The girl from Santa Rosa was across
from the nurse’s station in a shared room with three beds where, it seemed to
me, shit happened and none of it good. Like sailors, nurses are a superstitious bunch. If you talk about having an easy shift it will quickly get more
difficult, that’s the kind of thinking that can be common on a hospital unit. If you say something like, “No admissions yet,” you’ll suddenly see a gurney
rolling through the doorway. The problem, we think, is an unlucky room or ICU bay,
it’s haunted, ghosts of patients past. But this child’s room wasn’t really unlucky, just problematic, partly because there were three beds and more patients,
potentially, to go bad. This isn’t about logic, however, it’s about nursing. The child’s right eye was bandaged.
There were bandages on her scalp as well. Brain surgery, literally, she was a
couple of days out from the procedure and what they said in morning report was that something went wrong during the operation. More important she was in that
unlucky patient room. It could get worse and was going to. Part of the problem
that day was my fault, to be fair, not knowing the Children’s Hospital
physicians very well or how to handle them, which is just as important as
managing the patients.
My first day in the newborn nursery
in Minneapolis another nurse told me that my job was to “take care” of the
doctors working in the nursery as well as the babies, there was a component to the work in other words that had nothing to do with patient needs. It turned out not only to be true, what the other nurse said, but for
the first week of my orientation the
attending pediatricians were all there and you could tell they were testing me
to see if my instructions had included the vital information that their care was as important as anything done for mother or baby. Go
and get that kid from mom’s room, for example, one doc said, this child needs a
tube put down for feeding, another told me, for that baby we want to send blood—it doesn’t matter what you’re doing, you can do that later, after
you do this for me. That sort of thing. Forewarned is forearmed. At UCSF it was
like that too—only more so, because as a research institution everyone took
themselves more seriously. Nobody really told me but it was something you figured out on Mount Parnassus.
In the same room where the Mexican
girl would be, one night there had been an infant, early in my stay at UC, who had
surgery to straighten plates in his skull that were overlapping.
Craniosynostosis, it’s called—not that that matters here. The kid’s head was also
in a bandage and there was a lot of swelling, a lot of drainage, every few
hours the dressings had to be changed which freaked out the parents and me. My
idea, which was not an original idea, was to get the neurosurgery resident on
call to take a look and reassure me and mom and dad. Through a series of phone
conversations it became clear he didn’t want to come to see the child and in
like the third call it became clear why: he wasn’t on campus. He was
taking call at somewhere home in the city and seeing the patient meant getting dressed and coming
into the hospital in the middle of the night. “There was a lot of swelling,” he
told me, recalling rounds during the day, when he last saw this kiddo, “and as
the swelling goes down the extra fluid is draining.” He gave me something to
work with, gave me something to tell the parents and even gave me a clue about
the institution, the University of California at San Francisco, UCSF for short, which was that
the pediatric neurosurgery resident on call may not be in-house, a way of doing business that
was new to me. And he was right. He was a smart guy, which UCSF has a lot of,
guys and girls, and the rest of the night was happily uneventful. The swelling
lessened. Saw the kid and his parents sitting at an outdoor café a couple of weeks
later in Outer Sunset and the baby looked great. Good work
by the surgeons. So the resident was right and that’s the primary rule of
healthcare: if the outcome is good don’t question the call or the person who
made it. But that’s something you have to learn as a new nurse, not whom to call but whom not
to call and when not to call him, or her, and they don’t always tell you that
in new nurse orientation. Each facility has its own culture of care and
caution. You have to feel out the situation and get an idea of the hospital
environment. If you're a nurse sometimes you do have to insist, yes—whatever that culture is.
Another kid in the same jinxed room
transferred over from intensive care and spiked a temperature, almost 104, the
kid was getting something for fever but he had a tube in his chest to drain fluid, and some other
things going on, and my insistence that the resident come and look, literally step ten feet across the
hall from the doctors’ freaking charting area, was met with resistance. This time the doctor wasn't off campus, he was sitting at a computer a few feet away. That’s
life in any hospital today, everybody is busy, you have to make it good and you have
to have not just an understanding of a young doctor’s responsibilities but what his or
her life as a medical resident is like, which can be brutal. This particular second-year was a cocky white guy, which did nothing to elevate him in my esteem, and he made clear he didn’t have the time or interest to see this child. He didn’t look busy, actually, or harried, just unconvinced of the urgency. My concerns were unfounded,
that was his response and he took longer saying it than he would have taken
going to see the patient. The impasse developed into a kind of struggle of
wills, nursing versus medicine. Surprisingly, nurses have a pretty good record in those kinds of contests. Strength in numbers, you could call it. Doctors are not afraid of individual nurses but they are afraid of the institution of nursing because physicians are outnumbered and they know it.
Anywhere else my patience would
have been more limited. 104 is a high temperature whatever is going on,
especially for a child, and my normal operating procedure would be to call whoever
was next up in the feeding chain, a third-year or senior resident or attending physician if need be, and
anywhere else it would have worked but UCSF was not like anywhere else, or
not like anywhere else in my nursing experience which was not great but was
considerable, certainly more than this resident’s time as a
doctor. Did my concerns about the patient trump his knowledge about the disease process? Isn’t that the real question? Who was more likely to know what he was
talking about? My concerns as a worried nurse were more rooted in scientific knowledge than his lack of clinical concern as a second-year resident. This was a learning moment for both of us, he was teaching me that there was a higher level of acuity at this hospital, while my lesson for him was he needed to listen to the R.N.s. The physicians were more
important at UCSF, self-important even, sometimes even the residents—certainly
more important than the nurses, that’s true everywhere and should be—but
these doctors were also more important than the patients, it seemed, and in an
obvious and troubling way. So, like, the resident finally gave in. He got tired of me
bothering him. He went and gave the child a quick look that reassured the mom
and the nurse. It also allowed me to chart that the physician was called and
saw the patient, which covered my ass if things went wrong later. Although that wasn't my concern at the time. It is about covering your own ass sometimes but not
entirely. If patients are getting good care you don’t have to worry so much
about what the Nursing Board might say later. The right care usually means
catching problems before they become problems, especially with children because
you have less time to respond before a bad situation gets worse. The bottom
line is that a nurse has to be able to call and get a physician to come and
look at a patient, for whatever reason, and when that’s not true the system
breaks down. We don’t have much power but we do have that power. Except apparently—my suspicions were starting to grow—at the University of California
San Francisco.
Again, this wasn’t original
thinking on my part. No. We had a mandatory nursing in-service not long after
my arrival and after whatever issue that necessitated the meeting in the first
place was discussed and disposed of, a kind of general bitching session followed,
nurses ragging the doctors, which is very often what nurses do, we rag MDs. And seated around me that afternoon were some very bright and well-educated R.N.s and the ragging was high-level. Then something was said that kind of woke me up in the back
row.
“These are very powerful
physicians,” one of the senior nurses told the meeting, speaking of UCSF faculty, “and they don’t want to listen.”
My feeling at the time was yeah,
kind of—sort of—maybe it’s true, maybe not, because the nurse’s motives
are not always pure although that's what Hollywood tells us. That's the propaganda about the profession. And just because a R.N. says something
should or shouldn’t be done and the MD disagrees doesn't mean the doctor is an arrogant asshole, although he or she may well be. The nurse is not always
right. Sometimes the physician doesn’t listen, that’s true, but sometimes it’s
because the doctor has heard it before or has already considered whatever
issue the nurse wants to raise and doesn't want to go over it again. A neurosurgeon can spend eight years as a
resident and a fellow. That’s after
four years of medical school. There’s a good chance that he or she has already
considered whatever issue the R.N. is raising, the doctor just doesn’t feel it’s
material, doesn’t feel it’s important in this particular case. It was my experience that if you had to count, the doctors were usually right in disagreements with
nurses. Maybe by a 6 to 4 ratio, but it’s the 40% they write
screenplays about, starring a noble nurse. Consider the resident that night
describing the drainage from the baby’s skull—he was right. My question was
valid but he knew more. He didn't need to come in that night, especially if he had surgery in the morning which he probably did. The physician does need to listen,
yes. As it would turn out though, and this is where we’re going here, nurses do too.
The girl from Santa Rosa was in the
haunted room together with her family and none of them spoke English except the patient herself. The
explanation given to me in report was, and this is not a scientific explanation but was enough background for me to take care of her, some kind of
irregularity in the blood vessels in her brain and that in the course of
correcting that problem, a couple of days previously, the surgeons hit an artery feeding her right eye. Which was why it was bandaged. Which was also why she was still in the hospital.
The day was busy. The middle of a morning shift on a
weekday meant that everyone was there, especially the attending physicians, and
tests were being ordered, procedures getting done. The girl from Santa Rosa was
my easiest patient. Pain medicine maybe, or antibiotics, yeah, she was there for an IV, but she was already up
and moving around so there wasn’t much that needed to be done. The dressing
change was simple. Her family was there to care for her as well and we were all
basically waiting to talk to the ophthalmology team that checked her vision and after they came back with results she would go home. They were humble
people, the family, awed by the great Children’s Hospital and
grateful for what was done for their child. They communicated that to me. It
was a bad day for me personally, busy as hell, but the family was a joy and
they liked me because they could talk to me which is a pretty big deal, whether
it’s a question of a foreign language or non-verbal communication with another culture. On every shift somebody in the family has to be
able to understand.
So, like, in this case there was no call
ahead of time. The ophthalmology team just showed up to speak with the girl’s
family. That was okay. If you counted the times the physician called ahead and
told you he or she was coming and would need you, compared to the times they didn’t, this was
business as usual. One moment the docs weren’t there and the next moment they
were. We’re not assistants but we’re here to assist. Drop everything and go see what the physicians need.
They asked the father or
grandfather, an older man who looked like he was too old to have a 12-year-old
daughter but was nonetheless the senior figure in the room, deferred to
by the rest of the family—the doctors asked him and the mom to step out into
the hallway. The ophthalmology team was two young white male residents and a
thirty-something white woman who was the senior resident, or she may even have been the
attending physician, the big dog, the boss. She came out into the hallway and
asked me to explain something simple to the family. So far, so cool. You didn’t
have to be there to imagine the scene: two family members, three white coats
and a nurse in blue denim scrubs who was me. We’re standing in the middle of the hallway,
people passing by, not Market Street kind of foot traffic like downtown but busy enough and
the father, if he was the father, looking back and forth between our faces
because he knew something was wrong before being told. Which was, like,
more than the nurse knew. The older gentleman knew more because it was his child. There’s no
other way to explain it. He was more attuned, you might say, even despite the
language barrier. While it was unclear to me yet what this was all about. The
patient needed more tests would have been my guess at the time, that would have been what
the lady doctor wanted translated because the lady doctor was in a hurry and she said she
just had something simple to tell the family. “We need her to stay in the
hospital another day,” something like that would be the message, that was my expectation. The attending signaled to me again
they were in a hurry. If you have something to say to these folks—this
was my subliminal message in reply to her—let’s rock and roll.
“Tell them,” she said, “that she’s
lost the sight in that eye and she won’t get it back.”
Even though the physician was
speaking English it took a moment for me to process. Actually it
wasn’t a message at all, it was more of an event. Kind of like a car
accident, something bad happening except in slow motion and at first you’re
powerless to intervene or even understand. That
was what she wanted to tell the family? Standing in the hallway? My every effort was directed at keeping an expression of shock off my face. Should we push them to the exit after that? Like, tell the family to pack up, back to Santa Rosa, we need the bed for somebody else?
That seemed to be the natural follow-up to this particular physician’s
approach. Oh hell no was my feeling at the time, not as a noble nurse but as an ordinary human being.
“Excuse me for a moment,” my
actual response, keeping cool not for the physicians but for the family. The
family, it seemed to me, was about to be stressed enough. The lady doctor
didn’t look happy at the delay but her posture relaxed and then slumped as she went into an
energy-saving mode, to give me time to do what had to be done. From my earliest training the instructors taught that a nurse's primary responsibility is not to the physician, not to the hospital, but to the patient. Nursing instructors beat that into us often enough that it became instinct. My first call was to the house
interpreter and luckily he wasn’t busy. He said he’d be right down. The guy was
from Argentina not Mexico, two countries a long way apart geographically and culturally but he would still do
better explaining the complexities of the situation as well as doing a better
job with the subtleties of the language. Tact was in high demand and the Argentine
guy had it even if the MDs did not. It’s also sometimes called cultural competence which is closely
related to language skills but not the same thing at all.
Next there was a quick search for
an open office. There was a conference room they could use. At my prompting everybody started moving that way. Except me. The right thing to do, as a nurse
and as a human being, was to follow everyone into the meeting and be there for
the family. This was also Nursing 101. My feet just wouldn’t go. For me
there were two conflicting emotions, rooted respectively in my profession and
my race. My feelings as an African-American were actually the simpler of the
two. On that level, as a black man, this was wrong. It was so wrong it was
embarrassing to me personally. The race card that everyone talks about actually has two faces. White people often speak about minorities “playing the
race card” or saying something is racially motivated when it is not, but you’ll
never convince me that this was not a racial
or ethnic slap in the face for the family from Santa Rosa, intentional or not. Nothing could convince me even years
after the fact, with cooler emotions in control and giving the hospital the
benefit of the doubt. No way: if this were a white family or a family of any
resources, especially one whose members spoke English, the physician would not have been trying to break the news in the hallway because she was in a hurry to go and
do something else. That was my view at the time and it’s my view now. Even in
healthcare in this country—especially in healthcare in this country—there’s a
racial and class component that is ugly, if you look too close. The
ophthalmology team was giving me a microscopic view and it made me ill.
The team would have called ahead
for me to arrange for a social worker, for a white family or a wealthy one. The people responsible
for the “adverse event,” which is what they would have called it—“misfortunate occurrence,” they might have said as well, speaking to the family—the surgeons, would have been there too. At that time San Francisco was already filling up with
high-tech families, the beginning of the migration to the Bay Area that is so much in evidence today, people working in Silicon Valley, at Genentech, Google or wherever—Facebook—and these digital parents would have been shocked and horrified even if
you had a priest present and the hospital chief of staff in the room. If the message
was that their perfect 12-year-old just lost use of an eye? Due to a surgical slip? And would need a prosthesis? Please. Imagine how that conversation would develop and it wouldn’t have started in a hallway. Even if you didn’t get around to the prosthesis. If the patient was white and/or affluent that would be the risk, the certainty
in fact in the back of the mind of any doctor. This is going to be ugly. How
we as an institution handle this is critical for the child’s healing, that might
have popped into his or her mind as well. The hospital would have prepared for
a scene. White people or wealthy people or the educated would not be getting a quick conference standing in foot traffic, followed by a bum’s rush to the
door. Culture is a matter of
perspective and of history and African-Americans often see events in terms of
race, yes, because we’ve been there, even when it’s happening to someone else.
We’re like that especially about healthcare. Because our experience is that
outcomes or the sequelae of outcomes are not evenly distributed. It’s not the
bell curve that scientists like to talk about. It’s much more skewed than that.
Something kept me from following
the family into the conference room and even at the time it was clear to me that it was shame.
Not because a mistake had been made
in surgery. No way. Shit happens, that’s the danger of any procedure—that is the danger of life itself, shit happens—and in the hospital there’s a
reason why you sign a consent recognizing risks. Regarding this
child from Santa Rosa you didn’t even have to consider the worst motives either, like they had tried an experimental approach on a charity patient or the
attending surgeon let the intern do something he or she wasn't ready to do. You didn’t even have to go there. Let’s keep it simple—a mistake
was made, however it happened. What was shameful was what followed. Healthcare
in this country has many of the same pitfalls as every other aspect of our
culture, and the same class issues, including that the poor
are treated poorly, it would never be clearer to me than that day and
the following days on 6 Long. And it would turn out that some of the
worst offenders had “R.N.” after their names. That’s heresy, we all know, doctors
not nurses are the bad guys, witness the girl from Santa Rosa.
But even in her case the fault was mine as a nurse who lacked moral courage—not going into the room to
hear the bad news with the family. Not calling for a social worker. Not calling
my supervisor. Oh well. We live and learn, on a nursing unit like anywhere else
all you can do is promise yourself you’ll do better next time. And
unfortunately that opportunity soon presented itself, in the person of another
kid who was my patient post-op.
The procedure was successful and
the family was headed out, it was their last day in the hospital, again with me
as the nurse. So, like, doing my assessment the kid was maybe ten years
old and had thick beautiful brown hair like his dad who was in the room with
him and another sibling. And you couldn’t help noticing that on the back of the
patient’s head there was about a two centimeter long plug of hair missing.
The scalp was exposed and bald. His other hair was long enough to fall over the
spot but if you tousled the back of his head the bald spot was obvious.
“They said he was lying too long
on the surgery table,” the father answered, “without being moved.”
“You mean here, in the hospital?”
Which was a dumb question but was asked anyway. In an assessment the
dumb questions can be the most illuminating.
“Yes,” the dad answered.
Everyone thinks California is
super-sophisticated, cutting edge and ahead of its time. Some of that
reputation may have faded after the most recent meltdown, or the latest outbreak of dysfunction in Sacramento, but outside some selected
areas of the state it’s never really been true. If you look at the coastal counties like Los Angeles, San Diego, Santa Barbara, San Francisco, okay, but the inland
counties can still be small-town agricultural communities like Santa Rosa,
populated by people who don’t think of themselves as somehow better than anyone
else. Like small-town Texas which is my ancestral home there’s still some humility left—and a
few Bubbas, yeah, even rednecks, let's be honest here. Cowboy hats and pick-up trucks with gun racks,
people who may have many failings but feeling superior isn’t usually one of them.
This dad was white, the family from
a small town, and they too were grateful and awed by the great hospital that had taken
care of their child. They didn’t want to complain about any mistakes.
“We didn’t want to make a big deal
about it,” the father said.
He said the surgeons told him that
there had been a delay or the procedure took longer than anticipated, something
like that, and the pressure of the weight of the boy’s head, without being
moved, under sedation, had caused the bald spot. Someone should have adjusted his position when
he was under anesthesia. Like the girl who had lost her vision, this dad said he was told
the hair wasn’t coming back.
It wasn’t the end of the world, no.
But it was a big deal, yeah. At any of my previous hospitals these would have
been mistakes that would have made management stop and examine procedures. Heads might or
might not have rolled but certainly something would have been done. UCSF was
already the most-dinged hospital by the California Department of Public Health, mostly because of surgical mistakes like leaving sponges in patients, but that
was not the real cause of the problem here. Not directly. It was the culture of the institution that was
problematic, like that senior nurse said in the in-service. And it’s only
through speaking up that things change, she also said. There’s the rub. Because
speaking up can be dangerous which is what this is about or is going to be
about. There are always consequences for speaking up, you have to know that ahead of time, before you raise your voice. You can't challenge a lion in his den and expect to walk away unscratched.
Usually nurses still do it. We
still speak up. We’re the people who the public relies upon after all. The
public doesn’t necessarily trust the doctor but relies almost instinctively on the
nurse, to have the patient’s back. Patients and patient families assume you're on their side and most of the time you are. That was the formula that had been instilled
in me in nursing school and it turned out to be the formula in practice in the
hospital most of the time. An example: At the county medical center in Minneapolis before my transfer to the nursery, we had a new
surgery team on call and the senior resident, a young white woman with a less than
adequate bedside manner, showed up a couple of times as night shift ended, to do her morning
check of the post-op patients, prodding and probing without giving us a chance to
pre-medicate the kids, to give some pain medicine to make their
experience of the doctor’s exam a little easier. A couple of these munchkins were crying
when the surgical team finished rounds. This was a county hospital, mind you, it’s
important to remember, which meant many of the patients were indigent, poor
families or foreigners or both, Minneapolis as a community accepts a lot of
immigrants, Somalis, the Hmong, Peruvians, whoever, a lot of immigrants from Puebla for whatever reason, and you got the feeling this resident
would have shown more concern if she were at Minneapolis Children’s Hospital
where the families with money or insurance were treated. So, like, we told our
clinical manager Julie and the very next morning she came in early and was
waiting to ambush the surgical team at 6 a.m. when they came away from the patients.
“You will call the unit,” she said to the senior resident, “a half an hour before rounding to give the nurses
a chance to administer pain medicine before you touch the patients.” The way
Julie said it was professional, close to the senior but not up in her face, a
firm voice making clear that there would be no argument. And there was none.
Because mistakes happen at any facility. And the resident wasn’t a bad
person, she was just in her concentration mode, which doctors go into, especially surgeons, probing the wound and tuning out the crying. Or the crying was just more
information to process, to tell her about the healing: “So it really
hurts when I press here?” For me the difference between Minneapolis and
San Francisco was that you didn’t get the feeling at UC that there was
recourse for bad practices or for bad news. The cutting edge of
healthcare science, as the University of California advertises itself, leaves some unintended
casualties along the way, collateral damage, risks
that exist in healthcare as well as on the battlefield. This time would be different
though, that was my pledge to myself. This time, with the child missing the plug
of hair, something had to be said, something needed to be done. The system had
to be mobilized and my feeling was, based upon my prior experience, my three
prior trips through nursing school—the nurses were the way to
go. So, like, there was a master’s trained Clinical Nurse Specialist on 6 Long who served as a resource for the staff. She’d been there a
while, knew a lot and had her own little office where she worked on protocols
and procedures and the like. Take it to her., that became the plan.
Me and another nurse went to her
once when the physicians wanted us to stick a tube into the bowel of a kid to get
some gas out. The tube looked kind of long and neither of us had done anything
like that before and we had, well, some doubts. Like, should we be doing this
at all? Because we knew the first question the investigator from the Nursing
Board was going to ask would be, “What were you thinking?” and you wanted to be able
to prove you were thinking something,
at least, so we ran the request by this lady, the Clinical Nurse Specialist, and she
was completely cool with it. She drew a little diagram for us, comparing the length
of the bowel with the length of the tube and said, yes, the doctor is right,
don’t be afraid, there’s a lot of room up there, you’re just decompressing the
bowel. And everything went well, there was a big fart and after that the
lady with the master’s had our trust. So, like, going to see her
about the kid on the operating table too long, who'd lost the hair, was the way to
go, it seemed to me. But this time it was a different woman sitting in that
little office. She had the same face, yes. The same plus-sized, under-exercised
middle-aged nurse who looked like a lot of us do, like a lot of R.N.s, actually, like she
needed more time at the gym, or needed more sleep, and definitely needed less
time at work. She looked tired. Really, she was the same woman. Only the
eyes were different. Her eyes now were—kind of—dead.
