It was 8 AM and I was reviewing the slides of the cases that were removed by the surgeons from the day before. My duty as a first-year pathology resident was to pre-view each slide and order any additional studies that may be needed to render a diagnosis and complete the case. I would then sit at a multi-headed microscope with my attending pathologist and give him my interpretation. Depending upon the complexity of the case and body site, the attending pathologist may ask me to show the case to another pathologist with expertise in that particular organ system. The most common intradepartmental referrals were to the neuropathologist (brain and nerve pathology), hematopathologist (lymph nodes and bone marrow), and dermatopathologist (skin pathology). This collegial professional environment first attracted me to pathology since it required humility and self-confidence for any surgical pathologist to admit they could not be a master of every disease within every organ.
During this morning’s case reviews, the department dermatopathologist, Dr. Jake Lee, strode by my desk. “Hey, Paul. Got any interesting skin cases you want me to take a look at?”
I smiled and nodded. The entire pathology department always deferred to Dr. Lee’s expertise in skin pathology. Even if the skin biopsy was quite routine, all of the other attending pathologists would insist that the residents show the case to Dr. Lee for his diagnostic blessing. In the decade of the eighties, within this mid-western university medical center, Dr. Lee was the only Asian attending pathologist in the department. Being one of the two Asian pathology residents, I felt a kinship with him, reciprocated by his amicable nature. One of my skin cases was very difficult with a complicated medical history. Although I had yet to show the case to my primary attending, I had no doubt that he would ask me to review the case with Dr. Lee.
As Dr. Lee and I peered at the slide together through a double-headed microscope, it was clear that the case had piqued his interest and after several seconds of conflating the histopathological features of the skin biopsy with the clinical history and physical examination findings, he rattled off a list of obscure differential diagnoses, before narrowing it down to the final diagnosis. Once again, I was in awe of Dr. Lee’s expertise and elated to save some time by bypassing the usual triage process.
By 1 PM, my primary attending, Dr. Smith, had entered the signout room and I joined him with my trays of microscope slides at the multi-head scope. The first hour was uneventful as he reviewed my cases and made insightful comments about how I could improve my observations, suggesting additional tests I could order to better define my diagnosis. We then arrived at the skin biopsy. As I read the complicated history from the requisition sheet, Dr. Smith nodded as he reviewed the skin biopsy. I was surprised. Perhaps he did know the diagnosis? A few seconds of silence passed between us and he looked up from the microscope and smiled. “Well, I don’t think I am going to get very far with this case. Why don’t you show Dr. Lee this case?
Yes, I thought!
“Dr. Smith,” I began. “Dr. Lee has already reviewed the case and he thought it was an example of a Sweet’s-like hypersensitivity reaction secondary to the colony-stimulating factor medication he was receiving after his induction chemotherapy for leukemia.” I proudly regurgitated what Dr. Lee told me. I was expecting a compliment from Dr. Smith, instead, I received a cold stare. He pushed himself away from the microscope and snarled at me, “If you prefer to sign out with Jake, go ahead!”
I was stunned by his reaction.
“Dr. Smith, I don’t understand…I..”
Before I could finish my statement, Dr. Smith interjected, “You obviously prefer to be with your kind!”
My eyes opened wide in horror as my sensibility snapped.
“What do you mean, ‘YOUR KIND’ ?” I glared at him, my entire body shaking.
Dr. Smith immediately realized his blunder and attempted to back it down, but it was too late. “I…uh…no, I didn’t mean anything by that.” He fumbled with his words. “I just meant…that you obviously feel more comfortable signing out Dr. Lee than with me….so maybe you should just sign out all your cases with him.”
Now I was shouting. “NO, Dr. Smith. I am always happy to sign out with you or any attending pathologist. You are the attending pathologist I will first show any case to but Dr. Lee just happened to walk by my desk and he asked if there were any interesting cases for me to show him.” I tried to calm myself down but my voice was still quivering. “HE asked me to show the case to him.”
Over thirty years ago, such politically incorrect statements were not uncommon, particularly within the minority deficient medical center and training program where I was situated. Yet Dr. Smith’s statement was over the top. It revealed his intense insecurity over his own diagnostic abilities and obvious jealousy that he harbored for Dr. Lee. Needless to say, the remainder of the signout was frigid and in the end, Dr. Smith abruptly stood up and left the room, without saying another word or issuing an apology.
Racism has existed since the beginning of mankind. Although there were traces of racism in Hawaii, where I grew up, the multi-cultural and ethnic diversity on that small Pacific island population always served as a social damper because of the continued integration. Few ethnic groups ever felt denigrated to minority status. It was only when I began my pathology residency in this midwestern university teaching hospital that I began to be keenly aware of my minority status. This was reinforced by several racist encounters, including this one.
There is neither Jew nor Greek, there is neither slave nor free, there is no male and female, for you are all one in Christ Jesus.
Galatians 3:28 (ESV)
Racism is an oxymoron. There is no superior race amongst many, there is only one, the human race. We are all created in God’s image. We can choose to fan the flames of prejudice and focus upon perceived or imagined differences or we can embrace our diversity and look beyond our human relationships to our higher calling. In Jesus Christ, all of us are equal, sanctified and justified through faith in His Name. We are equal because we are all sinners, in desperate need for a Savior and redemption through the death and resurrection of Jesus Christ.
Yes, I do want to be with my kind. I want every person of all ethnicities and cultures to freely and willingly accept by faith, Jesus Christ as their Lord and Savior.
Love and trust the Lord; seek His will in your life.