

“They have to repeat first-year,” she whispered.

“Why?” I asked.

“I guess because they didn’t pass last year. What other reason is there?”

“That doesn’t look good,” Greg said.

“You’re right about that,” Angela said.

I agreed. Despite our varied backgrounds, we knew the stakes: Affirmative action may have done us a favor in admissions, but it certainly hurt us whenever a black student struggled.

“So who’s the third person?” I asked, referring to the white person in that group.

“Her father is a tenured professor here,” Angela replied.

“That figures,” Greg said.

As Daniel Golden detailed in his 2006 book The Price of Admission, elite schools are widely known to give clear admission preferences to the children of alumni and faculty. Harvard, for instance, admits the children of alumni, or “legacies” as they are called, at three times the rate as general applicants. The numbers are similar at many top schools. In contrast to race-based affirmative action, the beneficiaries in these instances are overwhelmingly white, a testament to the reality that these institutions were almost exclusively white during the pre-civil rights era.

“I think if it came to having to repeat a whole year, I would just quit,” Angela said.

“That would make things look even worse,” Greg said.

Over the next several weeks, I learned that minority student struggles were indeed a real problem. A college friend at another elite private medical school told me that three black students from the previous year had failed and were in her class, and that another had flunked out altogether. Other friends at different medical schools told similar stories. From what we saw and heard, white and Asian students were far less likely to suffer academically to this degree.

Our stories fit within a broader picture. The University of California, Davis (UC-Davis) medical school, ground zero for the famous 1978 U.S Supreme Court decision (Regents of the University of California vs. Bakke) which supported the use of race as a tool in admission while striking down numerical quotas, conducted a twenty-year study of admitted students from 1968-1987. Those admitted under special consideration, meaning that traditional admissions criteria were not used in reviewing their applications, were far more likely to be black. They got lower grades in medical school and were more likely to fail their general medical licensing exams compared to students accepted under general admissions criteria. On the other hand, the students in this special consideration group graduated in similar numbers and ultimately achieved specialty board certification at comparable rates.

Defenders of affirmation action say that these studies of medical school classroom-based performance do not predict one’s success as a physician; they argue that practicing medicine requires far different skills than sitting in a classroom and circling or clicking multiple-choice bubbles. And perhaps they are right. No one can define a good doctor in the precise ways that tests identify good medical students. As Robert Ebert, the dean of Harvard Medical School from 1965 to 1973 who oversaw the school’s implementation of affirmative action asserted: “the purpose of medical education is not to pass the National Boards with the highest scores, but to send out physicians who answer the needs of our society for excellent care and quality research. A good doctor has nothing to do with how well he or she did on a test.”

Yet this probably offered little consolation for the two black students who’d been forced to repeat their first year. It is often said that the hardest part of an Ivy League education is getting admitted. But for a significant group of black students, surviving medical school is a real hurdle.Some critics of racial affirmative action, such as Supreme Court justice Clarence Thomas, contend that “stigmatized” black people are the real victims of racial preferences. Those in Thomas’ camp assert that these black students’ failures are largely due to a lack of adequate preparation or mismatch between the student and the school they attend. Affirmative action supporters, on the other hand, are more inclined to believe that social aspects – such as feelings of cultural isolation faced by otherwise qualified black students – play a larger role.

During those first few months, as I was living the experience that so many had talked about in abstract and intellectual terms, I feared that both factors were working against me. As a black man from working-class roots and a state university, I worried about my future at Duke. Was I destined to become another academic casualty?

**********
My racial anxieties intensified after Dr. Gale asked me to fix the lights in his classroom. Clearly, he didn’t see me as a Duke medical student, nor was I confident that I could succeed at this level. According to Shelby Steele, a self-described conservative black scholar at Stanford University’s Hoover Institution, this is one of the costs of affirmative action: it “nurtures a victim-focused identity in blacks” and increases their self-doubt as “the quality that earns us preferential treatment is an implied inferiority.” Steele makes some valid points, but his theory did not predict how I responded to Dr. Gale.

That way I saw it, confronting Dr. Gale about the incident seemed like a bad idea because he had final authority over my grade. What would I say to him? How would I expect him to react? Likewise, I felt that reporting the incident to a medical school administrator would prove futile, and possibly even damaging to my future at Duke. His words hadn’t been blatantly racist, and I envisioned that his middle-aged white colleagues would have had trouble understanding how I had interpreted them that way. These influential people were likely to perceive me as a hypersensitive, borderline-militant black male looking to make everything into a racial issue. Given my innate aversion to controversy, that wasn’t the reputation I wanted.

Further, if I complained to the administration, exactly what result would I have sought? For Dr. Gale to give me a formal apology? To all black students at Duke? Would I have wanted him to be forced into racial sensitivity training? Or something more serious, such as suspension or removal from his teaching duties? I couldn’t imagine any of that happening; all I could foresee were future repercussions against me if I was labeled a racial agitator. If that was the power to be had from exposing this encounter, or identifying myself as a victim, then I wanted no part of it.

Given Stan’s and Rob’s reaction to the incident – laughter – I doubt my other black classmates would have acted differently. And yet, I was furious. I had to do something with that energy in my own way, to show Dr. Gale how wrong he’d been. So instead of taking my case public, I turned inward and did what any good medical student knows best: I studied my ass off.