She listened to my rap about the
kid and my expectation was that she would start the paperwork, tell me who to
talk to, maybe begin the incident report. Get the administrative ball rolling,
so to speak. Go and look at the child, for example, as a place to start. My
expectation was outrage—the good kind, that brings about change. Like my old
boss Julie with the unfeeling senior resident. But that was in provincial
Minneapolis at a county hospital where people are less sophisticated. That was the Midwest with boring old-school Scandinavians not the Left Coast, home of the super-cool. It
would have happened in Austin too, at my first pediatric hospital, or in
Galveston at the second. But in high-tech high-power San Francisco the doctors trained with God, and none of that happened. This nurse
looked too tired to care. She gave me some half-mumbled, half
thought-out directions, and then her door closed with me standing outside.
The last look on her face is what struck me most. Completely jaded, tired and
beaten down, not like it was a bad day but like it had been a bad while or she
had just been there too long. When she helped me and my co-worker earlier, that was an outlier,
something she knew something about, an outcome she could effect as a teacher. A measurement, literally, conducted within the bounds of good practice. A surgical error was
something else. Her facial expression this time concerned me more than
before because it conveyed two possibilities, both of which were bad: Either
that mistakes like this happened all the time—or a patient being
left too long on a gurney was the least of her worries. Frankly, leaving her
office, you didn’t want to know which. So,like, there’s an obvious temptation
to blame this city, certainly. Baghdad on the Bay. San Francisco is a tough
town, no doubt. Shit happens on the streets of the big bad city. My own family’s
experience proves that. My gangster grandfather was actually the first of my kin to pass
through San Francisco and the city made an impression on him too. Not a good one. He was recruited to the cavalry, because he knew how
to ride and shoot, and after serving in the Far East he mustered out at
the Presidio in 1901. He rode back to Texas where he got into a little
trouble with the law, and then returned to California but chose L.A. instead of the
Bay Area to stake a claim.
A lot of what has been good in my
life has come from being a nurse. My earlier work was desk-bound and suddenly finding myself in a hospital, wiping asses and changing diapers, has
taught me a lot about life. Literally. But unlike the girl from Santa Rosa my experience
at UCSF didn’t leave me blind. Much of
what’s wrong with American society, the inequality, the dysfunctional social
systems and a bureaucratic apparatus that benefits white people,
and the racism, yes—nursing taught me all that—because nurses are just as
responsible for creating the system as the doctors. Ground Zero for that lesson was
the School of Nursing, so something good actually came from my tuition
after all. This is about the city but it’s also about an institution, the University of California, and a profession that enshrines inequality and hypocrisy. Bold words but as
you read on you’ll find that they are true. Back in the day, during my stay as pediatric patient at UCSF, can’t say the nurses impressed me either, or the orthopaedic surgeon, whose was
Dr. Smith, not that that is important now. What hangs in my memory was the trip to Mount Parnassus. We were living in the
East Bay, my mother and my brother and sisters and me, and it was my mother’s
responsibility to drive me to the hospital for doctor visits and the
procedure itself. We were a pretty typical single-parent African-American
household of the late '60s and the morning ritual in my home usually involved
my sisters bending over an ironing board and straightening their hair to the
sound of Aretha Franklin on the record player. That would have happened on the
morning of my final drive to UCSF as well. My mother was the
first black on the city desk at the San Francisco Chronicle, an educated, literate woman who truth be known listened to the surgeons with what, it seems now,
must have been the same confusion and blind faith as the Santa Rosa father who
did not understand English. That strikes me now in retrospect, knowing the
system, but wasn’t what struck me most then.
This was the era of the Vietnam
War. Whatever you may think of the Bay Area today it was different back
in the day. Calling it a tumultuous period doesn’t even come close. There was
race war in Oakland, where we lived, political strife in Berkeley, where two
of my sisters studied, cultural wars in San Francisco where my mother and
oldest sibling worked, and the real war across the Pacific in Vietnam. Oakland was
the army terminal for soldiers going to the Far East, shipping out and coming back, or not, and Alameda was a port for the 7th
Fleet. You can’t imagine the scene without the music. My sisters listened to anything by Aretha, or to Dionne Warwick, asking “Do you know the way to San Jose?” as they ironed
their hair. My mother was into Aretha too and we as a
family listened to any new Aretha Franklin song with the seriousness of a State of the Union
address. For me there were many, many songs as well but one especially, that came
out during our stay in the Bay Area was played so frequently that the music
lodged in my soul. “Black Magic Woman,” by Santana.
Like my Buffalo Soldier forebear, for the GIs headed east or coming back, Oakland was the point for
boarding transport or disembarking. The presence of thousands of G.I.'s and sailors with uncertain fates was a heavy burden in the Bay Area. There was
a reason even my classmates were starting to get high, everybody was on
edge, for a variety of reasons. Anyway the Navy was stationed there as well, aircraft carriers coming and going, including the most famous ship in the world, the USS Enterprise which was based next door in Alameda. Leaving for
the hospital with my mother we had to cross the Bay Bridge to reach the city and
sometimes there was one of the carriers moving on the sea below, the planes on deck
with their wings folded like birds roosting. If you counted the planes on deck coming back from the war, which is the sort of thing boys do,
there were always fewer than on the ships leaving. That’s the memory associated with my surgery, actually. Missing airplanes. That’s my earliest
memory of UC San Francisco too. For me the Mount Parnassus campus has
always been about loss, personal and otherwise as well.
CHAPTER FOUR
Life begins in Cole Hall.
Life at the University of California San Francisco may begin in a test tube for all we know, at one of the labs on campus, and it certainly begins in the delivery rooms at the hospital in Mission Bay but if you’re a student or a trainee, life begins in the main administration building on Mount Parnassus in a cavernous lecture hall where the rows of seats drop down precipitously like a classical Greek theater. My first official day in graduate school took place there, sitting expectantly alongside a couple of hundred other R.N.s gathered to meet the leaders of the School of Nursing and be cheered on in our new role as students of advanced practice. A “diversity exercise” was also on the agenda. Sitting down that morning the seats already felt warm. Presumably the new medical students were there before us and the Schools of Dentistry and Pharmacy not far behind.
The first day of school has always been one of my favorite times. Not Christmas, not necessarily my birthday after so many years have passed, nor All Saints Day or anything related to dead presidents but the first day of school which for me, over the decades, has taken place in Tuskegee, Oakland, Austin, Galveston, Guangzhou, Nanning, Nice and Dresden. There have been a lot of first school days, on both sides of the podium, teaching and studying, and as with many beginnings the bright promise of a first day of class has not always been borne out through the semester and would not be in San Francisco either. Still, in my mind’s eye looking back at myself sitting in Cole Hall that morning, waiting for the collective wisdom of Florence Nightingale and her successors to be laid out in front of me like so much therapeutic gold, including the mystic “healing touch” that prior nursing instructors promised me exists but which so far was so not a part of my practice. For me nursing school promised fun. The best part of school is buying books and supplies, loading up on thick texts and cool unlined notebooks that might remain miraculously untouched throughout the semester but nonetheless made me feel, that day, like graduate school was the beginning of a trip, within the boundaries of the City and County of San Francisco.
Anyone not knowing the UC campus in San Francisco and not knowing that the assembly in Cole Hall that day was a gathering of nurses would have been struck immediately by the distinct demographic of the attendees. Cole Hall has 378 seats and my guess would be that there were, counting students, instructors and administrators, about 250 people in the room. Of those, ninety or ninety-five percent were women and more than ninety percent of those were white. A good guess would have been a gathering of sorority sisters or a conference on women’s rights with a couple of guys present for appeaarances' sake. It was not a perfect match of race and gender, not every woman was Caucasian nor was every Caucasian a woman, there was a smattering of other races including mine—a half dozen or so people of color altogether. My sex, probably fifteen men total. Sitting there as a fair-minded black man, in Cole Hall that morning, in Baghdad by the Bay, if you turned to one side or the other there was a very good chance you’d be talking to a young white chick, not that there's anything wrong with that. And when the School of Nursing administrators showed up they were three women, two of them white. That was to be expected. The demographics and all. That's not what this is about. Or not entirely.
Sitting in the front row was a small dapper black man of about my age named Michael Adams, the head of the campus "Office of Affirmative Action, Equal Opportunity and Diversity," who was scheduled to give a short intro to what UC considered diverse and non-diverse behavior and who would also serve as facilitator for our diversity exercise. Ignore for the moment that the State of California had and still has a law limiting affirmative action and that UCSF as a public institution was bound by it and that the national fight against quotas had its first and greatest victory just down the road, at the UC medical school in Davis. Not that there’s anything wrong with that. That Mr. Adams presided over affirmative action on the San Francisco campus meant his office was reduced to just what he was about to do for us, lead an exercise. The university was not diverse but the exercise, we were assured, would be. Barack Obama’s Secretary of Education would soon be saying that schooling is the primary civil right. For us, for black people, it’s always been true. We’ve always known that what most separates us from whites is not color. During my childhood, while my mother led a peripatetic existence as a journalist, dragging six children with her in an old Ford, literally, until the kids started to peel off one by one, my family did a few tours in the Deep South at a time when Barack Obama wasn’t yet born and education wasn’t a civil right, nor much else. The first time in '61, in Tuskegee, during those days of nascent racial unrest. A Tuskegee public elementary school room was the official start of my school life, starting first grade in Macon County, Alabama. My first day in what would be a long series of first days. Repeating this now, with some pride—that made me part of the last generation of black kids to attend segregated schooling in America. It was like in a prior generation, my great grandparents for example, saying that you were born a slave but lived to see emancipation, a dubious distinction and exceptional nonetheless. You were proud to have survived, or prospered, or as William Faulkner would have said, "endured." Even if it was a leaky ill-equipped classroom set aside for the colored peoples of the earth. That fact alone and more than any other, having attended a segregated school, would influence my interpretation of the scene that morning in Cole Hall on the elevated Mount Parnassus campus.
At a young age, just beginning the first grade, segregation had no meaning to me but we lived in Alabama twice during the early Sixties so gradually the idea of race took shape, at least as the concept was expressed at Louis Adams Elementary, the colored grade school in Tuskegee. And that idea was most shaped by two realities of school life: At recess when we went out to play we had to provide our own ball. And the playground we played upon was unpaved—which meant that if it was raining, which it often does in Macon County, sometimes with a Biblical vengeance, the playground turned to mud and stayed that way for quite a while after the rain stopped. The rumor was that was not the case at the white elementary school. The rumor we as Louis Adams kids heard was that the school district provided toys and there was a paved playground for white children, something we could never confirm for the simple reason that we were not permitted to go there. The separate and unequal debate has been laid to rest by a Supreme Court ruling, you cannot have one or be one without the other, for those who have not known institutional prejudice and what it can mean in practical terms, the effects differ from situation to situation but that it has a practical effect is without doubt. This was not a mere theoretical distinction, going to a black school as opposed to a white one. To me as a kid it meant bring your own ball. That was my introduction to racial prejudice in America. Bring your own ball and hope it doesn’t rain.
My experience in Tuskegee had relevance at UCSF four decades later.
Looking around me in Cole Hall, well, this was the white school that they wouldn’t let me attend before, right?
This was in fact the whitest environment you could imagine at a public institution in a state that is, OMG, majority Hispanic and black. It was like something in the Ivy League—or a research campus in Europe, Germany yeah, Scandinavia, where minorities were few or arrived as refugees. As an American-born member of a minority group on the UC campus in San Francisco, it would be easy enough to feel like a refugee, someone alien, someone who did not belong or who was merely there as a nod to liberal sensibilities, not because of any legitimate right to study like everyone else. That’s not a chip on my shoulder, it’s a boulder. Crackers are all the same, whether it’s East Texas or East Bay, the first indication that UCSF was different in a racial sense, the same way the white school in Tuskegee was different, was not the white chicks sitting around me in Cole Hall but the walk across campus and through the medical center. Listening to the voices passing in the hallways, in the first hours after my orientation to the university, it was like being abroad. Languages have always been my hobby and what you heard in the hallways of the medical center and in the labs was interesting primarily for the lack of Spanish being spoken in a state with a Hispanic majority. This was so unlike Texas where Spanish is part of the current of daily life, on campus, in the hospital and on the street. The most common foreign tongues that fell on my ear on Mount Parnassus were French and German, and Hebrew. There was no Spanish because there were barely any Latinos, not as students, not as instructors/researchers and not as medical center professionals. And while there were many presumable Asian-Americans or Asian students and staff, none of them was speaking Mandarin, or Cantonese, at least not in the hallway. The support staff, the thousands of seemingly faceless people who worked as cooks and housekeepers, groundskeepersand clerks were mostly non-Latino too. Not to be judgmental. But for whatever reason, apparently Latinos didn’t fit in either. For those few students of color in circumstances like these the thing about alienation, the “not fitting in” that is the most common symptom of distress on any campus, from post-secondary to post-grad, is that it cuts both ways, indeed it’s hard to determine what comes first. My argument would be that it’s a push-pull dynamic at all times and may sometimes be due to rejection. On Mount Parnassus you may ask me and it’s a fair question—all questions are fair, that’s my feeling, although some are fairer than others. Were you rejected for who you were, which caused “acting out” as a dissatisfied graduate student or were you actually acting out before you arrived and came with a bad attitude which made it impossible to have a successful outcome. To have those bright days of learning that the first day of school is supposed to promise? My first acting out was about to take place in Cole Hall that morning of orientation. Let’s see what happened. You be the judge.
This was my fourth trip to nursing school so the first day ritual was kind of a known quantity. In my first two passes through healthcare training, in the community college in Austin, first studying practical nursing and then to get my RN, there were no introductions, no first day inductions, you started class and you went pretty quickly into skills. It was basically all about skills, theory came next and the ritual and ceremonial aspects of the profession were not much commented upon.
At the University of Texas Medical Branch for a bachelor’s in the Science of Nursing the ceremonial component of the first day was more like at UCSF. At Medical Branch we also began in a lecture hall and were addressed by the Dean who shook each of our hands as we filed out of the room. No shit. Pamela Watson, dean of deans in the Nursing School, the godmother, you could call her, she said a few words to me and took a moment to correct the grammar of my reply which amused me at the time but did not anger or embarrass me because, one, Dean Watson was kind of hot and Number Two, unknown to me at the time, my eventual graduation would be Highest Honors and Dean Watson would give me a glowing recommendation for graduate school. She would be responsible for me being in San Francisco one day, although neither of us knew it at the time. When you’re sure of yourself and your credentials, it seems to me, you’re less likely to take offense. You're less likely to feel alienated. Dean Watson’s vibe was okay—at least she showed an interest. It turned out to be a rocky relationship but largely a respectful one. UCSF, as it turned out, would be the former but not the latter. The Dean at UCSF was Kathleen aka “Kathy” Dracup, a distinguished-looking white woman who, unknown to me at the time, was previously a professor and then Dean of nursing at UC's Los Angeles campus where my original undergraduate work was done. We were both Bruins at one time. We had that much in common. Her name was also in the American Heart Association manual of cardiac resuscitation used to renew my credentials a couple of days before classes began. She was some kind of heart expert—but she didn’t do pediatrics and therefore was, frankly, of less interest to me.
Standing at the podium Dean Dracup looked confident, intelligent and benign, as many nurses do, but you don’t rise to the highest level in the second most highly-ranked school of nursing in the country by being a pushover, or being unable to use elbows, and her manner did not distract me from the likely reality that she had busted a few balls or ovaries, as the case may be. It just didn’t concern me because my only interest in her was literally academic. If anyone had asked me the purpose of my enrollmentat UCSF my unashamed response would have been, “I’m here for the degree.” Nursing practice interested me but not so much the theory and not at all the politics of academia, the gossip or intrigue that it was my bet was endemic to any school of nursing or faculty of medicine. Especially with an ambitious group of white people like was gathered around me on Mount Parnassus in San Francisco, California, in the Year of Our Lord 2008. My plan was to get in and get out without coming to the attention of Dean Dracup or anyone else in power and with minimal bruising on my part. That there would be bruising was sure. That’s part of the learning process but like blood loss in a medical procedure, my feeling was, best to keep it to a minimum—especially if the blood is my own, you feel me? Looking at my pre-enrollment to-do list today, pretty much none of that got done. There was a lot of blood, almost exclusively mine. There would also be some scrapes and bruises on the three ladies looking down from the dais. And Mr. Adams, our diversity coordinator. Anyway, in Cole Hall that day Dean Dracup launched straight into her spiel.
“The only reason I went to graduate school,” she told us, “was to get off working nights.” A roar of knowing laughter met the one-liner.
There’s a theory about the moment a speaker has the audience and at that moment Dean Dracup had us. You could tell it was a prepared delivery, something she had probably said many times before but any nurse who has worked nights could empathize and for that reason it was true and endearing. Next she followed with the second key to success giving speeches: she kept it short, ending with a warning that those of us who were used to getting straight A’s in coursework would be disappointed at this School of Nursing. This is the big leagues, she said without saying it. Actually for me the classes would be easy but there would be a career-ending failed clinical practice, at General Hospital.
The whole time the Dean was speaking my attention was focused on the one person of color on the stage. Her name was Judith Martin-Holland and she was associate dean in charge of the SON’s diversity efforts. Unlike Kathy Dracup, Dean Martin-Holland did not give off any air of competence—it was more a given, something with this woman that you would never even question. Ditto, the intelligence. But “benign” would not have been the first description of Dean Martin-Holland that came to my mind and that was already my impression before the first day of class. This was the first day of school but actually we’d met previously and in this very same Cole Hall, months before, on my visit to check out San Francisco as my plans firmed up to apply. Taking the train to the Left Coast from St. Paul, my good fortune was that the same night of my one-day visit happened to coincide with one of the School of Nursing's information sessions, on the nurse practitioner program. Led by Dean Martin-Holland herself in this very room. The session offered little new in the way of concrete information except that the Graduate Record Examination, that had obsessed me a year or two earlier, would not be required. The high point of the evening in San Francisco was Dr. Martin-Holland’s explanation, in response to a would-be-student’s question, that the hardest part of graduate school for most nurses is the expository component, expressing ourselves on the page. Approaching Dean Martin-Holland after the crowd had thinned, to introduce myself and make small talk about the SON, her face was not unwelcoming exactly, but unchanging.
Having done my time as a nursing student in a psychiatric rotation at the State Hospital in Austin, my first inclination was to think flat affect, the kind of description that sounds more clinical than it really is. There was actually something at work with Dean Martin-Holland: a kind of detachment, as if the fact that we were both African-American did not register or did not matter. There’s a saying about black people from California—that they are weird, frankly. The same way a lot of people from California are weird, that the weirdness of the Golden State trumps the exceptionality of being black in America. African-Americans from California act, someone profound once said, “like they were raised by Koreans,” not that there’s anything wrong with being raised by Koreans, it’s just a different culture and that’s the foundation of the observation. Raised by stereotypically analytic Asians not stereotypically emotional and touchy-feely Negroes. Both the kind of generalizations that Mr. Adams, our diversity facilitator, probably would not have approved of but are nonetheless illustrative here. Someone else might have said that Dean Martin-Holland was wrapped too tight, a highly-controlled uneasiness that expressed itself by a lack of connectivity with others, even with others of her own kind. But with Dean Judy that sense of detachment was an indicator of something else, a completely different dynamic that would only be apparent to me later, too late you might say if you wanted to be dramatic, only a year after that morning in Cole Hall. This black male was already in shit and didn’t even know it! The orientation was advertised as brief and the longest segment was actually devoted to Mr. Adams. “Non-verbal communication,” he began his comments on diversity, which was a relatively new term at the time, “is often more important than what you say.” We were suddenly in the diversity exercise. That the university felt it necessary to mention race and gender, sexuality and prejudice on the first day of class meant it was on everyone’s radar even if no real effort was being made to resolve the issue. At UC people like to hear themselves talk. It doesn’t mean anything is going to get done.
Mr. Adams went through the list of things you couldn’t say on campus—about people’s races, physical appearance, religious beliefs and/or sexual orientation—among other aspects being skin color, weight, attributes like breasts or behinds, hair texture or eye shape, as he navigated with some deftness the issue of sex and human attraction and how you can communicate interest in others without causing offense. Hooking up, he seemed to say, although he did not use that term. It’s going to happen but you have to be careful with people you work with or study beside. Sitting there, listening to this professional facilitator, the rule about interpersonal relations on campus seemed to me to be very similar to the basic rule of medicine itself. If it worked, whatever the approach, don’t question how it happened. That’s if you have a good outcome. If not, you’ve got some explaining to do or you may get sued.
Mr. Adams turned to non-verbal communication. This was the dangerous ground, he said. He singled out eye-rolling as a particularly inappropriate behavior that, Mr. Adams told us, is likely to lead to trouble—for a reason that escaped me at the time but was one day to become very clear. Any behavior when used to demean or belittle, as when someone is talking about their culture or their impressions of an event and the listener rolls his or her eyes. That's against the rules, he said. Oh, okay. Got that.
Mr. Adams’ rap only began to falter when he moved into the larger discussion of race on campus. He seemed to be less sure of his subject and your first impression hearing this now may be that is because the subject itself, race and prejudice in America, although much examined today, as in the past, has no fixed rules. Well, it's worse at a university which was making no effort to accommodate those different from the white privileged majority.
Mount Parnassus had just gone through a couple of nasty episodes involving women who felt themselves to be demeaned or undervalued on campus and a telling comment had come from the university chancellor himself, J. Michael Bishop, the Nobel Prize-winning medical researcher who was steering the ship. Instead of directly dealing with the issue raised by the women, sexism in medical research (which threatened to morph into the topic of sexism and racism in nearby Silicon Valley), instead Dr. Bishop criticized the women for speaking up publicly. A bad call. He said that they should have dealt with the question quietly and in-house. That’s why Michael Adams was there, one supposes. To deal with the issue quietly which, some might argue, meant not dealing with it at all. Later, as my own struggle with the university heated up, an African-American medical student—literally a girl who was born in Africa and moved to the United States with her family—describing Michael Adams’ approach to racial problems on campus, she said, “He should be a lion! Instead, he is—” and she left unspoken what kind of animal from her homeland would best describe the director of Affirmative Action, Equal Opportunity and Diversity. Her confusion was understandable because Mr. Adams could not be confused with a wild animal at all. It would turn out he was a much tamer cat.
We broke into groups to begin the exercise.
The room was divided into a half-dozen sections, each led by a facilitator, with Mr. Adams floating among the groups as a kind of grand facilitator or facilitator-in-chief. Our instructions were to take the role of any ethnic or racial or identity group other than our own. As an African-American male in a sea of white women, my only instructions were to pretend to be anything other than an African-American male in a sea of white women.
The white chicks in the room, for example, could be guys or gay guys or Asian gay guys and discuss with the other members of their group what life must be like as an Asian gay male. There would be an opportunity to share our findings with the larger group at the end. We were being told to walk in someone else’s shoes for a few moments and although that instruction might have seemed silly or forced—it did seem both silly and forced to me, and for any age group beyond the teens—under the right circumstances this could have been a useful exercise. Role-playing is a powerful technique and you could imagine some of these very bright and enthusiastic young women, in years to come in their nursing practices or personal lives, remembering what they learned in Cole Hall and pausing in an interaction to think about what others are feeling. There was a better reason to do it, though. It’s nursing school and in nursing school you do diversity exercises and other kinds of exercises because you’re told to. Over the course of my professional schooling, up until that point in time, in Cole Hall, my classes had been asked to stand and stretch together, to pat each other’s backs, look in each other’s mouths, ask about personal moments, fears and hopes and dreams. Biases and implicit biases. What can you say? Nothing, except it’s a touchy-feely profession and nursing school includes instruction on touchy-feeliness.
My group was led by a woman named Dorrie Fontaine, the associate dean for academic affairs which meant, if my understanding of the SON hierarchy was correct, number two in the administration, waiting in the wings to run her own School of Nursing or ready to step forward should Dean Dracup get hit by a cable car.
Dean Fontaine was an attractive blond in a pearl-earrings kind of way, perky would have been my description, a gross stereotype but that doesn't mean it wasn't true, possibly a sorority somewhere in her past. Completely stereotyped, once again, but not necessarily wrong. Perky is said here without any intention to demean, by the way. Some of the best minds and some of the most talented people in the world have gone into nursing, for the past century at least, especially during the days when talented women had few other outlets for their abilities. That included sorority sisters. My ass and the asses of my patients had been saved on more than one occasion by women like Dean Fontaine, energetic and deft practitioners of an art and science, who stepped in and reversed the downward slide of a patient without breaking a sweat or mussing their hair. At moments like those my interest was focused on fingers not pearl studs in their ears. So, like, perky was a good thing in practice. Just not that morning, or in those circumstances, in Cole Hall.
The university was asking me that morning to deny my identity,which may not seem to be a big deal in hindsight. Would it have killed me—you may ask—to pretend to be someone else for a few minutes, as a prelude to beginning my studies?
Let me turn the question on you.
Imagine that morning from my point of view as a black male. Let yourself participate in a diversity exercise here and now, imagine being an African-American male sitting in a totally non-diverse group of white female students and instructors at a public university that had made no visible effort to desegregate, at the end of the first decade of the 21st century. And imagine being asked to pretend that my identity was something other than it was, as part of an ersatz effort at inclusiveness.
Imagine what that experience is like—being asked to participate in a game of role-playing that simulated racial diversity in an environment where there was none. It seemed bogus and demeaning to me then, just as it seems bogus and demeaning to me now. And my response was to decline to participate. Not standing up and making a statement, no—not walking out—instead acting busy or preoccupied with my telephone, which seemed an appropriate response then and an appropriate response now. Not bothering to participate but not really giving a shit, frankly. And my lack of enthusiasm was noticed. Dean Fontaine began shooting worried glances that said, “You’re not playing!”
Soon, responding to the dean’s subliminal distress signals, Michael Adams, the master facilitator, came over to our group and fixed his unapproving glance on me.
“You,” the expression on his face said, “are going to be trouble, aren’t you?” He had that right.
CHAPTER FIVE
Nursing school isn’t difficult.
Dean Dracup’s claims notwithstanding, even at graduate level the content of a
nursing education requires only common sense to understand and a certain
attention to detail to master. Sometimes you don’t even have to do the reading.
Attendance in lecture is a plus
but for some gifted students that’s not always necessary either. You do have to
go to clinical practice though because instructors are probably watching
patient care much more closely than they’re listening to your answers in class.
Nursing is all about doing. The level of difficulty starts at wiping butts and
rises from there. An instructor actually gets two shots at any student, to
decide if he or she has the right stuff, grades being the objective standard of
performance while the other, clinical practice, is almost completely
subjective. If an instructor decides to get rid of a student that’s often where
it happens, in the hospital.
In my original RN training there
were two other guys in the program and one of them, named Glen, showed me his
books at graduation and they were still in the original shrink-wrap.
Early in the first semester Glen designed a plan of study that did not in fact
involve study. He came to class and he went to practice in the hospital where
he put to use what he heard from instructors in lecture and that was enough to get him
through his coursework without burning the midnight oil. Nursing was described in
our textbooks as “an art and a science,” but for much of history it’s been a grueling
job with limited intellectual pretensions. In my nursing classes back in the
day the saying was C=RN, and although that was no
longer true in Baghdad the level of slacking off at UCSF was probably equivalent to
shirking in my prior programs. Liking ideas and facts made the homework and test-taking fun for me.
That didn’t mean that being at UCSF was easy, at least not in
those early weeks, but the difficulty factor had little to do with what they
were teaching in class.
The program itself was the usual disorder:
At 10 a.m. were we supposed to be practicing gynecological exams or discussing
AIDS awareness? Did we really need to read that article about stool-hoarding by
pre-teen males or was it only recommended? Were the clinical sites for our practice
decided upon or were we still winging it? There was good reason to forgive the
confusion: the University of California is a research institution and most of
the faculty from assistant clinical instructors to full professors and
department chairs have their own area of interest or their own hospital/clinic
gigs. Students are among priorities but probably not number one. Which
was okay with me. One of the particularities of graduate school is that the
higher you go in your field the more it resembles a buffet. You’re filling your own plate rather than being told what to consume and although
there are definitely basic requirements, like the government's old-fashioned food pyramid, that requires consumption from different nutritional groups, part of graduate school is choosing
what you like and digging in. A bigger issue was purely administrative. UCSF is
on the quarter system not semester-bound like Berkeley, or Stanford. UCLA is
also on the quarter system and my first college experience, back in the day,
accustomed me to the faster pace of the quarter and was my preferred system of study. Three 10-week sessions instead of two 16-week semesters, although you
underestimate the challenges of the shortened timeframe only at great risk to
your grade point average. Basically in a quarter system both instructors and students have to
hit the ground running. By the time you’ve found the library you’re taking your
first exam and by the time you’ve gone to office hours it’s because you’re
prepping for finals.
On top of that there was the job
search that became part of my settling in. The first instructors to take
an interest in me was a professor named Karen Duderstadt who was author of our
pediatric assessment text and who chose me to work with her in the Children’s
Clinic at San Francisco General Hospital—probably, once again, because of my
Spanish ability. She told our class early one day early on that to get the most out of graduate
school we really needed not to be working at all, in order to be able to take
advantage of the courses offered. There was some groaning in response to the
suggestion, for obvious reasons. Who can afford not to work? Many of the
medical students had deep pockets or families with deep pockets but there’s a
class division between medicine and nursing as well as an intellectual divide: even
at high-dollar high-profile UCSF my sister students still consisted of a lot of people living paycheck
to paycheck. Professor Duderstadt was right of course and in a better world her
suggestion would have been the norm but it just wasn’t going to happen, at
least not in my case. As an out-of-state student my tuition was $10,000 a
quarter, literally a thousand dollars a week just for classes, and work was suddenly a
priority for me and was the first place the shine went off my relationship with the university.
It’s embarrassing now to describe rookie errors made
in California—a state which was supposed to be a known factor, a familiar
environment for me. Not having seen the Bay Area in four decades my error was feeling that somehow San Francisco was still in my back pocket. Although wide
experience in exotic surroundings may make you think you’re prepared for a new
locale, especially one in your own backyard so to speak, and especially at an
age when you should know how to parachute in and get a job done—suddenly making
do on your own, living off the land—the dumbest error you can commit is
to think the place you’re arriving is similar to wherever you’ve been. That’s
an especially dangerous mistake to make in a city like San Francisco that has
its own particular order of difficulty, its own peculiarities and way of doing
things. Austin, my adopted hometown, was at the time of my departure for the clean, family-oriented Midwest, warm and cuddly—Austin being a small Southern city that had grown explosively but not changed much in fundamental ways, even if traffic got a lot worse. At the best of times San Francisco is stark and beautiful, a kind
of coolness that approaches coldness and a variety of life—predators and prey—that
stunned me even in my fifties and even after seeing so much of the rest of
the world. My eyes weren’t completely closed however. It seemed to me, arriving
for school, that the peace-and-love Bay Area of my adolescence, experienced on
the trips to the UCSF with my mother to see the doctors, had become the kind of place where if
you had a heart attack walking along Market Street, for example, people would
step over your warm body and keep going. But my first mistake actually had more
to do with misunderstanding how the State of California operates than the City
and County of San Francisco. The S.F. mistakes and UC mistakes were still waiting
in the wings.
Texas prides itself on limited
government. People know that and don’t expect much although what you can
expect from the Lone Star authorities including what you don’t want is done
with some efficiency. Not so in California where state government is more
expansive but somehow harder to pin down—and certainly more difficult to get
anyone on the telephone to discuss. Like Washington D.C., Sacramento takes
forever to mobilize but when you do get the bureaucrats’ attention it can be
overwhelming. My first mistake at UCSF regarded my nursing license and the
error was waiting until my arrival in California to get an endorsement to work
in the Golden State. After my request for licensure a few days passed and an
anonymous bureaucrat in Sacramento scheduled me for an appointment with a
private fingerprinting business near City Hall, to run my prints through the
Big Computer and be sure there were no warrants or criminal convictions in my
past. Then the real wait began. More than a month passed—and nothing. It wasn’t
even so much my need to work, my savings were still carrying me
through, the real urgency involved my clinical rotations for school. Instructors
would soon be sending me to hospitals in the Bay Area for practice and that
wouldn’t be possible without a California professional license. Talking to classmates
who had also come from other parts of the country the smart ones, which meant everyone except me, requested their endorsements to work in California long before arriving. As my desperation grew,
day after day expecting a letter from the Department of Consumer Affairs that
never came—someone suggested emailing Dean Dracup, that she might know somebody
at the Nursing Board who could get this done. The Dean’s reply was prompt and polite, it surprised
me that she answered at all, but she couldn’t help. She suggested it was best to
go to Sacramento myself and then other students chimed in, the Dean is right,
license problems are best dealt with at the Board face to face. If you
wait you’ll still be waiting when you graduate, they said. It certainly began
to look that way. So, like, it was my mistake and one that it was mine to
resolve but luckily an excuse for a train trip has always been an excuse for me
to buy a ticket. The next Friday found me on the commuter express to Sacramento. One of the train stops was Palo Alto, Stanford University lurking in the trees somewhere nearby, and eventually, in the capital city, there was an expensive taxi ride to an anonymous office park in the
suburbs, to the equally-anonymous offices of the Board of Nursing. They issued
my license then and there which begged the issue of why they had not done so
previously but some questions are better left unasked. My plan in grad school, by the way, was to move forward and not get sidetracked by unnecessary details like trying
to understand government snafus, which meant not asking some questions and not raising ancillary issues, to save
time and get the most out of a very expensive education, as per Professor Duderstadt. Later, catching the train
back to the city meant gearing up for the next step in my odyssey: the job
search. And that was, even more than any diversity exercise, my first
experience of what kind of institution the University of California really is. And it wasn’t pretty.
First however a self-assessment was in
order. Graduate school forced me to take a long hard look at my own skills and
my own practice. After three trips through nursing school there were some good and a few bad aspects, as you
might expect—and some unknowns that my course of graduate study would erase. Having come to the profession late in life, already in my forties at the
time of my graduation from a practical nursing program and arriving almost a
decade later in San Francisco was both a blessing and a curse. The blessing was having gone through school so many times my fundamentals were solid. The “nursing process,” such as it is, was hard-wired in my brain and
although you might not have chosen me as the first nurse to be at your side in
case of an emergency the thing about age is that it brings a certain wisdom. My
fundamental wisdom was that instead of being the best nurse in an emergency—avoiding
the emergency in the first place is better practice still. Especially in
pediatrics, it seemed to me, avoid complications early because, speaking as someone
who spent time in a hospital bed as a kid, what happens to a child leaves
bigger scars than for adults. Best to avoid the trauma entirely, you know?
Professionally,
there were other pluses to my practice. The year in a nursery in the Midwest made me baby-friendly which is perhaps the hardest part of pediatrics for a
male. Mostly the safety of my practice was attributable to the sheer length and
variety of training: On a field trip during my vocational training we’d gone to
the Texas Board of Nursing and watched a nurse lose her license which, looking back,
was the single most important lesson for me in my entire healthcare schooling—more
critical than starting my first IV or catheterizing my first baby, or running
my first code. The nurse being disciplined was an older black woman from a
small town, near the Louisiana state line, who had been reported by her own facility, and
listening to the testimony it was easy to see how a nurse’s practice can get
away from him or her and the importance of continuing education. Which is what happened to the lady before the Board that day, nursing had left her behind. Have you ever heard of the book All I Really Need to Know I Learned in
Kindergarten? Most of my basic lessons in healthcare actually came in vocational nursing school, like the trip to the Nursing Board, core instruction taught by Sandra
and Yvonne, the two black women who ran the program at the community college in
Austin and who first steeped me and my peers in what it meant to be healthcare professionals.
If you make a mistake with a medication for instance, they told us, the first
person you want to tell is your patient who just swallowed the wrong pill.
That’s what it means, Sandra and Yvonne said, to be a nurse. Also they taught
us that apologies are a good thing and why nurses unlike doctors rarely get
sued because we say we’re sorry—and because we don’t have the money the
physician has, sure, that’s true too. This practical wisdom was built upon in
my associate degree and bachelor’s coursework in Galveston.
The program of study at UCSF was
divided into two halves administratively and then in halves again by reality of
experience and the education of trainees like me. By far and away the biggest
cohort in the School of Nursing was the “master’s entry” students, meaning
their bachelors degrees were in other fields than healthcare and they had
undergone a year-long crash course to become R.N.s through certification not degree, but had limited
experience as nurses. You couldn’t underestimate these students because they
were very smart and some of them were very adept but in an experience-dependent
profession like nursing, lack of experience shows. They were almost all grouped in the
primary care program that would mostly lead to work in a clinic, doing well-baby
checks or ordinary pediatric outpatient care on mostly healthy or perhaps
chronically-ill kids. In other words ordering vaccinations, feeding issues, diagnosing ear
infections and the like. Some would end up in hospitals too but there were only
a half dozen or so students in my program with bachelor’s degrees in nursing and
we were in the smaller acute-care track where we were specifically studying to
work in a hospital, in an emergency room or an ICU setting, seeing sick kids as
in-patient providers, writing orders and doing procedures. Yeah.
Men are no strangers to forming
cliques but among women it’s an art form and in nursing school it always fascinated me
how women form groups based upon affinities that to the male eye are not
apparent. As a guy in a population of a lot of women it was usually easy to be
welcomed whatever posse you approached, for group study for instance,
and being a guy your own allegiances were written on your face. You wanted to
be with the babes, no matter what clique they themselves belonged to. At UCSF
my experience was a little different. My thing, my weakness for the opposite
sex has always been for smart women who aren’t bitchy, although finding that
combination can sometimes be difficult—not the smart part—just joking! On Mount Parnassus, bright attractive, cool women surrounded me. Nursing school was like
a candy store in that respect. Part of it was generational. Women had changed so much just in my lifetime: In my memory of the cultural mileposts of the Sixties and
early Seventies there was the day, back in the day, across the bay in Oakland, when girls were allowed to
wear pants to school for the first time. As a sympathetic observer that was for me the
beginning of women’s liberation. Women say, rightly of course, that they have not yet
reached equality decades later but the change since the time when girls no
longer had to wear skirts to class could not have been more stark. My sister
students at UCSF had benefitted from the evolving feminist revolution and these “girls”—these women, these nurses—were not
just smart but strong and self-assured and most of them could have kicked my
ass without breaking a sweat, not that physical prowess is important although
it sometimes is. They still had issues in the city, obviously, just like
their older sisters, because on a personal level, on the human attraction front, San Francisco was a pretty competitive environment for a single straight young woman. All the gay guys were off the market, so the women of my acquaintance at UCSF who
were interested in men were still attuned to traditional measures of “femininity”
and attractiveness, in order to hook up like anyone else, but probably less so
than anywhere in my prior experience and certainly less than in tradition-bound
Texas. In San Francisco the young women’s sexuality was self-assured and
sometimes assertive but more than anything else, it was a given, whether the
individuals themselves found what they were looking for or not. At UCSF it was a pretty
awesome group of chicks, actually, direct and self-confident, and smart—my fantasy of women actually,
and suddenly the reality, on Mount Parnassus, in Baghdad by the Bay.
Among the master’s entry students
was my buddy Tara, originally from the East Coast, a writer, beautiful and
kind-hearted. She was on the primary care track, her prior degree in the
humanities, and she became my crush among the other students. In
my own acute care track my classmates included Carina, a Filipina from Illinois who was already working
as an ICU nurse in Children’s Hospital when classes began, and Elizabeth,
also originally from Austin, who had graduated from the University of
Virginia’s nursing program and worked at the children’s hospital in D.C. before
coming west for grad school. Carina and Elizabeth were my professional crushes.
Both had bachelor’s degrees in nursing and both were smart young women who
were very competent at bedside. Elizabeth was married and, although she didn’t
say it, she struck me as pretty conservative, probably Republican not that there’s
anything wrong with that. When she mentioned that her family had moved from Texas to Virginia after high school, which would have been about the time W
left Austin for the White House, my guess that Elizabeth’s dad was a spook or high-ranking
military was only met by a sphinx-like smile on her part. It was actually Elizabeth, already working as a charge nurse in the UCSF pediatric ICU when our program
began who first pointed out to me the fundamental hypocrisy of life in S.F.
She said she’d been sitting in a café somewhere in the city getting a lecture on
environmentalism and responsible greenness from the person sitting next to her, and then her seatmate got up and left the café and went outside to get behind
the wheel of a multimillion-dollar SUV. That was the well-heeled political correctness in San Francisco, a
religion often preached by the wealthy, with hypocrisy as one of its major
tenets, and it took a conservative like Elizabeth to point it out. She said that
although she and her husband loved the city (who doesn’t?) no way could they afford a home there. At that point in time Google and Facebook hadn’t yet taken over whole
neighborhoods but the housing affordability crisis was already on the horizon for
anyone to see. Both Carina and Elizabeth outclassed me in terms of skills and high-level
experience but they did so without being showy and to the degree we formed a
clique, that was it, for me. Mostly it was the acute students. The SON instructors,
however, were a different breed, and a different generation entirely. Most of these
ladies were my age or a year or two younger and they did not seem, frankly, to
be very happy women. It’s a generalization but appeared to be generally true—at
least in my dealings with them. Maybe it was me, maybe they just didn't like me, which is fair, but at that time my efforts
were mostly directed at not pissing anyone off, especially anyone who had access to the grade book, outside of diversity exercises. My
behavior was good because once again prior schooling had prepared me. No male
in nursing is unaware of his surroundings and in the best programs that
awareness even has a formal component. We are literally taught to watch out, to
tread softly among women and to watch our asses. Towards the end of my vocational nursing
studies Yvonne, the head of my program, had set up a guys-only seminar for the
handful of men studying with me. She sat down the four guys in our class in a
conference room and brought in the lone male instructor to
talk to us, to tell us literally what to expect. Yvonne laid a couple of pizzas
on the table and stepped out, leaving it to us to come to terms with what it
would be like to be men in a woman’s profession. The male instructor was gay—and he
said that his back hurt. Surprisingly he told us that the biggest drawback for
him in the profession was that women claimed to be equal but whenever there was
heavy lifting to do, literally, like pulling somebody up in bed, or restraining
a violent patient, or picking up someone who had fallen, the females called
him. “I have a bad back now,” he told us, grimacing as if he had just helped to lift an obese patient. As men in nursing, a bad back would actually turn out to be
the least of our problems.