Day after day, I spent just about every waking hour with textbook in hand. I was determined to prove to each of my professors – but especially Dr. Gale – that I wasn’t a token student admitted to medical school by accident or pity. After class, I headed straight to the library, reviewing my notes and rereading the material until the wee hours of the morning. No matter how enticing the invitations to take a break with classmates, I declined. For those next several weeks, I slept only three or four hours each night.

Other black doctors have traveled this same terrain. In his memoir, Brain Surgeon, Los Angeles-based neurosurgeon Keith Black recounts a similar episode during his medical school years at the University of Michigan in the 1980s. While working under a young physician he perceived as racist, Black was assigned to present a case to the chairman of the department. He prepared more diligently than ever before. “Obviously the chief resident was going to be gunning for me,” Black wrote, “but I decided that I would not live down to his expectations. It was time to stand and deliver.” Black warded off his supervisor’s attacks and impressed the chairman so much so that the chief resident was forced to give him the highest evaluation possible, setting Black on his path to neurosurgery. Ben Carson, in his first memoir, Gifted Hands, tells a remarkably similar story from his medical internship of his perseverance in the face of a chief resident from Georgia who “couldn’t seem to accept having a Black intern at Johns Hopkins.”

In the days after our final exams, a nervous energy again pulsed through our class. With our single-minded perspective, many of us attached the same importance to these results that a patient might to a skin biopsy or blood test. When word spread that the scores has been posted outside the main administrative office, dozens of us crowded around the 10-point font print-out stapled inside a large, sliding glass case, as if the NCAA basketball selection committee had just listed the names of its invitees to its annual March Madness tournament, and we were trying to find out if our team made the cut.

The report identified us by a number that had been given to us individually to maintain confidentiality. Along with our separate scores, the printout showed the class mean and graphed our results on a bell-shaped curve.
“There are some gunners among us,” a classmate mumbled to her friends.

This word, gunner, slang for a hyper-competitive student, was new to me. All of us were overachievers in a broader sense, but it was socially unfashionable to appear too ambitious.

Ordinarily, I might have cared about that distinction, but I was too preoccupied with proving myself to Dr. Gale. I knew I had done well on his exam, nonetheless, I was surprised by the result: In my class of one-hundred students, I had received the second highest score.

Since the final counted twice as much as the midterm, I hoped that I had earned Honors, the grade reserved for the top ten or so students, even though my midterm score was nowhere near the top. I carried my exam to Dr. Gale’s office during his scheduled student hours to find out the verdict. His cluttered office was open for visitors. We were alone to hash out my fate.

This was the first time we had stood face-to-face since our exchange a few weeks earlier. His eyes darted away for an instant as he tugged at his shirt collar. I knew that he recognized me. Surely, he understood that our initial interaction was at least potentially insulting, if not something more. Were the roles reversed, I would have apologized profusely – if not at the time of the mix-up, then definitely the next time we spoke. But Dr. Gale clearly had no such plan.

“How can I help you?” he asked.

I gave him my midterm and final exams and asked whether I had met the cutoff for Honors. His eyes widened as he looked at the final exam score. He removed his glasses and squinted before putting them back on to make sure his vision was not failing. He then stared at my ID card, to see if the name on the exam matched the one on my Duke badge.

“Wow,” he said, unable to conceal his astonishment. “I am very impressed that you scored this high. You’ve definitely earned Honors. You have absolutely nothing to worry about.”

I had imagined this moment from the time I turned in the blue exam books the week before, playing out all the pointed things I might say to put him in his place. But now that it had arrived, all I could do was stand there mutely.

“Congratulations,” Dr. Gale said, his excitement showing no signs of dimming. “This is really incredible. Are you interested in doing research in my lab?”

In just a few weeks, I had gone from pariah to prize pupil. This unmitigated praise felt like another aspect of Stephen Carter’s “best black” syndrome. The stereotype of black intellectual inferiority was so ingrained that for a black person to do as well, or better, than whites and Asians, they had to be “exceptionally bright” – earnest admiration and condescension wrapped in the same package.

I thanked Dr. Gale and told him I would consider his invitation, although I had no intention of doing so. I wanted nothing to do with a professor who could be so dismissive of me one moment, only to change his mind without apology, as if his earlier comments could be erased like chalk on a blackboard. I left Dr. Gale’s office – the last time I ever saw him on Duke’s vast campus – with a confused mixture of pride, relief, frustration, and bitterness. “Are you here to fix the lights?” stirred then – and still today – each of those emotions.

In the nearly twenty years since that episode, Duke has made clear strides on the racial front. Under the direction of admissions dean Dr. Brenda Armstrong, Duke has become among the most racially diverse private medical schools. Many of Duke’s black graduates have gone on to specialize at highly competitive programs nationwide. Perhaps my success and that of others has enabled certain professors to embrace something once unimaginable.

At that time, however, I had no concerns for future black medical students. My victory was strictly personal. No matter what else happened, I had proved to myself, Dr. Gale, and any other doubters that Duke had not erred in accepting me. It didn’t matter whether my classmates were Asian or white, had gone to Stanford or Princeton, or had parents who were surgeons or law professors. I could keep up with them, and rightfully assume my own place as their peer. Affirmative action, despite its flaws, had worked. I had held up my end of the bargain.

But the good feelings didn’t last long. As I transitioned from the classroom to the clinical setting the following year, I was about to witness the greater struggles of black patients play out before me.