Having grown up in a household with
three sisters, if anyone had asked my comfort level working with women my
response would have been good—like, no sweat. My game was already tight in
interpersonal relations, it seemed to me. Black women have long represented the big leagues of
feminism, the fearless standard to which white women in this country aspire and it was my view that, having survived my own home life for eighteen years, much of that time the lone male in the household as my older brothers left for college in the East, the currents and
eddies at the nursing station were not difficult to navigate. So, too, Yvonne and Sandra as my first nursing instructors laid the groundwork
for my success. Both these women were under no illusions about what life would
be like for me and the other guys in our class, especially minority men. As
African-Americans, Yvonne and Sandra themselves had also begun as outsiders in a
profession dominated by white women and they communicated a sense of caution to
us. One of my other instructors, a white woman named Chris, went a step further
and laid out some practical survival skills when dealing with any woman, nurses or otherwise. Let me
say at the outset that common sense had already taught me that when working
with a female, which was like ninety percent of my day, keep a low profile if
she has argued with her husband the night before. Also, since women working
together are said to cycle together, if you find yourself being chewed out by one
female co-worker for no reason at all there’s a good chance the other women on
the unit will see you as fair game too. What is called charm in men is a
socializing skill and very often a potent defensive tactic. At all times, notice new hairdos or new scrubs and commenting appropriately. So, too, a secret often does not mean a
secret among women and if you really don’t want other people to know something
you don’t mention it at work or in class, even to your best friend. The reverse also
applies: if you want something to get around the nursing unit as fast as
possible, tell the first R.N. you meet that it’s a secret. That was my
knowledge base up until the point when Chris, who had done a lot of psych
nursing and was familiar with the research, added that the single most
important compliment to make to any woman—"scientific research proves this," she
told me—“studies show,” in other words, as we read in the media—is not that
she is beautiful or a great nurse or that she is understanding and compassionate,
or whatever, but instead you look like
you’ve lost weight. Weight loss can be an obsession, dieting is religion and talking
about dieting can be a daily occurrence at a nurses' station. Chris told me this early
on and it may be a stereotype but in my experience it was a stereotype that was
true.
Chris also mentioned an interesting
study that appeared in Psychology Today. A group of women was shown two different photographs of a man and asked which guy was
more attractive. The trick was that it was the same guy in both photographs,
dressed more or less the same, the sole difference being
that in one he was wearing a Rolex, featured prominently on his wrist, and in the other he
was not. The women overwhelmingly chose the photo of the guy wearing
the expensive watch as the more attractive. That didn’t have much bearing
on my shift in the hospital or my time in school but did tell me
a little about security issues that many women face—should pairing loom
in my future which, thankfully, it has not, not because of any dislike for the
opposite sex, something that single men who are not gay spend a lot of time
explaining, especially during slack times waiting for a patient to arrive, but
because of my lack of interest in family life. My work in pediatrics already
met all my parenting needs, thank you very much. Anyway, to sum it all up, arriving in San
Francisco my feeling was that women were not the mystery that many men believed them to be. For me at that point they were the same as guys—only different. The
strengths and weaknesses differ from one gender to the other and person to person but the
fundamental humanity is the same. Women often rely on the fiction that they are
somehow better than men in a moral sense, nobler or more humanitarian, or whatever, but that’s
not my view. The humanity merely manifests itself differently from gender to
gender. As does the evil.
Although the women instructors at
the School of Nursing, especially the higher faculty levels, may have loved the profession and given their adult lives to expanding the practice of R.N.s, many were what one hopes are members of the last generation of women
with limited opportunities or career choices. There was some bitterness, that appeared
clear. Born a few decades or even a couple of years later they might have
become MDs or scientists, or astronauts, and they blamed men rightly—although
it was hard to explain to them, not this
man, because my own life hadn’t been any walk in a rose garden either. The
location of our interactions being San Francisco, the intellectual capital of
the Left Coast, these ladies were also steeped in feminism and for a few of
them it was clear they did not like seeing guys in the archetypal female
profession, which was a kind of bias that was new to me. In my prior forays in
nursing, both at school and at work, women seemed amused that men wanted to
join the profession, or confused that we did, but not overtly hostile: “You want to wipe baby butts?” they seemed to ask. Not at UC. In San Francisco the vibe was much more that men were
poaching on women’s turf, which was a surprising attitude since women had just
passed a major milestone in healthcare by becoming the majority of students in
most of the country’s medical schools as well, including UCSF. This kind of double
standard was an institutional view at the university. It says everything that
needs to be said, it seems, to remark that in the building that housed the
School of Nursing there were not men’s rooms on every floor while women had
multiple venues for their bodily functions. Like having to bring your own ball
to the playground, it was a handicap, but less damaging to my self-esteem in
graduate school than in primary school.
The job application was online.
The list of openings in Children’s Hospital was as long as my arm but weeks
passed and no one called. My qualifications were clear: African-American male—my
race made clear through a not-too-subtle reference to membership in a black
nurses’ association—with a Highest Honors bachelor’s degree in nursing, the so-called “gold
standard” of our professional education. More than five years experience in
public hospitals and in an academic medical institution, and Spanish-speaking. To
say nothing of currently being a master’s student in pediatric nursing at the
university that owned the hospital. Literally studying next door. Nothing happened, no response. My
application disappeared into the ether.
It was a little like waiting for my
nursing license but it seemed highly unlikely that this delay was bureaucratic. On breaks from class, wandering the hospital hallways and chatting with nurses,
the single largest group working as R.N.s in Children’s Hospital seemed to be master’s
entry students from next door, my classmates in other words, who had finished their certification and were in their
first professional experience as nurses. Almost all were white females and,
once again, it says everything that needs to be said that in my entire stay in
San Francisco, on and off for two years, of 2,500 nurses employed by UCSF my
path crossed with only one other black male and one black female R.N. The brother was the union rep and an ICU nurse in the adult hospital. The sister had been regular staff
on 6 Long but moved to Oakland Children’s, across the bay, and only came back a
couple of times a month to pick up a shift. In other words inappropriate
staffing, non-representative of the medical center’s patient base or
California’s population which were both heavily minority. Later, an open records
request informed me that two-thirds of UCSF medical center nurses were
white, six percent Hispanic and three percent black in a state which was
majority black and Hispanic. Only Asians seemed to be employed at anything like
their ratio in the population.
There was even photographic evidence of the
white privilege. Outside the administration building, which was the main bus stop for the Muni route that took me through the Haight and downtown into the city, there was a column with
pictures of UCSF nurses through the years and the photos were almost all white
females and the farther back in time you went they were
all white females. Only an occasional Asian face broke the pattern. The university couldn’t claim that hiring was restricted by
the same law that prohibited affirmative action in admissions, this was a
different dynamic entirely, it was no longer the 1960s, the era from which many of the
photos on the pillar outside Cole Hall seemed to come, the women wearing
white dresses and white caps, Jesus, just shoot me—we were decades later, a new century in fact, and the university
treated blacks and Hispanics as patients, certainly, it just did not employ us
as providers. Another week passed awaiting a call from human resources. Oh well, my decision was made. Let’s shake the tree. Sometimes the black man must confront the white beast in his or her lair.
The medical center’s human
resources office was in an office tower across the street from the building that housed Children's.
Time to try a direct approach. But the young woman who came to the HR counter seemed
confused by my visit. They weren’t used to walk-ins.
People started coming from the back
offices and joined her to stare at me in wonder.
“He’s asking about a job,” she explained
to her co-workers.
There were like five of them, all
Caucasian, dressed in dark colors for winter, everyone appearing young and urban and seemingly urbane. As a group they looked at the floor,
suddenly embarrassed. “We don’t do that here,” somebody mumbled.
“Oh.”
“Sorry. It’s all online. I mean,
this is Human Resources but we don’t have anything to do with hiring.”
The first feeling for most people on
an unsuccessful job search is what’s wrong with me? Rejection leads to
feelings of inadequacy, at least in the beginning. But in this case, precisely
because of my age and experience and because of my education, my first reaction
was hey, this is bullshit. This isn’t my
problem, this isn’t about me or unreasonable expectations, this is about UCSF and UC in general where blacks are mostly unheard
of as students or faculty or, apparently, hospital staff. It was as if Mount Parnassus was in a kind of time warp before the Civil Rights Act. You could even excuse that, the ignorance, except it was a university, literally where people were supposed to know better. There
was also the issue that Elizabeth had raised about the political correctness in S.F. being thick enough
to cut with a knife. White people were so sure they were on the side of the angels in social
debate, from race to the environment to capital punishment, but the correctness did
not include jobs. Time to up the ante, it seemed to me. Plan B, already developing in my
mind, was also direct.
As an African-American you have to pick
your approach in dealing with questions of race, whether it’s bias in employment
or getting stopped, driving while black. You can choose to be subtle when
correcting Caucasians but that tends to be a time-intensive approach and my own
feeling is that subtlety is best reserved for those rare occasions when white people
really don’t know what they’re doing and you're trying to educate rather than give somebody a bollocking. Which seemed unlikely at UC. That it was innocent. That these
well-paid prestigious nursing jobs were being doled out by white women to other white
women because of chance or because that’s merely how the hiring process
turned out did not seem probable. Possible
but not probable, just as the fact that practically every instructor in the
School of Nursing and ninety percent of my classmates were white females could be the result of chance but probably was not. You feel me? So, like, you can accept the
status quo or you can challenge it—and the history of blacks in this country is
that we usually speak up. As a practical matter that requires face to
face. But first, always, you have to do the math and make sure your argument is
valid. If these young white women with only certificates in nursing and no
experience had found jobs at Children’s and there were staff nurse openings, which was also true, there must be a job for me, right? If this huge medical center was caring for blacks and
males, black men and black boys, we should have a role in nursing care, correct? Is
that heresy? It seemed logical to
me. So, like, with my school badge prominently displayed on my lapel, identifying me
as a nurse and a grad student, my next step was to visit
the hospital units and ask in person, like, are you hiring?
At pediatric intensive care the
unit manager invited me into her office. Her assistant manager was there, looking
a little stressed, and the manager herself introduced me to the soon-to-be-ex assistant
manager who was giving up her leadership position to return to work as a staff nurse. Seemed
like a personal moment to me, but the manager still took time to answer questions
about the hiring process.
Speaking of the medical center’s online
hiring site, which she would theoretically use as a source of applicants for
open positions she said, laughing, “Oh, we never look at that!” The manager
got busy again and asked me to step out of her office for a moment. The assistant manager stayed behind. There was a lone male nurse at an unoccupied ICU bay and we chatted for a few minutes at his
workstation while the lady in charge did what she needed to do. This guy was waiting for an admission.
“I keep my area clean and orderly!”
he said half-defensively, a reference to being a guy in PICU.
Like a lot of humor it was actually a difficult reality. If a patient goes bad a lot of people are
suddenly at your bedside helping and it’s important that they’re not trying
to work around a mess of medication blister packs or syringes or tubes. A guy’s natural attraction to disorder
may actually be inappropriate in those circumstances, as a female nurse might observe.
So, like, it wouldn’t be bitching or being a bitch, it would be a patient safety
issue, which is everything. This had been a hard lesson for me a few years before and this guy learned it too
but seemed to have handled it better? The patient’s needs come first. That
is the central dogma of nursing, by the way, the nurse can always re-orient him or herself
by considering the patient’s needs, something that for example in medicine is
not always true. The PICU manager called me back into her office. “I have an idea,”
she said. She didn’t have any openings she said but she wrote a name on a piece
of paper and sent me upstairs to the Children's Hospital CICU, the cardiac intensive care unit.
The medical center was in a
kind of crisis that had nothing to do with hiring. This was my introduction to
the hospital and it was a busy place and as an outsider you couldn’t tell there
was a problem unless someone told you there was a problem. Which is what
happened upstairs in the cardiac ICU. The California Department of Health had just
swept in after an accidental death of a patient and placed conditions on hospital
operations. Despite the university’s advanced levels of practice, or because
the university pushed the envelope, UCSF made a lot of errors. There’s no other
way to say it. There’d been a series of “adverse outcomes,” which means something
bad happened, or “sentinel events,” which means something bad almost happened,
and like the hospital gown that doesn’t quite cover your rear the hospital was
exposed. It wasn’t like the state was going to shut down the UCSF medical center, no
way, it’s a major academic institution with a lot of political stroke, but
that’s always the threat the health department makes and together with bad
publicity, well, managers can lose their jobs, which is something that tends to
get manager’s attention.
Medication errors are an issue in
any facility if only because of the sheer volume of meds given and because
in-hospital drugs are stronger and potentially more dangerous, with routes of administration you don’t use when you reach into your medicine
cabinet at home. In the most recent death a patient in the adult hospital had received a lethal overdose of methadone, an opiate, that’s
all anyone would say at the time. But later, doing a little research, the
actual circumstances of the error were revealed to me by the Department of
Health website. The amount of liquid methadone ordered by the physician was X, measured as most meds are measured in milligrams—for purposes of illustration
let’s say 20 milligrams. The nurse gave 20 milliliters instead, a volume of 20 instead of a weight of 20. And the patient died. Depending on the concentration, it was just too much, a fatal dose. The
Department of Health’s response was to order an additional layer of safety
checks, an expensive and complicated addition to daily practice at UCSF but one
that the state believed was necessary to keep patients safe. On every shift at
every unit the state dictated there had to be a “medication safety nurse,” a R.N. who was not involved in patient care and who had no other responsibility than
to review medication orders and check doses, routes of administration, etc.,
and re-write or sign off the order before it could be administered. No
exceptions. The hospital was already short of direct care staff even without
having to take a R.N. out of the rotation, in order to create an extra layer of review, and the note from
the PICU manager to the CICU manager was to hire me as a safety nurse. The position was temporary
and was actually through a private contractor not UC but it paid
well and would give me a chance to get a better look at Children’s Hospital and
see where my future might be. Meanwhile, classes were under way and my plate was
suddenly full. With a paycheck assured, my focus switched to what brought me to
San Francisco in the first place, advanced practice, becoming a nurse practitioner, instead of a wage slave to The Man or The Woman.
CHAPTER SIX
Two Marys ran the nursing school’s
pediatric program. One was fair, one was not. One was administrative, one was
hands-on. One had intellect and one seemed particularly un-stimulated and
unstimulating, and came from the anti-intellectual wing of the profession that
can still be found even in major universities today.
Mary L was in overall charge of us while her subordinate Mary M—or “Mary Mac,” as she was
called to distinguish her in the SON—was in charge of the acute care wing that
included me. Mary Mac worked at Los Angeles Children’s Hospital during the
off-season, in between quarters, while during the academic year she occupied
herself with the second-year acute care students whose schedule was packed with hospital rotations
and who had less class time than we beginners. Those of us in our first year were
spending most of the day in lecture and doing skills check-offs which meant
being handed off among faculty as we were instructed in one aspect or
another of advanced practice, like the military's basic training without the
gunfire. Lectures themselves were relaxed enough, and interesting, a couple of
hundred of us from various nursing programs including the adult specialties
sitting in another cavernous hall listening to an explanation of how to approach a full
assessment on a generic patient—or being briefed on the most common conditions
we were likely to encounter in both adults and kids.
One of the first big lectures was
given by a professor named Naomi Schapiro who to our great surprise told us to go out
and do a “community assessment” even though it wasn’t a community health class
and we weren’t studying to be community health specialists. We were told to
form pairs or groups of three students and choose a San Francisco neighborhood
to walk around, “to evaluate community resources and needs,” which seemed like
one of those half-thought out assignments dropped on me in past programs and
which are endemic to nursing scholarship, not science and not sociology but
something in between. My bet was that the first-year medical students weren’t
wandering the streets of the Mission District as part of their coursework and it was
particularly tiring when Naomi insisted that we go in groups, “for safety,” she
said. As an independent-minded male my preference would have been working
alone—a guy thing—it doesn’t mean we’re bad people, it's just how
we’re hard-wired. Being on the streets of the city during daylight hours didn’t
seem to me to be a dangerous activity, either, not a task that required a group
for safety. But as make-work this assignment actually turned out pretty well.
My group included my homegirl Tara and an African-born chick we’ll call Umia
who was also a dish but, unfortunately, married. Tara had a live-in Brazilian
boyfriend who was a hot skateboarder so my chances seemed, like, totally limited, but just basking in
these young women’s glow for an afternoon was enough. They were both
smart and funny and the neighborhood we were assigned to explore happened to be
my own 'hood, Outer Sunset, running west from the campus to the sea and also bordered by Golden Gate Park.
Even now it’s hard to believe how
little San Francisco interested me in the details, on the sidewalk doing a neighborhood assessment or sitting in a café sipping a latte. People were
already falling over themselves to come to the city, to build a life or a
career, but my plan was to finish my degree and get out. To me there’s
something fundamentally scary about San Francisco, which can add to its allure at times, but not indefinitely—and this coming from a man who has been in conflict zones and in countries with failed governments. Danger can add spice to life but you don’t want to overdo it and S.F. was just too, too much. My
mother had certainly felt it. Even after rural Alabama, where she’d received death
threats working as a reporter—and living in Oakland, where the Black Panthers were
completely capable of capping any black person who did the white man’s
business—she feared S.F. more. We could sense
her apprehension every morning as she got in the car to go to work but it officially started when she received a telephone call at work from Amelia Newton, the mom of Panther generalissimo Huey Newton. My mother had written a story describing young Huey as "an urban guerrilla." "What do you mean," Ms. Newton wanted to know on the phone, "calling my son a gorilla?" Mother was still shaken when she came home that day and the ill-ease continued through her coverage of heiress Patty Hearst's kidnapping and the Symbionese Liberation Army. There were a variety of assassinations and shootouts. Almost half a century later, the atmosphere of the city attracted
me, sure, high-brow and post-industrial, apparently uninhibited and
superficially non-conformist. But that was all
that called to me. And going to see Golden Gate Bridge was never on my
list of things to do after class, nor riding a cable car or dining at
Fisherman’s Wharf. There is a fragment of memory, somewhere far far in the
back of my mind, back in the day, as a kid running to catch a cable car—but
that was when the streetcars were still a means of getting from Point A to
Point B and not just a tourist attraction. My mother had also taken me to
Candlestick Park to see a baseball game, the great Willie Mays was playing, and she introduced me to two men sitting behind us, the famous newspaper
columnist Herb Caen who christened the city “Baghdad by the Bay” and an
ex-reporter named Frank Herbert who had become a cult figure as author of the
science fiction classic Dune. That was the culture of San Francisco that stimulated me, and only a little. That was the city of my memory and it was the
limit of my interest, the outsized personalities certainly, Mrs. Newton and her son—but not any of what
people were now coming to the city to see. Or, frankly, the corruption, the attitude
that anything goes, which has always been as pervasive as the fog. One attraction
past and present did call my attention during our community assessment was the Pacific.
There were three of us, Tara, Umia and me. We crossed the Great
Highway and parked at Ocean Beach and walked along the sand. We were basically
killing time, there wouldn’t be a test and any one of us could turn in this
assignment blindfolded. Pass or fail, what do you have to lose? The instructors would be looking more at writing ability than the paper's content. We were just wasting the afternoon but there’s
nowhere better to do that than the beach, right? We passed a washed up seal
or what remained of a seal after a big chunk was removed, a monster bite that had taken
out its entire flank. Someone mentioned that along
this stretch of coast about once a year a great white misses the seal and takes
out a human instead. My routine was to swim every day after class but if a shark could catch me in
that pounding surf, he deserved the meal. Day or night at Ocean Beach the waves were crashing. Drowning seemed more likely than being eaten alive.
On the sand the two ladies stopped
to stare out to sea and Umia started to tell Tara about how her husband
proposed marriage at a restaurant on a cliff nearby, and from the snatches of conversation audible above the roar of the waves, how
romantic it all was, and all. They both got the dreamy look in their eyes that
women can get when the subject is an engagement. Out of respect for the
moment it seemed to me best to give them some privacy and my feet shuffled down the
sand. Not because of any disrespect for romance’s traditions, no. At various nurses
stations through the years my co-workers had told me about wedding dresses and
wedding plans and wedding costs, husbands or boyfriends who were losers or
princes—and a particular rule, common in Texas at least, that if she breaks the
engagement she has to return the ring but if he says it’s over she gets to keep the diamond. Maybe that’s the
rule everywhere, who knows, it all fascinated me, love’s rituals—it just didn’t interest me, you know? If it had been Tara or Umia and my age was
thirty-something not fifty-plus and the husband or skateboarder could be dealt
with—a hit and run might work for Tara’s boyfriend since he was exposed to traffic—my best efforts would have been to lead one of these young women up to a restaurant on a seaside cliff, just
as Umia’s husband did. But that stage of my life had passed and my
interest in women was suddenly much more sporadic, physical more often
than emotional. My claim here in retrospect is not knowing women—that turned out to be
hubris on my part. But familiarity, yeah. And respect, just not awe, except for Tara and Umia on a personal level, and Elizabeth and Carina on a professional
one. When female colleagues inevitably asked me, “Why haven’t you married?” my
answer was always timing. My own romantic life always seemed to me like running
for a bus: arriving too late to catch it, but close enough to see the driver's face and watch the connection
pull away. After awhile you have to choose another means of getting where you
need to go.
From the beach we drove back toward
school and walked along the N-Judah train line towards Mt. Parnassus. It wasn’t
clear what we were assessing but Tara spotted a useful resource on the sidewalk
at our feet. It was a tiny baggie with the residue of marijuana inside. A dime
bag! And only like five blocks from my apartment. Neither of these young women
smoked but the discovery meant that my stay in San Francisco might turn out to
be pleasant after all. Unlike hospitals in Texas the UCSF medical center did
not routinely pee test and San Francisco in general seemed to be pretty
loose about the whole drugs thing, not limited to marijuana use, either. A
couple of days earlier, before our visit to Ocean Beach, during a trip downtown to run errands, across the
street from the federal courthouse there'd been a guy sitting on the curb
shooting up. He just glanced up at me like he wasn’t worried who was watching.
There were all kinds of agents and marshals coming and going from the U.S. Courthouse,
yet he went about his business unconcerned and uninterrupted. Welcome to the Tenderloin. The guy on the curb had a
pronounced tremor but it wasn’t from fear of arrest. Using a little tuberculin syringe he went for the antecubital vein on a pretty
knotty, used-up left arm, and somehow got good blood return right away and
pushed straight on into nirvana. Having given a few shots myself, not being an
expert or anything but a pretty fair judge of how it’s done, yeah, this guy had
good technique. Except for drugs and sex though San Francisco didn’t seem to
me to be quite as wild and crazy as people believed. Dangerous, yes—but not unconventional.
The dangerous side of the city was all about money and power, which are the most
conventional aims anywhere. That was my impression of Austin too, where
people think they’re living much closer to the edge than they really are. In most cities in my modest
opinion you need to have a decent-sized black population to show white
people how to party down or really be decadent. In order to get past natural Caucasian
inhibitions that may allow slavery, conquest or colonization, or ethnic cleansing, but not
old-fashioned guilt-free fun. At that point both Austin and San
Francisco had already been gentrified or were well on their way. Even at the
start of my studies at UCSF most Negroes were already gone from the city,
forced out by high rents or police pressure, or both, urban renewal-cum-urban
removal—“renovation,” it was called in San Francisco, or, on a personal level,
“remediation,” which is one of my favorite words and is actually the phrase that
UCSF would use when the administration showed me to the door. The SON insisted on my remediation, that was what the chair of my department Dr. Rankin would
actually tell me, “You require remediation,” while my opinion was that she needed
to take that white sheet off her head. Neither of us agreed to what the
other asked. But that’s getting ahead of ourselves. These were still the good
times, the idyllic and idealistic first days of school, full of innocence and
high expectations, my notebook still mostly blank. There were some preliminary ideas
floating around in my head but nothing yet on paper.
Outside of work, at night, checking
medications in the kids' cardiac ICU, or swimming, or sleeping—or reading learned papers
about the minutiae of pediatrics—most of my time was devoted to lecture
or lab. Among the skills we learned that first quarter of the program were two
that were almost perfectly invasive. Even though we were in a pediatrics
specialty we still had to master how to do a prostate check and a gynecological
exam on adults. Don’t ask me why, the gynecological exam was a possibility on a teenaged girl, maybe,
but according to my calculations there was zero chance of me ever doing a
prostate check on a boy. Nursing school! Not ours to question why—merely to
obey—and to be fair to the instructors, at that point we were still working in
a big group and not yet learning the intricacies of kids’
anatomies. Adults were the standard we were being taught and hardening
prostates and potentially-cancerous cervices needed to be examined, we were
told. Oh well. There was going to be a check-off.
If you’re a nursing student there’s
actually a science of how to approach a skills check-off. That's my personal opinion. You have a big
decision to make early on and that is do you want to go first or last?
Sometimes you draw numbers, like a lottery, but most often the instructors just
ask, like, “Who wants to be first?” They ask the question in an ironic way
because they know no one wants to be first. There are benefits
and risks to both choices, being first or being last, actually. If you’re first to
demonstrate a skill the major drawback is that you are the first to demonstrate
the skill. If you do it wrong—the instructor may fail you.
The upside is that nursing instructors get tired of the dodging and excuses and cowardice and anyone who
chooses to go first usually has the instructor’s sympathy and is more likely to
be passed because at the beginning of a check-off at least, the idea is to
encourage students not frighten them. So, like, unless you really really really screw
up, or the instructor is after blood for some reason, or she’s after your blood for any reason, which
happens, the chances are better than average that you’ll pass. The benefit of
going last, a position that there’s always considerable competition for, is that you get to
see the other students screw up and you may figure out what the
instructor is most interested in as she watches a particular skill being
performed. And if you didn't look at the book before lab you can try to pick up the correct moves as you watch those going before you. That’s the theory at least. There’s also a slight chance that the instructor’ll be tired at that point, at the end, and no longer paying so much
attention and she’ll just want the check-off over
as much as you do, but that’s probably more nursing school mythology than
reality and not something you want to bet your grade on. Traditionally, my approach has been
to go first and get it over with and rely on the kindness of the instructor.
This time my strategy changed. The first skill we were going to demonstrate was
the gynecological exam and to my horror the procedure was going to be performed
on a live woman not a mannequin. Oh shit. Oh double shit because never before
through my three prior passes in nursing school had we used a real live
breathing human being to learn an invasive task in lab. You practiced on real people in the hospital but
in pre-practice practice it was invariably a mannequin, if you were lucky.
Sometimes you just talked about a skill, listing the steps you would take in
the order you would take them—or you fooled around with a piece of hard plastic
fashioned to look like a particular anatomical part. This was going to be
different. Suddenly my plan was to go last. But there was already some
jostling for that particular position, a half dozen of us there in an
examination room in the School of Nursing and all of us trying to back up into the same
corner at the same time. It was like a backward mini-stampede of nursing students,
even the chicks wanted no part, which was a bad sign. They might share the
anatomy but we had all chosen pediatrics
for a reason.
Luckily, we were able to reach a
quick consensus—and we pushed Carina forward to be the one to demonstrate the
skill first. “Why do I always have to
go first?” she complained. Carina had been our unanimous choice a few times in
the past and she was starting to feel she was being singled out. Which she was.
The reason was that she was the
most highly skilled of our group. Carina was a critical care float nurse which
meant she went to all the most demanding units in Children’s Hospital,
pediatric intensive care, cardiac intensive care and newborn intensive care, on
a regular basis. She and Elizabeth were probably tied in sheer clinical
competence but Elizabeth stayed in PICU as charge nurse which is a pretty cool
gig, actually, until the shit hits the fan, whereas Carina had a different venue to
perform in every night. Which is hard to do even for a seasoned professional, whatever
the field. It meant that her game was tight, night after night, and
it was our belief—the belief of the other students that day waiting for a
dreaded check-off—that she was more capable of dealing with the stress of being first than, for example, me. That was our collective judgment,
our critical thinking as nurses, we had to choose and we chose her. Besides,
before arriving in San Francisco, Carina had done a travel nursing assignment
in Hawaii and there wasn’t much sympathy for her after we heard that. We pushed
her forward with not the least regret. Her tan from Waikiki went all pale.
Actually it wasn’t a tan, she was Filipina, but she still lost a little color. My turn did come last, gracias a Dios. The
surprise was that doing a gynecological exam turned out to be easy. You just
had to manipulate the speculum to open the view and visualize the cervix and
you were done. Get me out of here—my silent prayer—was soon realized.
Naomi was on a stool next to me and
on my signal she slid over to see that everything had been done properly. She was able to see the cervix. Normally this particular skill might also include collecting a few skin cells with a
brush, for testing, but we weren’t being ambitious that day and the whole thing
was suddenly over. What struck me though was that for the young woman being examined
this was work, used by nursing students and probably the medical school
as well. If she was cool with it you couldn’t help but be cool too and grateful to her, but for me it still spelled exploitation
on some level. And the experience brought into sharp focus the vulnerability of
the people whom healthcare practices on, those like this young Latina
who were being paid for their time or even ordinary patients who were
actually paying for the privilege of being poked and prodded by trainees. And
it occurred to me that those who were practiced on or experimented on were most
often people of color. Most of the time patients understand that “this is how
the system works,” this is how the next generation of doctors and nurses has to
be trained.
The patients whose prostates we
were now going to check in lab were healthy. So, there were a couple of guys
also doing this as part-time work, for the extra income, and the preliminaries
were dignified even if the exam itself is not. We shook hands and introduced
ourselves and then my guy disappeared behind a curtain to undress. Being of a
certain age myself, a prostate exam was already a part of my yearly physical
and my experience was that it could be pretty uncomfortable, yeah, but not
life-threatening or traumatic. One hoped. The best part was that it was quick. African-American men are especially
susceptible to prostate problems, my older brother had already had prostate cancer
at my age and both my grandfathers died of it. My mother’s father going
septic and my father’s father shooting himself when the pain and shame of
disease got to be too much. So far my own exams were all healthy, and the blood
tests looking for chemical markers of cancer were unremarkable, but this was a
condition that still meant a lot to me personally as a black male. It was
embarrassing to screw up the exam. Which is what happened. Kind of. At the last
second my hand slipped and instead of my finger gently palpating the prostate the finger bounced off the surface of the gland. Probably hurt like hell. The patient
turned and looked over his shoulder at me in pain and/or indignity. Oh shit,
again.
Heading for the door, our “skills
day” over, someone remarked, “Thank God I’m doing pediatrics,” and we all felt
like that.
We all had taken care of adults, at
least in our original training or early careers, but we’d
chosen kids irrevocably as our preferred patient population. Someone, another
peds R.N., said to me once that children are so much cleaner than adults and it’s not clear that’s the reason but it is a good reason. There’s also something much more natural about changing a diaper on a
six-month-old than on a sixty-year-old. Anyway, that was it. We were out of
there. That was our last glimpse into adult healthcare and it was a relief for me to see mature genitalia receding in the rear-view mirror.
Aging is all about keeping an open
mind. There can be certain protective factors in one's outlook on
life, which was something they actually lectured about in class, ordinary aspects of your personality or background that can lessen the harmful effects of physical or
psychological stressors, like getting older or being the wrong ethnic group or
being around people who don’t want you around. For one thing being older
than my classmates was different from being ancient. The aging process
represents, one hopes, an incline not a cliff. You may suddenly find yourself over
the hill but most of the time it takes a while to get there. If only because
you’re moving slower. At the time of my arrival on shinning Mount Parnassus the summit was still in
front of me and, frankly, my feet were in no hurry to get there. Which was one
of my reasons for applying to graduate school in the first place. Even if you
don’t learn anything concrete at a university you still learn that the world is
not a static environment. You have to change in order to succeed, even if it’s not in
the ways your instructors outlined in the syllabus.
And this may be the most important factor influencing survival in difficult circumstances: a sense of humor. Whatever my
faults, and they are many, not having a sense of humor is not one of them. Or a
sense of justice although that hadn’t been tested yet at the University of California, those first two
quarters in San Francisco. Being able to laugh at myself as well as others has
always been a big plus for me—just finding humor in the human condition and events of daily life. So too, being African-American and having been through a
grinder once or twice meant that the ladies of the School of Nursing weren’t
quite as fearsome to me as they might have seemed to someone else. They were very often objects of humor for me, especially the pompous ones like Dr. Rankin and some of the high-ranking physicians at Children's Hospital. Aging was actually
a protective factor for me because it came with experience. And-self-awareness.
And awareness of how others fit into the mix. What was most striking about the
women around me in the School of Nursing, looking back, was their lack of self-awareness: the
members of the white old girls’ club, Judy and Kathy and Sally had no idea they were
in any way similar to the white old boys’ clubs of Sam and Jeff and Dan that ruled
many of the professions that women wanted to break into. Or, if they did know they didn’t care which was worrisome but not yet scary. It would get scary once it became clear the lengths
to which Judy and Sally and Kathy would go to maintain their privilege, but that hadn’t happened yet.
Besides, the young women in my program—my classmates—were mostly open-minded and made me comfortable in their presence.
In recent years, for the young at least, ethnic background boils down to issues
of class and money more than skin color or cultural practices and the female
students around me seemed already to share that view. There was one exception
but she was the exception not the rule.
We were sitting in a seminar one of
the first days of class and the young white chick next to me, as we
waited for the instructor to arrive, identified herself as a nurse at Oakland
Children’s Hospital. She was a little uneasy sitting next to me, it seemed. To the degree she
was a “type” at all she was a type who was a known quantity in
children’s hospitals: prissy, ponytailed—often with a ribbon in her hair, not
that there’s anything wrong with a hair ribbon although it's a more
doubtful accessory in a woman’s twenties than in a girl’s teens—and a better
nurse than me without doubt. Which she may actually have been, who knows? Most often she was sure that whatever the circumstances she
was the last word in the care of children, whether the kiddo was black, white, brown or
Asian. So, like, this young lady in seminar looked me up and down and sneered at my attire, as we
waited to begin, me wearing shorts and flip flops and not really
giving a shit, frankly, about my appearance on a class day, dragging myself out
of bed before 7 a.m., my God, the instructors were lucky to see me at all. But they
always did. Never miss class was my mantra and my practice. Anyway, the young
woman asked me, “You’re a nurse?” She
wasn’t from the Bay Area obviously, you could tell, maybe Idaho or Utah, somewhere
with a low count of Negroes was my bet and the ones she had met certainly were
not professional equals or seated next to her in nursing school. She would soon find
that my casual appearance was firmly rooted in
normal for the Bay Area. Dress like mine, she would find out, especially working in Oakland, Jesus, was going to be the
least of her culture shocks. My response to her challenge was
moderate and measured, you would’ve been proud of me: Didn’t say anything to her
directly, never answered her question at all, just looked at her with an
expression on my face that said, “Yeah baby, and what are you?” It was a mean
girl’s moment but, please, you had to do better than that. Next up were the professors.
At one of our first lectures on
pediatric pathology, Mary L gave a great explanation about why a parent yelling
at a two-year-old not to run into the street doesn’t really work. The
brain circuitry is not hard-wired yet and it’s not that the kid doesn’t want to
obey, it’s that he or she can’t yet even comprehend the danger. That was the
kind of detail that attracted me as a graduate student and it was the kind of
practical knowledge that was important to learn because working with children,
even in the hospital you spent half your time explaining to parents why their
little darling age two, or sixteen, was not doing what mom and dad wanted him or
her to do. Especially if disobedience had led to the trip to the emergency room in the
first place. Mary L was good at that kind of perspective. She was a talented
lecturer who had worked for a time, she said, at a hospital in Ireland. My bias
is always to give greater credence to people who have spent time
outside their comfort zone, whether working abroad or starting a second profession, and that included, officially, Mary L who was my graduate advisor, by the way, although it
wasn’t my intention to avail myself much of her services. Still, it seemed like a good
idea at least to drop by and introduce myself. We were sitting in her office
after class one day just chatting and that meeting was a big hint that being a
guy in this SON would be risky business. My education was already headed south
and no one had even told me. Not to repeat myself. Or Mary was telling me right then and there, but
the message took a while to sink in.
She asked about my background.
“Well,” was my response, “I’ve done this and this and this . . . ” not bragging
exactly, just talking like a guy, clueless of course, without any fear that being direct about
life’s goals or accomplishments would not be well-received. You could see Mary just shutting down
mid-conversation, as if she were offended. It couldn’t have been
my ego that she found so burdensome. This was the University of California San Francisco where practically every
conversation with anyone from student to dean, surgical tech to surgeon, lab assistant to scientist, began with the other person telling you how
important to medical science their work and they themselves were. Many of the
people you met on campus were self-reported geniuses. There were geniuses coming
out of the woodwork because this was an ego-driven culture which is not the same
as an intellect-driven one, although there was that too on Mount Parnassus.
It was the kind of atmosphere you wouldn’t necessarily expect to find at a
university, actuallly—yet, nonetheless, was un-surprising at one that considered itself
the best. “Genius” was the hallmark of UCSF not mere intellect. When you were looking for the latter you always seemed to find the former.
My afternoon ritual included a trip to Ocean Beach but if the weather was funky or the surf was worse than
usual the swim took place early, before class, at the campus pool
across the street from Cole Hall, in the basement of an administration
building. In the men’s room one morning, relieving myself at a stand-up stall, two middle-aged physicians came to the urinals beside me,
small guys, Jewish if the names on their badges was any indication, and even
urinating they continued a discussion about status at UCSF that had apparently
begun outside, before the detour to take a pee.
“I was considered something of a
child prodigy,” said one guy.
“So was I!” said the other,
unzipping his fly.
“I was reading at age two.”
“So was I! To tell the truth, for
me it was closer to one-and-a-half.”
“I was going to be a concert
pianist.”
“So was I!”
They were still going at it, one
upping the other until my business was done. Shake shake shake, once again get me out of here. The core of the black race's nobility, if you asked me, is our humility. At age two, if my memory was
correct, my own weenie still presented a mystery to me, much less the
piano—we didn’t have a piano—so their conversation impressed me but made me uneasy as well. At UCSF, as it turned out, you actually met a lot of people who were going to be
concert pianists but the desire to help humanity called them to medicine at the last
moment. Somehow it was hard to take the helping-humanity claim completely
seriously when the person making it was wearing engraved scrubs and driving a
Mercedes, but that was life on Mount Parnassus.
The whole place could be pretty
ego-driven and hypocritical which was what Elizabeth had pointed out and which was why Mary’s response to my practice confused me. My ego didn’t even compare with most of the people on campus,
especially being a nurse, a profession that traditionally promotes self-effacement.
Even my most self-centered moments were naturally dampened by professional training and low ranking on the hospital totem pole. But that was it, that was my crime in her eyes: being
too into myself. And if that was my mistake with her, my feeling was, like, as an
insensitive, unfeeling male, too bad, you’ll get over it, Mary. Because humility was already pretty much an unknown quality in San Francisco, or at least on Mount Parnassus, and singling me out
seemed, well, bizarre. There was a neonatal surgeon who
kept appearing on the university website and every story about her mentioned
that she was a concert-trained musician, before she decided to help humanity. One
of the top cancer researchers made sure to mention in each story about
his research center, and there were many, that he was also a racecar driver.
So, like, whatever upset Mary about me was minor league, my ego wasn’t even an
also-ran in this particular competition. At the School of Nursing there was no talk of racing or musical aptitude: if you were walking
the hallways for instance, and the professors were chatting, and you listened
in, the usual bragging point involved research grants. People would talk about
how much research money they had, how much they’d been awarded, not so much the
project itself—not what it would prove or disprove, nor what it would mean in terms of
the advancement of healthcare—but the actual dollar figure being financed by
the federal government. None of which particularly impressed me. But it says something about
nursing and even about this flawed institution, the School of Nursing,
that the single most impressive individual who crossed my path on the heights of Mount Parnassus
was someone who appeared suddenly in those long hallways of the SON, another nurse, who was a remarkable woman because she lacked the ego to go along with
her accomplishments. She was African American although it’s my feeling now, still looking back, that her race was not what impressed me. Her
skin color was just what got us talking.
Early afternoon, early in my
studies, and walking down the hallway of the nursing building, minding my own
black business as the Constitution gives me the right to do, there was this attractive sister with a big smile going the same way. Being Negroes
in an environment like UC, known for its lack of colored peoples, we fell in beside each
other and started chatting. This was, for lack of a better description, the
conversation that Dean Martin-Holland would have had with me if the dean had had the power of speech when we first met. No matter. This particular talk
got talked and it was interesting because the sister in the hallway was
interesting. She was an army officer and a nurse-midwife and that impressed me,
the midwife part more than the army part. Even in the best of circumstances
delivering babies is a high-risk environment for mom and baby, and this midwife had just
returned from a tour of duty in Afghanistan where she’d been bringing kids into
the world, somewhere in tribal lands one supposes, unassisted by modern technology. Don’t
know if she was in San Francisco for a conference or for a short course—a
refresher of some kind or to learn a new technique—but she wasn’t a regular,
she wasn’t a student or an instructor in the SON because there were only so many sisters
around and they were already of my acquaintance. Her temperament set her apart
on campus too. Unlike the almost-concert pianists and racecar drivers, more
than the grant-hustlers, and certainly more than me, she was an accomplished
young woman who had placed her own life on the line to help people. And there was
no ego present. Or at least none that appeared during our chat. Just curiosity, which is a sign of the keenest minds. Questions are after all more important than answers, right? Doubt is often more convincing than
conviction. Isn’t that what it means to be on a university campus: not to know
already, but to want to find out? She said that what blew her mind in
Afghanistan, the part of her experience abroad that most touched her, was that
in the villages where she worked when a baby was born the custom was to place
the newborn on a cold floor to see if it survived. “Why do they do that?” she
asked me, not really expecting an answer, just trying to understand another
culture, working it out, out loud. That was what she brought back from
America’s wars: a question, not an answer. Her particular approach was humility, which you didn't see so much on Mount Parnassus. She didn’t
have all the answers, and that struck me because UCSF, of all the things
you can say about the institution, good and bad—and there were many good
things, just none that had anything to do with race or ethics—it’s not a
humble place.
If you closed your eyes you could
see this young woman working in basic conditions, her weapon in reach,
trying to help bring kids into the world. What made her the most impressive
person for me during my time in San Francisco was not just her technical skill but her
skill combined with curiosity. Modesty especially about other cultures was
the least common denominator you saw among the providers and the professors at UCSF. That was my impression at least, as a member of one of those other cultures. And that included me—if you
believed Mary L. Something,
whatever it was, that came out of my mouth in my meeting with Mary rubbed her
the wrong way. My bet now is that it was the environment as much as me
personally because my ego crimes were misdemeanors on a campus where felonies
were the norm. So, like, it was the climate: Men were permitted at the SON but like
children you were expected to be seen and not heard. This was a woman’s place.
That was my crime, being an unfeeling and insensitive guy in a world controlled
by insensitive males. Whatever. A day
or two later an email arrived in my in-box from Mary Mac informing me that she
was my new advisor and asking me to drop by for a chat. Mary L had bailed out
which bothered me a lot less than it might have. Once again, my self-assessment
helped me over the hump. If Mary L had a problem with me that was her right but one that did not cost me any sleep. My bet was that she would have been much
happier dealing with a black man who was clearly her inferior, who
came to seek her guidance as if she were a prophet, so that she could speak
down or assume the position of mentor. But what if you weren’t looking for a mentor?
What if you were just there for an education and when lecture was over you wanted to
go home? Did you have to bond with your instructors? Did you have to make your
instructors feel as if they were "helping black people?" If the issue
were nursing, Mary knew more than me. But for life questions, and questions
about navigating a system like UCSF, as a black male in an environment of almost
exclusively white females, including both Marys—my judgment was superior, by definition. Certainly as regards my own educational goals. My own advice seemed to me to be the
best advice. And still is. But at the University of California whites, it seemed, liked their minorities
looking up. The upshot was that Mary Mac became my new advisor. And actually, if it was possible, the
talk with her was going to be worse than the one with Mary L.
CHAPTER SEVEN
The site for my school practice was
the children’s clinic at San Francisco General Hospital. The students weren’t
consulted or this student wasn’t consulted but it was all the same to
me really, not having a car and not wanting to spend hours on a long public
transit commute to a far-off clinical site across the bay. A ferry ride to
Alameda just to lay a stethoscope on a healthy baby’s chest? No, thank you. You could do that in the
Mission District. General Hospital suited me as well as
anywhere else.
Mine was considered a prestigious
assignment but to me it was an appropriate one. General Hospital, run by UCSF, sees mostly minority patients and it seemed only right to have black and brown
providers there, if only as trainees. For me it was torture whatever the reason
and wherever the practice took place. This was Winter Quarter, the next step
after those tentative beginnings of long lectures and lab work early in the program and it was primary care—God forbid—sitting in a clinic seeing mostly
healthy children and advising mom and dad on the ins and outs of safe
child-rearing. Like, how can someone who’s never been a parent advise someone
else on being one and, more to the point, why would you want to? Just shoot me.
Working in the nursery in Minneapolis my responsibilities included teaching breastfeeding which was mindblowing for both mom and me, but being a trooper and talking to the experienced mothers, who were often
Latinas, pulled me and mom through. San Francisco General Hospital was—is—something else. But you can
do anything for ten weeks, right? And once this rotation was out of the way Spring Quarter would be chronic care, also in a clinic, where we’d be seeing
kids with longstanding illnesses like asthma or diabetes and who needed regular attention, just not a night in a hospital bed. As with my limited interest
in primary care, my interest in chronic care was also modest. But then, in
second year, we’d be in acute care,
in the real hospital, in the wards seeing really sick patients (yeah!) capped
in the final quarter by critical care or practicing in an E.R. It was like a
ladder, literally a clinical ladder, and they didn’t let you skip any steps.
San
Francisco’s historic old county hospital looked like a jail. There’s no other
way for me to describe it. In fact the county jail in Austin and the county hospital
in San Francisco looked as if they’d been designed by the same architect. Which
was not a bad thing, actuallly. SFGH is now Zuckerberg San Francisco General,
something like that, named after the Facebook trillionaire and his doctor wife who dropped $100
million on a hospital facelift, but at the time of my clinical rotations it was
just a funky old county “facility,” a term which is also used for county
lockups. It included indigent care and was the kind of place where most of my prior nursing practice had taken
place. You meet a better class of patients in a county hospital, that’s my
belief, people who may be crazy or poor but are usually grateful if you actually solve any of
their problems. At a private hospital if you help someone they assume that’s
what they’re paying for. Very often “at the county” people aren’t paying or
at least not directly and they say thanks, my favorite word next to “free.”
To have a feel for the old SFGH prior to the Zuckerberg dollars you only have to know that a patient went
missing from her bed in the adult wards and was found days later, dead in a
stairwell. Not only had no one missed her, no one found her—for days on
end. She didn’t bleed out, she wasn't assaulted, according to police reports published in the newspaper, she
just died on the stairs and apparently it took a while. This woman’s misfortune
aside, that would be my ideal place to work, a county facility, every day an
adventure in a kind of semi-controlled environment—unless you wandered into the
stairwell and then anything could happen. The SFGH children’s clinic was upstairs on the eighth floor, more upscale
than the wards, as pediatric units tend to be even in poor or inner-city
hospitals. Childcare is about shielding kids from the harsh realities of the adult world or dosing it one teaspoon at a time and in that respect a pediatric clinic is no different. It has a lot of balloons
and hanging mobiles and smiling faces you wouldn’t necessarily expect to see
out on the streets in the Mission or even elsewhere in the hospital. My
clinical instructor was Professor Duderstadt, who wrote our pediatric assessment
text and, looking around me, on the walls of her office there was a kid’s growth chart and the
mandatory poster showing the U.S. Department of Agriculture food pyramid. Out
in the waiting area there were boxes of kid’s toys and bright colors where the
families lined up to see providers, or for kids to get their shots.
In the SFGH children’s clinic you
did hear the occasional blood-curdling scream, the kind of noise only a child who
hasn’t yet been touched can make, with a long pause as the kiddo sucks in air
before exhaling murderous discontent—and pretty constant crying. But most of
the munchkins who were old enough to recognize their surroundings were old enough to
be resigned to their fates. In the end there was no escape for them or for me. The routine
was routine, seeing newborns for well-baby checks, immunization updates and,
always, answering questions from mom and dad. Karen tried to get me to learn
the immunization schedule by heart and the memorization task itself was not
difficult but it was the first step of a commitment that didn’t interest me.
More worrisome was Karen herself. From our first day together my sense was that
Professor Duderstadt saw me not as an individual but as a good work. That would include converting me to clinic practice. This seemed to be the
screenplay she was working off of, starring herself as mentor and me with second
billing as protégé. No thank you, that movie had already been made even then and me appearing in a supporting role in a remake of my own life didn’t attract me. Liking Dr. Duderstadt on a personal level did not mean trusting her on a
professional one—this was my education, involving my choices, and there was no
need for me to defend my professional aims or my career path to her or anyone
else. My relationship with Karen was therefore friendly and cautious. Didn’t want to get that attached, actually,
and—actually—primary care never attracted me as a nurse, for precisely the same
reason that critical care was not my favorite thing. You’re tied to a given location. My
mother’s wanderlust had been passed on to me, the last of six children,
with a vengeance. To call my attention span fleeting was to give more credit
than deserved. Unlike primary care, or an ICU bay, to me the beauty of the wards and the emergency room is that
you can wander, opening new doors, into different rooms, satisfying
the demands of a free spirit like mine even if your travels in the hospital
hallways include balancing a sick baby on your hip and dragging an IV pole
behind you. Karen was okay to work with, at the beginning, before the White
Woman’s Burden consumed her. The General Hospital was her regular gig a few
days a week. The rest of her time was spent teaching in the School of Nursing or
writing. She was an excellent lecturer, by the way. My hours in clinic covered her mornings while Elizabeth came in for
the afternoons. The lingua franca was Spanish.
Don’t know what Elizabeth’s
afternoons were like, maybe there were white families that woke up late, but in
that entire quarter of mornings in clinic not a single white face appeared at our
examination room door, during my apprenticeship. We had occasional Asians, an equal number more or less
of black people which is to say few—as gentrification exercised a slow
stranglehold on S.F.’s African-American community. The patient population was buoyed by a lot of Latinos, usually immigrants, who
somehow managed to stay in the city and go about their lives in what was
becoming a very expensive environment. The Mission where General Hospital sits was already said to be Ground Zero for the Google employee influx. The majority of the Spanish-speaking
families were Mexican or Central American, a handful of Peruvians or
Ecuadorians thrown in, immigrants like many of the newcomer Asians who were not
part of San Francisco’s old established Chinese community. To repeat, no
whites—not in the entire ten weeks of Winter Quarter. During my brief breaks
from Karen’s office there was a chance to scope out the rest of the clinic faculty and with the exception of an experienced older Chinese-American nurse
practitioner and a younger one named Andrea who appeared to be half-Chinese and,
one supposed, half-white—it wouldn't have been cool to ask—and who spoke
Spanish and Cantonese and
Portuguese—of the dozen or so providers in the SFGH kid’s clinic, doctors and
nurse practitioners alike, all were white females. All. Let me repeat that stat because it bears repeating: almost all the providers seeing almost exclusively minority patients were white women. So, the staffing
passed into my subconscious under a heading that would eventually become “lesser standard of care,”
something that would need to be pointed out at some point in the future but not
at that exact moment. Timing is critical and mine is often dubious but this was one of the few instances in my life when an inner voice told
me, don’t, just don’t—or, not yet. Being
a very spiritual, old-school Negro, however, my bones had already told me that my life
would somehow change at General Hospital. If
someone had also said there was an academic lynching in the making in the
Children’s Clinic that would not have surprised me because it was a potentially
dangerous professional environment for anyone who was not a white female. But
that it would be me hanging like the mobiles out in the waiting room—you couldn’t have convinced me, until the rope was already tight around my neck. Like going into any iffy situation, you never think it's going to be you who won't survive. You may recognize risks but somehow never think you're the one in most danger. Wrong, yet again.
My concern about the role of
segregation in the provision of healthcare was growing too, prompted more by my
experience in allegedly liberal San Francisco than in conservative Texas. But
you wanted to do your research and cross your t's and dot your i's before you spoke out because it was my
experience that liberal whites liked to be called out even less than do rock-ribbed conservatives. At the same time this was dangerous ground because it was also my
experience that white guilt is expressed most strongly after white people have done
something to feel guilty about. Yet—and paradoxically—to my mind this was still merely an academic struggle, which meant a bunch of white PhDs who could not take out an experienced Negro even if they wanted to. Wrong, wrong, wrong. And wrong, again.
But when you’re on the correct side of an issue you tend to think you’re
invincible. Yet another error on my part. To me, the big issues at the University of California were minority healthcare and
minorities in healthcare, which are essentially the same thing. It’s a minefield nonetheless, as is almost everything else
related to race in this country. There were resources out there to call
upon, yes. My brother graduated from and taught at Morehouse, the
historically-black men's university in Atlanta, and at the
time of my practice at SFGH the issue of color in medicine was beginning to
appear as a new front in civil rights. One of the members of Morehouse’s
medical school faculty was Dr. David Satcher, who'd been President Clinton’s Surgeon General, and in reply to an email Professor Satcher told me that
anyone who really wanted to know about the crisis in minority healthcare had
some reading to do: a big federal study that had come out a few years earlier,
the Sullivan Report on Minorities in
Healthcare, that confirmed what anyone in a modern American hospital could
see. Not only were people of color missing in the healing arts but the
implication was worse care for these same ethnic groups. A black or Hispanic or Asian provider
is more likely to know the ins and outs of his or her own culture’s health practices, and problems, while whites fake it every day with dire consequences for minority patients. As in so much of our daily lives, American medicine took a long time to
get there but finally reached the conclusion that a white shop—and exclusively white providers—is not in the best interests of non-white patients.
Except in San Francisco. At UCSF they knew the science, since they were talking
about it in lecture. Every other word in class was “diversity.” They just
weren’t practicing it in the hospital.
Which doesn’t mean that my own
practice was immaculate. It’s an axiom in this profession that if you want to
know if someone is a good nurse, talk to the R.N. who follows him or her at work.
Whoever is on the next shift can tell you how well the prior nurse did the job. There may be a more telling way of getting the lowdown however: Check his or
her medication administration record. Passing meds—by mouth, by rectum or by
IV, shots and eye drops, from nicotine patches to antifungal creams and killer antibiotics—is what we
do. And most often where we screw up. That includes me.
The
nurse who killed the patient with methadone made a mistake that’s practically
inconceivable to me. The difference between milliliters and milligrams seems so
fundamental that the only possible explanation would be fatigue, or
disorientation, being new or being discombobulated or just having too much going on.
We all have different blindspots and of course this is only speculation—but she
may have been a veteran nurse who just had the day from hell, which happens to
all of us eventually and perhaps frequently. The real risk-takers, the real “scary
nurses” as they’re called, are the ones who don’t recognize the possibility
that they themselves can err: an attitude that's a particularly profound
danger in pediatrics where there’s less leeway for making a mistake. An adult
can get a wrong dose and shake it off and most of the time it’s not the end of
the world, either for the nurse or the patient. A baby, no. Therefore the
weight is on your shoulders working with children and you’re a fool if you
don’t admit your own fallibility. A few years ago a senior R.N. at Seattle
Children’s gave a dose of a med that killed a baby. The details are still sketchy,
or not public, but she apparently made a mistake that’s easy to commit, what
you can call the “ten times error” in which, for example, instead of giving .01
milligrams she gave 0.1—ten times the prescribed dose. She said later that she
gave what the MD ordered in a quickly-evolving situation with a very sick child.
Apparently the order was verbal, for a cardiac med, and instead of helping
cardiac output the dose stopped the baby’s heart. The Seattle Children’s nurse
nonetheless gave the wrong dose, what
can you say—a lethal dose, regardless of what was ordered. She was fired. She hanged herself. Again, what can you say? Except that it’s an
easy mistake to make, especially with a verbal order in a crisis situation—or, at least, easier to imagine than confusing milliliters and milligrams, you feel me? Once, at
a prior children’s hospital, back in Texas, walking to a bedside to administer a med for
diabetes insipidus, and showing the syringe to the non-English speaking mom in the room—her
sole comment to me was, “mucho,” which led me back to the med room to recheck
the order. It turned out that it was the ten times error in the making: the
baby almost received a major overdose at my hands. All of which is mentioned
here for a reason. It can happen. And was about to happen to me. At the
UCSF cardiac intensive care unit. Nobody died. But it was a particularly humbling experience since the mistake was
made by the medication safety nurse, moi.
So,
this is kind of embarrassing. My scrotum gets a little tight just repeating
what happened. My balls tie up in a knot, which is the way anxiety is
often expressed by a sensitive, insensitive male like me. Came to work one evening and there, hanging on the cardiac unit bulletin board—among nursing news,
notices of mandatory in-services and a sign-up list with open shifts to fill—was
a clinical hall of shame: mistakes with meds, poorly written doctors’ orders,
failures to follow protocol. At the time, orders were still ink on paper and the
physician handwriting alone was enough to cause cardiac arrest. At the very
center of the board was a recent order for a med and the notation of the person
checking the order, which started well enough but ended as a scrawl running
down the middle of the page, as if the person writing had fallen asleep
mid-word. Which seemed to be exactly what happened. There was no signature because the
nurse checking the order was counting sheep by that point, but the early
handwriting looked uncomfortably like my own. Sudden fear seized me. Oh shit
oh shit ohhh shit. This made failing a check-off seem trivial, by comparison.
Mine wasn’t the
pee-running-down-your-leg kind of fear. My scrotum didn’t tighten up at the time because at
that point my testicles had already disappeared entirely, pulling up inside
like on a cold day, a sign of a moral and ethical unease that was worse than
physical fear because unlike mere bodily danger—running away wouldn’t help.
The CICU clinical educator happened to be there, as my shift
began, and she was the keeper of the bulletin board. She had posted my screwed-up order as an example of what not to do. She confirmed my worse fears,
that it was my error but because it
was such an obvious mistake no harm was done. Speaking of the posting she said,
“It’s not to embarrass anyone, it’s for people to be aware and cautious.” She
was cooler about it than the mistake really deserved. Nights! Dean Dracup was
right, they're hell. But having said that, about how hard it is working 7p to 7a, there’s still no
excuse. By law and by practice the nurse has no one to blame but
him or herself.
The key paradigm of this job, what has made nursing a respected
profession, is the personal responsibility of the practitioner. This is nowhere truer than in medication administration. If you gave the wrong med you have to take
the fall, it’s that simple. Also, if you signed off the doctor’s order you’re
responsible for seeing that it's carried out, another fundamental rule. There’s no one
else to blame. It’s often said that we learn the most through our mistakes, by
the errors more than the successes, and that was especially true for me at the
CICU. But you could also say that has been the story of my life: trying different
ways of doing things, different “experiences,” in different venues,
experimenting with life, so to speak, to find the best way to go forward—my way, to quote Frank Sinatra. Except, and this is a big exception, not intentionally, not in nursing, because in this venue, in this gig, in this profession, any
mistakes don’t fall on me—they fall on the patient. And that’s always seemed to
me to be an unfair way to perfect a skill. MDs sometimes get away with it when
they try out new surgical approaches or new medical treatments, especially on
“charity patients”—who very often are minorities—but nursing is not supposed to
be about exploitation of the vulnerable. This would turn out to be another
lesson learned at UCSF, by the way, where that prohibition did not seem to hold. The
best practices that should govern a RN were not always observed at the University of California San Francisco.
Sometimes we as nurses knew what was wrong and didn’t speak up. Sometimes, when
a R.N. spoke up, the other nurses closed in for the kill. That was going to be my experience. Oh shit, again.
So,
the CICU was a good learning environment, yes, regardless of my mistake and thanks to the competence of the people around me. Because of my age and my
upbringing during the civil rights movement however my eye was nonetheless conditioned always to look at the racial composition
of my environment both for my own safety and, frankly, to see who had the
jobs—and that was no different at the cardiac intensive care unit. Working both
day and night shifts, weekends and weekdays, it was a pretty select group
around me—maybe two dozen nurses, max, who were regulars. My classmate Carina
came to the CICU a couple of nights as a float nurse when the unit was short of
help and she was a pleasure to watch because her game was tight: drawing blood,
checking the monitors, giving meds, she invariably had two or three patients but never
broke a sweat, calm and practiced, in a rhythm and competent without being
showy. She told me she liked to come to CICU because she could use the computer at the nurses station to print out her school readings free of charge. She and a
Japanese-American chick who was a regular staff nurse were the only people of
any color, except the manager herself who was a Latina or had Hispanic blood.
There was one guy, an Anglo who looked military or ex-military. My shifts
were usually spent just watching or helping on minor tasks because even though
there was a cardiac fellow or senior resident usually present the actual number
of orders written was few. Among the new arrivals like myself there was a travel nurse
from somewhere in the Midwest who was also very competent, and kind of hot, not
that that’s important, and one night we were both at her bay with a newborn when
she noticed something: just a blink of the monitor, or a twitch from the child
himself. The traveler made a telephone call and started to bundle up the kid’s
lines and tubes to go and get a scan and, sure enough, the child had had a stroke.
It had completely escaped me, just a flicker of a waveform or a shudder on the
baby’s part but the traveler was sure something had happened and she was right.
It’s called experience. Definitely she was out of my league as a nurse but
not out of my range, you feel me? Anyone can learn any job, that’s my theory, and pretty much what the literature shows, but the ones who are most likely to learn new skills are those who are chosen
for the opportunity to practice them. In this CICU as in the rest of the
medical center those people were white. They had experience
only because they’d been hired for the position, but they tended to believe they
were exceptional rather than privileged. Which is cool—delusional, but cool.
Still, it was interesting to watch these folks because this was high-level
nursing whoever was practicing it. Another night a teenaged girl on the unit who
had a potentially-fatal dysrhythmia and would need a pacemaker coded, just a few hours before surgery. Everyone was at bedside, pushing meds, shocks,
the whole gamut of interventions—and the nurses and doctors were calm and
unflustered because, like, it doesn’t help to get excited, right? That’s
easier said than done. You heard a little nervous laughter anyway, the kind of
joking from people who don’t know which way a tense situation is going to turn. But no
loud voices, no wails of uncertainty, no cursing, no panic, just follow the protocol and keep re-assessing. My eyes were glued on the charge
nurse who was pushing the meds and she was completely on her
game. They got the girl back and that’s what mattered. At that point my
decision was made. This would be the location of my clinical practice for
school when we entered critical care during my final, capstone quarter. Decided by me,
that is—at that moment. This was my
screenplay and it suited me far better than the clinic scene that Professor Duderstadt had in mind.
Only the manager of the CICU said
no.
There was a student from City College’s nursing school doing her clinical practice in the CICU
and she wasn’t even a nurse yet the manager was cool with that—but she was adamant in saying no to me. And that was confusing: UCSF medical students did clinical
assignments there, in Children’s Hospital, dental students and pharmacy
trainees were also in clinics on campus and everywhere in the medical center.
What was the point of paying for this very expensive education if you couldn’t
take advantage of the hospital attached to the university? That was the reason the medical center was attached to the university, after all: it was a teaching hospital. The manager made
clear it had nothing to do with my botched order, she didn’t even know about
that, but she wouldn’t hint at what the real dynamic was. This wasn’t
about race, that seemed clear—as it turned out it was about
territoriality, some kind of in-house bickering between the SON and the
administrative arm of the nursing service in the medical center. Something
mundane in other words, which was disappointing but not threatening to me personally, or even about me.
Someone whispered in my ear, don't push it, just back off was the exact advice, as if it were coming from my own inner voice of restraint. Which meant to me, push,
yeah—isn’t that what it means to be a guy, if someone tells you not to do
something you have to know why not and even if there’s a good reason you do it
anyway? That was my fundamental training as a male in society, at UCSF or
anywhere else. It’s my definition of masculinity, and that’s
said with no shame or embarrassment about being male. Women have hormones too and none of them has ever apologized to me for being a woman—why regret my own testosterone? Then, just as my plans for raising the issue of clinical placements took shape, a more urgent concern came to my attention. One of my paychecks from
the vendor providing the medication safety service arrived and it was, like,
grossly inflated. Like twice what they should have paid me or had ever paid me
before. Having as much affection for money as anyone else but knowing that
people don’t give it away made me anxious once again. There had to be a reason, not merely an error in placement of a decimal point
The business office of the vendor that employed me was in the city and the big check warranted a visit to the manager. The vendor asked, like, what are you complaining about, it’s more money,
right, they’ll never notice—he was practically winking as we talked.
Ethics would probably not be my strongest character trait but having a
nursing license to protect forced the issue into my consciousness and started a brief right-versus-wrong internal debate. That lasted like five minutes. This was
theft or fraud or something illegal and it wasn’t my intention to lose my
livelihood or go to jail for something stupid—certainly not for a few
hundred dollars. A few million, we can talk, but this wouldn’t even pay for a lawyer to represent me if a state auditor started looking at my check stubs. Especially since
my compensation for signing off orders, or falling asleep, as the case may be,
was already pretty fair. Fairness more than traditional right versus wrong is an important consideration in my world. This would be
greed which is actually not among my many
faults. So, the search for a real job in the Children’s Hospital, as a real
nurse, shifted once again into high gear. Visited the office of the medical
center nursing recruiter and left a note reminding her of my application, my
experience, my gender, my ability to speak Spanish and my studies for a
master’s degree in hospital-based pediatric nursing next door, which seemed to me to be an attractive combination for any potential employer. Wrong. There were still dozens of openings for R.N.s listed for the Children's Hospital alone, to say nothing of the adult units. A day or two
later the recruiter left a message on my phone: “I can’t help you,” she said. “You’ll
have to do it just like anyone else.” Which blew my mind again. This wasn’t a request
for some sort of special treatment on my part. She was the
recruiter. Besides, how did all these inexperienced white women
from the master’s entry program who only had certificates in nursing get
hired?
Let me repeat: How did all these
white women get jobs? They’d done it “like everybody else?” The no-experience
and a year of nursing training stood out on their applications? Please.
CHAPTER EIGHT
Some lectures are useful, some less
so. Some instructors like the sound of their own voices while others go to the
lectern with a clear message and deliver it succinctly and sit back down.
Whatever the lecturer’s talent or abilities some students are less than fully
tuned into the content on any given day and may be sitting in one of the back rows of a
really big lecture hall engaged in a conversation that, in this example, had absolutely nothing to do with pediatrics, nursing or anything even remotely related to healthcare. So, that day me and Carina were those two students, sitting
in the last row, in a far corner discussing the presidential race. In low
voices.
“Don’t
you think,” she asked me, “it’s odd that you’re a black male and you support
Hillary Clinton and I’m a female and I support Barack Obama?”
Carina was a graduate of
Illinois State University and it was completely understandable that she
supported her home state’s favorite son. My own decision to vote for Hillary in
the California primary had nothing to do with United States Senator Obama,
actually. He sounded great. And, having recently arrived from the Midwest where
Barack Obama already enjoyed a good reputation even in mostly-white
Minnesota—what was not to like about the junior senator from Illinois? For me
personally it was just that having been burned before meant not wanting to be
burned again. Living through the governorship and presidency of George W. Bush meant extreme
care in the next election. And it seemed unlikely at that point in the campaign
that the Democratic Party would choose a top-of-the-ticket candidate who two
years earlier had been raising his hand to vote in the Illinois State Senate, or that
six months down the road the country would select a black man whose middle name
was “Hussein” to be the next President of the United States. Excuse my
skepticism. Wrong again—my bad—my claim has never been any kind of ability as a
political seer or visionary.
Our main
subject of discussion that morning was not political. It was instead Mary Mac, our mostly absent program
leader. The intelligence the students exchanged on instructors was just as important to our success in graduate school as anything we heard from the front of the lecture hall. Mary was still dealing with the second year students but as Fall
Quarter passed into winter she became a limited presence in our first-year
lives too, and because we would soon be joined at the hip it seemed
like a good idea to learn what we could about her sooner rather than later.
Carina had just met with Mary, and my own appointment in our program leader’s
office was already booked. Students can be cruel about clueless teachers, we
know that. But my bet is that instructors make some of the same comments about
clueless students. What follows is offered as a harmless but illustrative
exchange on graduate school life.
Carina said she had visited Mary to
talk about the program and her plans—Carina’s “future endeavors,” as professors
like to say.
“Yes!” Mary said
energetically, per Carina. Mary agreed with my classmate’s clinical aims and how she intended to go about achieving them. Carina may even have added an
imitation of Mary’s voice and manner that is beyond my ability or gender to
mimic now. “Good!” she quoted Mary’s emphatic, no-nonsense way of speaking that would soon become familiar to me.
“So, tell me—” Mary asked Carina,
perhaps even leaning in, as feminists now say, “who is your advisor?”
That was actually why they were
having the meeting in the first place. “You,”
Carina told her, “are my advisor.”
The anecdote fit into Mary’s
reputation for cluelessness which seemed endearing, even charming at the time. We had a good laugh. But my actual meeting with Mary would turn out
to be so much less entertaining.
Mary Mac was an attractive woman
about ten years my junior who looked as if she spent more time at the gym
and in the salon than many of her colleagues. Not my type, not that that’s
important—me being the kind of man who prefers brains to boobs, most of the time. There's nothing sexier than a smart or accomplished person—but Mary was
someone else’s type, certainly, that was my guess, or she played for the other team. There’s an old stereotype that many men hold
that an attractive woman is a bubblehead and that‘s one you’re quickly
disabused of, if you hold it in nursing. There’s no
logical connection between “hot” and “dumb” and the only consolation to women
who have been mischaracterized in that way is that some women hold the belief that "dumb" men can be wrapped around their fingers. Having noted these
provisos—Mary Mac, bless her heart, really was a bubblehead. She had somehow
gotten her name on a scholarly paper as a co-author (one of the other students found it on the Internet)
which was doubtless one of the requirements for her position as an assistant
clinical professor at this very prestigious university. But in
conversation to find a less intellectually-driven academic would have been
difficult. Mary was there, one presumed, because she knew someone, which is the
UCSF way, and also because this specialty, hospital-based pediatric nurse
practitioner, had in fact few practitioners. There were only a couple of schools
in the country with an equivalent program and Mary was one of the few
individuals competent to teach the subject. To say Mary was anti-intellectual wasn’t
to say she had not read a book but to say, instead, she had probably not even
read a newspaper, or not recently. Later, after the proverbial shit
hit the proverbial fan, when two years had passed and the university finally
released documents related to my dismissal from the School of Nursing, Mary was
quoted expressing disapproval that a man of my age was studying in her program
in the first place. Excuse me? She was teaching at the University of California
and she didn’t know she couldn’t discriminate based upon age? After my
appearance before the Regents she was also quoted in documentation reluctantly
released by the SON saying that she would “NEVER”—their caps—allow me to
complete my studies. She apparently had not heard of the rule against
retaliation, either. That Mary was intellectually and temperamentally unsuited
to the classroom did not mean to me, however, that she was a bad practitioner. Karen Duderstadt also had professional issues but was quite competent in clinic work. Actually that
was where, it was my bet, Mary shined. She was good in clinicals—good in the
hospital—which made her invaluable to a program which had very few
people capable of instructing it. There were other people to give me the
didactic content, after all. Bubblehead intellectually didn’t necessarily mean bubblehead in practice, there are different kinds of intelligence and nursing is a mix of skills, and since she was there to teach us the hows of practice, not the whys, that was okay with me.
Until we actually started to talk
to each other. During the meeting, which started well but ended poorly, there
was only one moment when we connected as two people. “Why,” Mary asked me, “did you
get into nursing?” It was a question that had also perplexed me from time to time. “Burnout,” was my answer. My prior job was at a desk and
eventually, well, you just get tired of sitting.
She nodded. It was an explanation that Mary could understand. Anyone working in
a hospital who doesn’t understand the concept of burnout is not working on the clinical side.
She only seemed surprised that it could happen sitting down just as easily as
on your feet.
We returned to the boxing ring.
“You know,” she asked me, “that I can kick you out of the program if I want
to?”
She was smiling as she said this,
standing behind her desk like a ship’s captain on the bridge, me seated in
front of her as she looked into the distance in what was actually, despite Mary's pretensions, the claustrophobic
office of a junior member of faculty. Assistant clinical professors don’t get
windows, apparently. Anyway this wasn’t really Mary talking or it didn’t seem to be her at the time, it was really the hierarchy of healthcare
reminding someone who might step out of line that a pecking order exists.
Civilians often mention brain
surgery as the top of the hospital feeding chain but my own experience is that cardiac surgeons are the big men and women on campus. They do heart
transplants—and as accomplished as neurosurgery may be, no one
has yet managed to transplant a brain. My information was that at L.A. Children’s, Mary worked the CICU
where, if true, and if it was anything like UCSF’s CICU, there was a well-established
hierarchy. During my shifts at UCSF's cardiac unit one of the principal pediatric
heart surgeons appeared on the unit from time to time and his chest was so
puffed out that his sternum passed through the doorway a few seconds before his
feet. So, like, Mary was accustomed to working in the same kind of top-down
environment and she was reminding me to bow in her presence. She was clueless, just as
the reports had come to me, because she didn’t realize that her threat was not
only inappropriate but how it might be viewed by an African-American male
studying in an environment of all white women. At that point her threat could
easily have been seen as an attempt to create a hostile environment
for a minority student—actually, that effort would come a few weeks later. But my feeling at
the time, based upon reports of the other students, was that’s just Mary. She’s
a bubblehead.
Part of the problem here was also
generational, a dynamic you could see day to day in the
School of Nursing. The instructors were used to dealing with twenty-something white chicks—most students were recent college graduates—almost exclusively white women like themselves. If a student stepped out of line the ladies of the SON reminded her who was calling the shots. Most
of these young women were new to nursing and new to professional life in general and looked up to the instructors as
sources of wisdom beyond the skills of healthcare. Which is fine. But that was not me at all. First, my role was as a student but also as a consumer of a university education, which is the modern view of college, by the way, and my expectations of my instructors were just as high as theirs of me. My instructors knew more about pediatric nursing, that was a given—and was the
point of my studies. But on any other issue my intention was to keep my own
counsel and in the event it became necessary for me to seek guidance about some
aspect of my life, frankly, my first choice would not be SON faculty. It certainly would not have been Mary. A woman like her would not have the experience
or background necessary to be helpful to me as a black male, actually. Or the intellect. In any case, in
reply to Mary’s threat—that she could kick me out of the program if she wanted
to—my response was simple and direct, which experience had taught me was the best way
to deal with threats of any kind.
“You can try, Mary.”
Wrong again. As it turned out she
did force me out—or she led the way. And it would be little comfort that she followed me out the door.
Being hired as a nurse in the
Children’s Hospital turned out to require a single conversation. Doing it “the
same way everyone else does,” as the recruiter advised me, meant getting a
connection—a rabbi—or using what the Chinese call the hou men, a back door. Hooking up, in an employment sense. As you may already know it’s not what you know, very often it’s who you know—if only someone had told
me that a few months earlier! Believing in a system of merit-based employment at the University of California had held me back. Oh well, wrong again, but only for the best of reasons.
Among the two dozen or so students
in the pediatric nursing programs there was one other male, named Dan. A white guy, from an inland county in California and a graduate of UC Santa Cruz. He was a
wannabe surfer by avocation. He had a certificate in nursing from the SON and
had been hired on 6 Long at Children’s Hospital, like so many white female
students. 6 Long was the so-called “dumping floor” for kids who didn’t have
heart ailments and who wouldn’t go to CICU or the step-down cardiac unit—or
just weren’t sick enough to be in the PICU in the first place. Or who had left
PICU for a “lower level of care,” which is an unfortunate phrase. Hearing of my
job search Dan walked me over to meet his clinical manager and she hired me on
the spot. Done. It was that simple.
Most work environments have a little who-you-know-not-what-you-know going on,
connections can have a role in hiring whatever the circumstances, but a year or two later, as the university began half-hearted
efforts at reform, in a moment of candor the head of the medical center’s
nursing service told a diversity conference that the connectedness dynamic on campus was so strong it
got in the way of integrating the workforce. White people were mostly connected to other whites.
Have you seen the film Four Weddings and a Funeral? Me, neither. Apparently it's about a man and a woman who see each other at a number of social gatherings and fall in love. It’s a great title and it actually applied to the remainder of my academic
quarter: Four Meetings and an Evaluation that was like a funeral. Unlike the movie there was no eventual love interest. The meetings were with Associate Dean Fontaine who would directly threaten my academic progress in a very up-close and
personal way, in case the unofficial hints were not enough; with Associate Dean
Martin-Holland, when we finally attempted to bond as black people; with the
queen bee herself, Dean Dracup; followed by a kind of ménage a cinq with most of the above. Deans Martin-Holland and
Fontaine and the two Marys and me. That one was kind of fun, actually, because it gave
me a chance to score a few points of my own. Unless you’ve decided to be a
victim you have to defend yourself and, in all modesty, my idea was to put the
administration on the defensive with aggressive counterpunching and deft
moves in the ring. No, the gatherings were not
scheduled merely because the women-in-charge had nothing better to do. They
made time for me—but only in the cases of Deans Dracup and Martin-Holland was
it at my request. My activist side had come once again to the fore, and having
secured a job and with my academics in good shape, for me this was the correct
time to challenge the system. Today in the era of BlackLivesMatter and the return with a vengeance of racial protest
on campus no one would think twice about speaking out. But neither my open records
request to see the stats on the number of minorities in the
School of Nursing, nor to the medical center for the racial and gender
breakdown of staff nurses went over well with the administration. So
much for transparency: it’s fine in principle, issues only arise when you
actually ask to see the data. There was also the question of why UCSF nursing
students weren’t allowed in the UCSF kids' cardiac ICU, which needed to be revisited—or so it
seemed to me. The only issue that remained off my radar for the time being was
San Francisco General Hospital and that was a good thing in the short run because
in the long run it would cost me my head. So, like—if you ask me now—the only
problem with creating a perfect storm is that if you create one you find
yourself at the center of it. Being right is a mere detail. The most lasting lessons you learn
in graduate school may not have anything to do with your coursework. You learn
about higher level negotiation and you learn about the levers of power, even if
it’s still not your own hand on the lever. Being at UCSF taught me a
fundamental rule that had somehow escaped me up until that point. There’s
always pushback. No one should graduate from graduate school without knowing that fact of life. In similar circumstances—challenging an established order—retaliation is not just a possibility. It’s a certainty.
Noting a certain hostility among
the instructors as email began to fly, to and from me, as well as about me—and
having heard of this kind of environment before, what the courts call “hostile”
to minorities, whatever their stripe, color or sexual orientation—my way of
communicating changed, as my own professors made me wary. Avoiding some
conversations in person, if possible—replying only in email so that there was a written
record of what was being said—and very often replying in an oblique way and by
making points that my correspondents were not mentioning. About my rights as a
student, for instance, should things go south, which was the direction they were headed. Meanwhile Dean
Holland-Martin was called upon by her colleagues as the “strong black woman”
who was supposed to serve as an arbiter in any dispute. She wrote an email
to me and the Marys, after reviewing our correspondence, saying that it seemed
to her that we were talking past each other. That was correct. But it
wasn’t because we were miscommunicating or because we “weren’t on the same page,” as people like to say, it was because we had different agendas.
Negotiations break down not only because people don’t compromise but because
goals can be so fundamentally different. The Marys were defending the status
quo while my design was to foment change, while still protecting my ass. Once
again, we all failed. But that’s life at a big institution full of smart and
opinionated people, all with different aims—a marketplace of ideas, literally,
in which being right or having history on your side is no guarantee of
success. Even today it’s still possible to see a certain humor in events, black humor of course. Until things were no longer so funny.
First up for face time was the
associate dean for academic affairs. If my understanding of the SON hierarchy
was correct Dorrie Fontaine was Dean Dracup’s right hand and chief enforcer and
anything that Fontaine had to say could be viewed as coming from the Big
Lady herself. We met in a conference room outside Dracup’s office, sitting down
next to each other at a long table where Dean Fontaine’s mission was to make
clear to me that activism has a price—something that was kind of clear to me
already, just not how high it would be. Dean Fontaine was there, you might
say, to show me the price tag. Ours was a surprisingly intimate get-together,
just we two, side by side, close enough to kiss, the kind of encounter you
would expect with the Mafia before someone slips a stiletto under your ribcage.
The only missing touch was the theme song from the Godfather playing in the background. Our chat was going to be an
official warning to watch my ass and unlike my chat with Mary Mac, who had
delivered an unofficial one, this time really would be scary if only because Dean
Fontaine was no bubblehead. Historically the biggest mistake in any conflict, it seems to
me, is to underestimate your opponent. That was not going to happen here.
The dean was an impressive woman on all levels.
Smart and self-possessed, she was on a playing field she knew and where she felt comfortable. She had a sense of humor which is an important quality, it also seemed to me even then. It was cool to watch her even if it meant that the
better her performance, the worse must be mine. There was no reason to believe she
harbored "racist views"—her approach could be viewed as more practical. This was business. Once, in fact, a few weeks before our
meeting, my African-born friend Umia had been walking with me down the hallway of
the the nursing building and we passed Dean Fontaine standing in front of a doorway and the dean
smiled seeing us—here were two R.N.s, a black male and black female, men and
minorities, the future of nursing. She would have to be a Neanderthal
not to know that the old world of all white women was changing, Fontaine’s
smile was instinctive and unforced. It was emblematic of nursing, indeed, which
includes so many people like Dean Fontaine and Dean Dracup who were
completely in favor of diversity, whether it be men or black people or
Hispanics—so long as diversity did not affect their own place of privilege as
white women in the profession. That was the only conflict. Like transparency, diversity was perfectly acceptable in the abstract, only when their daughters or friends didn't get the job or weren't admitted to the prestigious nursing program did equality become problematic. So, as an educator Dean Fontaine liked what she saw
walking along the SON’s corridors and may even have liked what she saw sitting
next to her in the conference room that afternoon, a black male who was the
antithesis of what nursing had been up until that point. Nevertheless she
wasn’t there for herself, this wasn’t about her or her likes or dislikes, this
was about protecting a hierarchy and a power structure. In our conference she
was there to deliver a message from the Old Girls Mafia: back off or you’ll
find yourself wearing concrete overshoes, sleeping with the fishes in San
Francisco Bay. That may sound dramatic but in short order the
UC police would be following me across campus. The danger became physical as well as academic and Dean Fontaine played a preliminary part in that.
She started out not by asking me
about my background, as Mary had done, but by reminding me of her own—remarks
which were intended to convey professional superiority, one supposed. Fontaine was a hotshot
in critical care circles, she said, and there was no reason not to believe that
was true. Still, it was a mistaken approach on her part. We
weren’t meeting to discuss nursing practice: we were not putting our heads together to
decide how to modify a setting on a ventilator or how to regulate a critical drip, in which
case her expertise would trump mine every time. This discussion would be about race and equal opportunity and, in those spheres, my experience was at least as compelling as her own. After mentioning the
prominence of her clinical experience, before we went into a clinch or started
exchanging low blows, she did something that freaked me out. She mentioned the
dean as if she were invoking the name of Florence Nightingale—or even God.
“Kathy Dracup,” Dean Fontaine said, her eyes
rolling back. “Kathy Dracup!”
Dean Fontaine spoke as if she were
mentioning a lover—displaying a mixture of affection and admiration. She
obviously had a major girl crush going on which was cool with me, not knowing Dracup personally: my meeting with the dean of deans was still a
couple of weeks away. Again, there was no reason to doubt Dorrie Fontaine’s
reasons for admiring her superior in the SON administration, as a nurse or
educator. But that wasn’t the discussion we were there to have.
Fontaine’s immediate goal was
to get me to sit down for a couple of other meetings. This was becoming
death-by-meeting, an effort not so much to iron out differences as to enforce
conformity of opinion. Specifically she wanted me to make peace and sing harmony with the Marys, but having met those two ladies my response
was to politely decline. Mary Mac had just sent out announcements of next
quarter’s probable clinical locations for the students in my program and mine
was the only placement missing, which meant the SON had decided to play
hardball. Escalation breeds escalation, you feel me? The card up my sleeve was
knowing that administrative procedures and protections do exist on campus, if only
in theory. My academics were excellent and no other student in my program was
being asked to attend meetings in order to proceed, which meant the SON was
singling me out when my only “behavior” was to question diversity at a
university and in a school of nursing where there was none. As a guy you pick
your battles. This seemed like one that could be won.
“We will stop you,” Dean Fontaine
said, bypassing the carrot completely and going straight for the stick, “from
registering for the next quarter.”
“You can try, Dean.” This was said
without raising my voice or any particular emphasis whatsoever. Life’s best
lines are delivered deadpan, right? Having used this one twice now, though—it
occurred to me that it might not be effective the next time.
There was some more jousting but we
were pretty much finished at that point. One interesting takeaway was
that the women in the SON were not used to real conflict—were not used to
conflict as men define it at all. Since men invented conflict, something they taught us in nursing school, we get to define it, correct? These women worked by consensus and by
forcing consensus, which was easy enough in a mostly homogeneous population.
They were accustomed to dealing with young white woman who, it was my bet,
would probably roll over at the first flexing of muscle by the deans—not because the students were
cowards but because, again, in my experience, women pick their battles much more
carefully than do men and are often smarter and more oblique about how to fight them. Reading
The Art of War as an undergraduate at UCLA, back in the day, it
had seemed likely to me the author was a woman: the conflicts that represent
the greatest victories, as Sun Tzu wrote, are the ones you never directly come to blows over. The ladies in the
SON administration were certainly not used to dealing with Negro men who had no
particular interest in singing Kumbaya if it was unfair to our own prospects—not
because we’re unreasonable but because “consensus” as proposed by white people
may not be synonymous with “equality“ as defined by blacks. We shook hands and the
meeting ended.
My respect for the dean was in no way diminished and some time
later, running into each other at Starbucks, she even introduced me to her husband. This was business, nothing personal, Dean Fontaine had called me in to deliver a
message which she had delivered and that was promptly ignored by me. In
fairness to her, our conflict probably had nothing to do with her own views of
race or gender. Instead, it was about privilege and power—who’s first in a pecking
order, who gets abused or used, not skin color per se, and to the degree it was
about gender, as a guy you had to remember that historically women have mostly been on the
losing end of that particular debate. Except in nursing. The ladies of the SON saw female sexism
as payback for their own mistreatment by men in other fields, which is understandable, kind of, even if hypocritical and wrongheaded. It was probably hard for these nursing professors and administrators to conceive that they were doing anything
wrong. Not knowing Dorrie Fontaine that well, she
may have actually harbored fewer prejudices than the Reverend Dr. Martin
Luther King—or Mother Theresa. This was about power.
And at that point she was bluffing,
frankly. That did not mean she had no authority to bring to bear. But unlike Mary,
the dean did know that she was stepping onto dangerous ground by threatening
the academic progress of an African-American student in good standing because
he refused to participate in a meeting that no other student was being required
to attend. If this was her best shot, and clearly it was not, she needed to
take it. That was my feeling at the time. It was a trap for her not for me, one
of her own creation, or of her superiors’ making, and my bet was she would not step
into it because she was no fool. No one was going to block my registration for the spring quarter. So, that threat dealt with, my next stop was the library to
study. Being a good student was my best defense. If there was time after hitting the books—and the surf cooperated—there’d also be a swim at sunset, on Ocean Beach. So far the sharks were much more of a
concrete danger than anything at the SON, you feel me? But unknown to me there were also some very sharp teeth on campus.
CHAPTER NINE
The biggest difference between
graduate study and my prior experiences in nursing school was that my previous
learning took place in clinicals: the hows of delivering care, knowledge most
often acquired in the hospital from veteran R.N.s. But in my first
year of the UCSF program the classroom content took precedence because we were
delving deeper, into the
pathophysiology of illness for example. What went on in clinic was less
compelling.
The well-baby checks that were
never demanding were soon formulaic. Listening to the heart and lungs, looking at chapped butts, discussing pooping and eating with the parents—especially feedings because
that’s an activity when problems can manifest themselves. Vaccinations
were also a big deal in the Bay Area as affluent moms began to opt out of
their kids’ shots in the belief they cause autism: the upshot of the parental
refusals was that everyone else including poor and minority children like those we saw at General Hospital were carrying the burden of prevention. With older kids there were vision checks and the mandatory
ear exams as well as discussions about issues at school that might actually be
reflections of physical problems, not mere behaviors. Allergies were a constant concern, and weights: don’t know how many times we had to explain to parents
that just because the child was drinking fruit juices not sodas that did not
mean there was no unwanted sugar. In Texas there’d been an epidemic of Type 2 or
“juvenile-onset” diabetes that was suddenly child-onset but Northern California
didn’t seem to have caught up yet, at least in San Francisco, perhaps because there was a higher proportion
of immigrants who were still eating as they had in their home countries. Which
was a good thing.
To say that clinic was not
difficult does not mean it was easy. One moment there were no patients and the
next there were too many. You were always behind. Suddenly it made me feel
sorry for the people working in all those doctor’s offices who, through the
years, had delayed my own ten minutes with the physician. They’d been doing their best, as were we. For the patient the benefit of seeing a nurse
practitioner is that you do get more time than with a MD. Professor Duderstadt was very thorough
and deliberate but in a couple of cases when we divided our efforts the kid
ended up being seen by me alone. Karen accepted that reality, signed off on my
findings and mumbled something about the family being back in a couple of
weeks for a re-check, when she’d give the kiddo a good going over. Moments like
these in clinic also taught me a truth about being a grad student, whether in
nursing or any other field. You’re free labor. In my prior forays in nursing
school the debate among the staff nurses who oversaw us as preceptors was
whether it would be quicker to show us how to perform a task or simply do it themselves. In clinic that debate was resolved. It was hard to see how Karen
could have done her job without our assistance. Which makes her behavior either
understandable or not understandable, practical or exploitative, depending on your point of view.
She began dropping hints that she
wanted to fail me and keep me “for another quarter.” You can imagine my
reaction. It was kind of amusing, though, once my temperature returned to normal,
but only if you have a sense of humor: the SON administration wanted to get rid
of me and Professor Duderstadt wouldn’t let go. First, a word about my
credentials: In additional to five years of general pediatric experience
including wards, an ICU and an ER, there was that year in a nursery taking the
newborns from labor and delivery, drawing blood and putting down feeding tubes,
doing first assessments and dealing with providers, giving the first shots and
eyedrops and that critical first bath—which was kind of satisfying, actually,
for me if not for the newborn, cleaning off the goo and telling the
kid a few of life’s important lessons in between dips in the water—as well as, yes,
instructing parents on care of the little bundle of joy they were taking home.
So it was hard to believe my competence was any less than any other
student—especially those who had only certificates in nursing and mere months
of experience, who were the vast majority of the pediatric nurse practitioner program. Karen told me she didn’t like my technique holding a baby, for
example. Okay, but it had served me well enough so far. We the students talked
among ourselves and no one in either of the groups of students, not
acute care nor the primary-care track that included all those young white women who
were new to the profession was under threat of failure in their clinical practice. Only me, the lone
African-American male: that was only coincidence, of course. Knowing Karen’s
rationale helped a little but not much. She was still working on that
screenplay in which she starred as the white liberal pulling me out of the
ghetto. Even if it meant that in order to help me she had to hurt me first. In my mind’s eye it was
possible to see her sipping wine and telling her friends how she’d
rescued me from whatever fate she imagined. Couldn’t do anything about her
dreams but my advice, as to the practical reality, would have been that if she
wanted to fail someone she could try Elizabeth instead. Except Elizabeth wouldn’t have
taken a failure on false pretexts either and, one would assume, as a strong
young woman—would have made Karen’s life hell in clinic. One hopes. Karen had
chosen me not because of my clinical performance but because she saw me as
vulnerable, an outsider in a white female environment, and was extending her
protection in exchange for me doing what she wanted me to do. She wanted to make me her nigger, in other words. That's my view, you can disagree but since it happened to me that makes me the authority.
As Elizabeth herself pointed
out, her Spanish was poor. Elizabeth was an impressive young woman on all levels and a
great nurse, better than me, certainly, but in clinic it was all about communication and her knowledge of
the lingua was limited. As she herself joked once, during a break from class, describing life in
the PICU, you don’t have to talk to the kids so much because they’re often in a coma. My Spanish was not native-level by any means but was
better than Karen’s and better than anyone else in the Children’s Clinic with
the exception of Andrea, the young NP who spoke Cantonese as well. Karen was
taking advantage of someone she perceived as weak, a miscalculation on her part
and a betrayal of her espoused liberal tenets but nonetheless revealing. That
she was making a mistake did not mean the threat could be ignored, however. Mine were
the best grades in the program but students know that if an instructor is after
you in nursing school it will happen in clinicals where the instructors’ judgments can be almost
completely subjective. The reasons for failure can be perfectly sketchy and still
impossible to refute. If Professor Duderstadt really believed in my
incompetence, my other suggestion would be that she needed to call back in any kid whom she hadn’t seen, having relied only on my exam, and re-do the physical. Instead Karen picked her moment—and made her move.
It was a well-baby check and the
kiddo had Trisomy 21: floppiness, slanting, widely-spaced eyes, small nose, the
palmar crease wasn’t apparent but that was about the only aspect of the child’s
appearance that did not scream Down’s Syndrome. Don’t remember any
cardiomyopathy, it’s a possibility, we didn’t actually get that far. My
examination began and Karen asked me, as if this were the single question that would decide my academic future, “Is there anything exceptional you notice about this child?”
And except for the obvious there wasn’t. Which was the answer that she wanted to hear, the obvious, and upon which my education depended. As a matter of fact my niece has Down’s. My sister-in-law was just over
35 at the time of conception but was told by her doctor that an amniocentesis
was not necessary. And while doing my first prerequisites for nursing school my day
job was at a public facility, run by the State of Texas, called the Austin State School which was not a
school at all but part of the Department of Mental Health and Mental
Rehabilitation and where, like, a quarter of the residents had been born with
Down’s. My expression fixed on Karen, like, really? As we say in Texas, Karen was looking for something to hang her hat on
and she expected me to cooperate, to slip up on something obvious, in effect to hold the hat while she looked for a
hook to hang it on. Dream on. It was then that the trust went out of our relationship,
the thrill was gone to quote B.B. King, although not the affection. She was an
impressive woman and a good health provider but as an instructor it was about Karen not the student, which is cool
too, that’s reality at a big important research university—you never wanted to go looking for altruism on Mount Parnassus because you would be disappointed. Still it
seemed a flawed paradigm for a teacher, just as is a nurse putting him or
herself before the patient. And, not to be critical of women or anything—but
sitting through my classes there was all this bitching from the female instructors
about men—men as the source of all evil and what’s wrong in the world, men who watch porn and frequent prostitutes to say nothing of practicing violence—and a
complete failure to acknowledge female weaknesses, like the inability to be
direct. Hello? It would have never occurred to Karen to just ask for my help the next quarter. My
answer would have been no but that’s the risk you take when you want something from someone else. The other person may refuse—a risk that women need to accept as well as men.
In a prior career, much of my
working day was spent with important people, very often politicians, and my
observation was that the higher people go in the world the less willing they are
to tell lies, or at least not explicitly. They have an underling do it or they
don’t respond to a question if they can’t safely tell the truth, or they avoid
the conversation altogether. At the SON they lied first—what you could call
“summer camp lies,” the kind of thing no one really believes, neither the person
speaking nor those listening. Falsehoods which are told merely to get from
point A to point B, you could call them. Unfortunately for Karen this one was not going to get her
where she wanted to go. We weren't in summer camp. After that, she didn’t
broach the subject of failing me again because she saw the look in my eyes was not
receptive. Our relationship became more formal. What had happened between us still concerned
me, much more than anything from the Marys or the deans because it was a
betrayal of friendship as much as being
prejudice. It was also an attempt to take advantage of the vulnerable which was a
UCSF hallmark. Mostly the episode added to my fascination with the limitless
self-absorption of white people: A few decades earlier, during the era of President Reagan, it had become popular for conservative whites to say that black people have
an “expectation of entitlement.” Entitlement became a kind of watchword for
laziness or African-Americans wanting a handout. Actually, that would be whites
themselves. In dealings with black people, even the most liberal whites may think
it’s about them and what they want—at UCSF the need to promote a white liberal
narrative even at our expense, to say nothing of, in this case, seeking free labor.
Clinic was drudgery but not a complete
downer. My theory is that even in a risky environment, and that would include
my time at General Hospital—you still have to have fun. Back, back in the day during slavery, whites used to call black people childlike, apparently because of our
playfulness, and that’s one stereotype that may be true. It certainly doesn’t
offend me even today. We maintain our good nature and sense of humor at all times, until we don’t—and then
things get ugly. What was about to happen was actually pretty cool. Without a car, my daily schedule was dictated by the university shuttle that one day dropped me off at General Hospital earlier than expected. Karen
wasn’t in clinic yet and passing by the nurses station my eye fell on a pile of
patient folders belonging to the kids we were going to see. Flipping
through the charts, most of them were SOS, the same old shit—it would be
another morning of wet diapers and howling, healthy kids. With one exception.
A lot of children have heart
murmurs but the murmurs are usually innocent and resolve, in time, or such had been my experience as a working nurse. A few are
pathological and a kiddo we would see that day had one of those. Karen had
referred the child to a cardiologist. At that stage of my education we hadn't yet explicitly studied pediatric heart sounds and the most that was expected of me
or any of my classmates was that we could recognize an adventitious sound but
not much more than that: not knowing for example if it was the kind of murmur that needed
to be referred to a specialist, as Karen had done in this case. With this munchkin that was an easy enough call. His heart sounded like a little washing machine
in need of repair. But when Karen asked me to describe my findings, expecting
me to say, “Ah, I don’t know, I think he has a murmur,” something inarticulate like that—let me put it this way, it was
too much of a temptation not to display the entire range of my knowledge about this baby. Stagecraft is important in
healthcare. Even nurses and doctors have seen too much television and there are
certain expectations of appearances, even drama, among practitioners. A stethoscope around the neck can be more a totem than a tool: carried even
if one has no plan to use it, because patients expected to see one. In this case
Karen was my audience and my movements were orchestrated for her benefit. The
parents were out of the room getting shots for another child.
Listening to the munchkin again,
for a long moment, hesitating as if to collect my thoughts, shaking my head
gently to elevate the level of suspense, that was the beginning of the performance. Then, looking over at Karen to deliver my
clinical judgment, while lowering the stethoscope slowly from my ears: “A grade 3
diastolic murmur, certainly pathological . . . . best auscultated at the margin
of the . . . . more pronounced upon expiration.” There’s a grading system for
murmurs which was already part of my knowledge base from prior hospital work—that much of my assessment was actually me speaking, from my own
experience. The rest was knowledge acquired more recently—that morning in the chart, in fact.
Not wanting to sound exactly like the cardiologist’s finding, changing a word
or two here and there—and Karen looking at me first in amazement, then
suspicion, knowing my findings were accurate but somehow faked, just not
knowing how because she was unaware
of my earlier access to the file. The look on her face was worth the quarter’s
tuition. Almost.
Now tell me that wasn’t fun!
You have to enjoy yourself while
you can, that’s my mantra. Life involves balance, after all. The meeting with Dean
Holland-Martin was next on my calendar and that get together, by contrast, would land on
the serious side of the scale, as had my encounters with Mary Mac and Dean Fontaine, providing less opportunity for diversion.
To me, Judy Martin-Holland was a
more sympathetic figure than Professor Duderstadt and in part, yes, because the dean
was black. It was easy to imagine what she had gone through to get where she
was and it was entertaining to watch her plan her next move. Seemed like a good
idea not to get between this lady and her goals, and despite my respect for
Dean Fontaine there wasn’t any doubt in my mind that if Dorrie Fontaine and Judy Martin-Holland
walked into a dark alley together who would emerge, alone, whistling an innocent tune at the other end. Although Kathy Dracup didn’t seem to be planning to leave the big office any time soon you could sense the competition to be seen as heir apparent to the throne. My
money was on Dean Judy.
There’s a stereotype about black
women that helps to understand the environment at the SON. My
experience is that Caucasians especially Caucasian women are often
intimidated by “strong black women,” which is a trite phrase itself but
nonetheless an accurate description of Dr. Holland-Martin. There’s also a
belief that black men will do what a black woman says because of some kind of
atavistic relationship with our mothers. Dream on—because, like, that may not
be something you should bet money on. In the coming weeks as my situation in
the SON deteriorated, so to speak, very often someone would say something
like, “Judy Martin-Holland says …” or “Judy Martin-Holland thinks …” and expect
me to roll over with my feet in the air. But at a university, it seemed to me—wrong again—more important than who is speaking
is what the person has to say, whoever
the person may be, from a member of housekeeping to the dean or the university
chancellor. That's the ideal, knowledge not position or identity. My respect for black women is boundless, knowing “what they’ve gone
through,” but that doesn’t mean that when a sistah
speaks it’s my duty to obey without question. Life is a negotiation not a
pre-printed order set and we overestimate the value of anyone’s experience in
overruling someone else’s rights. My mother for example was a short black woman, and she lived her entire life with three strikes against her—her stature, her gender
and her color—looking up literally and figuratively at white people, especially
white men, from the day she was born. Although useful for her understanding of
civil rights, and for my understanding of her, that experience didn’t somehow
imbue her with the wisdom of Buddha in all things. And having similar skin color shouldn’t
confuse the relationship among black people ourselves, either, because we’re
still individuals. Although we were extraordinarily close, my mother and
me—certainly closer than was my relationship with my father—that was
principally because my mother got custody when my parents divorced, not because
black womanhood is closer to saintliness which it is not. My mother was a
flawed individual just as is the rest of humanity, including yours truly. Yet the SON
expected me to somehow accept whatever it was that came out of Dean Martin-Holland's mouth as if it were Gospel. In my opinion, going to see her one
afternoon, that depended on what she had to say. You have to listen to the pitch
whether in the boardroom, in the classroom or in the bedroom. What’s the offer?
Finding out what Dean Martin-Holland liked or what she wanted would be met by an
inevitable question on my part, “What’s in it for me?”
What would she be
offering that would help me achieve my goals, both
personal and in terms of opening up the School of Nursing to minorities and men?
There are no guarantees for either side in a negotiation. As it turned out,
Dean Judy was simply less than convincing. As a leader of the Old Girls’ Mafia
she was supposed to make the kind of offer you can’t refuse. She did not.
She did have a cool office though.
The Judy Martin-Holland who met me
at her door was a different woman than the one who’d been on the podium in front of
me a few months before in Cole Hall. In person she was gracious, welcoming, and recognized
me as someone akin to herself, without going over the top: No clenched fist
raised in the air but she did greet me as a brother, in whatever sense of the
word she defined it. That was cool too. Recognizing our mutual Negritude didn’t have
any practical meaning but is nonetheless required for two black people meeting for the first time and especially in white circumstances, so to speak—a custom that goes
back historically to showing you’re not trying to pass for white. Even meeting
on the street as two complete strangers we often acknowledge each other, just a nod of the head if the
environment is benign, or an ain’t-this-a-bitch raising of the eyebrows in less
congenial circumstances, when the police are present for example.
The dean’s office was the kind of
space that called to me. It was maybe three or four times the size of Mary
Mac’s hole, with a window looking out on the quad, the location alone speaking
volumes: Dean Judy was not upstairs with the powers that be. She was self-confident
enough not to feel she needed to be along the corridors of power. The ambiance
itself was dark and quiet, a style like a high-end lair. For a moment she just
watched me, looking around, in wonder, my obvious appreciation complimenting her
taste. “I like it,” was my final, definitive judgment.
“That’s why I chose it,” she said,
not because it pleased me but because it pleased her.
My theory and this is not an
original theory is that a sociologist could do a "learned study" of the
connection between office spaces and power. Somebody probably already has. Kathy Dracup had two
offices in the School of Nursing, actually, the big one on the fourth floor, together
with anteroom, and the mandatory male assistant, belonging to the dean, and another as a
professor somewhere on an upper floor that she would return to when her days at
the reins of power came to an end—sooner
than she planned, thanks again to yours truly. But consider the office for a moment not the occupant. What
does a space itself signify? Once, back in the day, in my prior profession one
of my immediate supervisors was promoted but refused to take the bigger office
that went along with the new job because, from her original modest cubbyhole,
she told me in confidence, “I can see who goes into Greg’s office,” Greg being
the big boss whom she hoped to and almost did supplant next. So, my belief is
that the office itself often conveys more information than anything you hear in
it. That almost turned out to be the case with Associate Dean for Diversity Judith
Martin-Holland.
We started innocuously enough, discussing
something that had nothing to do with nursing: a life-related subject that was trivial and, true to SON form, the
dean told me not just what she thought but what for me to think, too. It was like she was talking to a kid. She was at
least five years my junior, neither of us a child any longer but if it were a question
of age or worldly experience mine probably trumped hers outside of academia. This was an example
of the SON practice of lecturing that extended beyond the classroom. On nursing
training, however, Dean Judy certainly had me beat: a bachelor’s degree, a master’s in
public administration, she was a clinical nurse specialist in cardiac care, a
family nurse practitioner and also a PhD. She had hit the books big time and power to her for that. It’s said that blacks have to be
overqualified to be qualified and she fit that particular profile. We talked
for a moment about the next skill we would approach in my program, suturing,
and she told me about her experience learning it. Suturing actually turned out
to be easy—we did chicken legs for practice, the same fowl anatomy we’d used in
pediatric advanced life support for intra-osseous line placement. Poor birds! “Meat is murder,” that’s my motto, by the way, sewing chicken flesh
was almost as bad as eating it, although that isn't germane here. Back to Dean Judy's office. It was time to see where she stood on the issue of integrating the School of Nursing. My first comment was a
general remark on the lack of men and minorities in the SON, in order to test the water. My bet ahead of time was that she would say something uncontroversial,
nothing that would cause her problems if it got back to the rest of the administration:
“Yes, it’s a very challenging issue, isn’t it?” or “We’re doing the best we
can. I’d be interested in hearing your views.” But she didn’t say anything at
all. As in, nothing. We were sitting across from each other, in her office, no one else present, no distractions or background music so it was hard to believe she hadn't heard me. She just didn't reply. That was a response in itself. She sat there, mute,
as if she hadn’t understood the question, which was unlikely since her portfolio in the
School of Nursing was diversity. So—try, try again.
“My brother works for the United
Negro College Fund,” began my next effort to draw her out. “I could contact him
to see if some way could be arranged to funnel more black people . . . .”
She just looked at me again.
Absolutely not a fucking word came out of her mouth. Again, in the relatively confined quarters
of an office it was hard to believe she hadn’t hear me. You know, UNCF? The most important black institution in America next to the NAACP, famous for its motto, "a mind is a terrible thing to waste?” She
appeared not to have heard, again no response whatsoever. Her lips did not move: which told me
everything there was to know about Dean Holland-Martin in this context. It was
all about timing, really. If she solved the problem of race and gender in the nursing school too
quickly that would take away her main advantage when she made a move to
occupy the dean’s office. Despite being on a different floor she was only a couple of steps away from the throne
and she wanted to keep her position as a contender. It also meant that if it
came to a showdown on race and gender in my own case, not only would she not be on my side but
even expecting her to be neutral was unrealistic. It might have been my education at risk—but it was her career advancement in play. Most people don’t fight their own personal interests
unless they’re revolutionaries and Dean Judy didn’t strike me as one of those. She
was more a player.
Which doesn’t mean our conversation
had no meaning, or value. That doesn’t mean there was no practical point in talking to this woman. It was then actually that Dean Judy taught me one of the most important lessons
of my life, transferring more wisdom in one minute than anyone else at UCSF
did in the year that constituted my abbreviated studies and proving correct my original judgment that she was an exceptional woman. Since race was a no-go
zone, we discussed something else, which had no particular pertinence, and
during which she gave me some advice which has universal pertinence. It was a cosmic lesson—the kind of aphorism
that most attracts me. Hers was a single comment that had only been matched once before in my life, also in an environment of higher learning.
Thirty years ago, longer, standing
at a bus stop across the street from the University of Texas was a hot young
woman, on a hot summer day, wearing a summer dress. Legs like a lioness at a time
when a woman in a short skirt attracted me inordinately, before reaching my present, higher
level of consciousness in which sex has no meaning. Went right up to her and gave her my best pick-up line,
actually, a cold call as salespeople say—without an introduction and without
further ado. It was completely a come-on but this complete babe took me completely
seriously.
“What do you think,” was my
question to the young woman at the bus stop, “is the meaning of
life?”
Instead of replying in kind,
agreeing to a possible hook-up, or not, she gave me a real answer, after a
moment’s thought.
“It’s not what you have,” she said,
apparently a deep thinker herself. “It’s what you do with what you have.” And then she made clear that no she
wasn’t interested in knowing me better. That afternoon in Dean Judy’s office my question to her
was meaningless but her answer was golden.
“Once you put something on the
table,” she said, meaning that once you raise an issue or open a debate, “you can’t take it
off.” That was knowledge worth the price of my
tuition.
CHAPTER TEN
The Pacific became my muse. At
first the crash of water was deafening but then it became the only background sound that let me think. One day a bad wave caught me just
fifty feet from shore, the tide threatening to take me out into open water and
people along the edge of dry sand were walking past not knowing they were watching the
prelude to a drowning. As a proud strong African-American male, struggling
daily against the forces of the oppressor—you can’t let people see you sweat, you feel me? Spit out
some water, stop fighting and collect your thoughts. Having seen a lot of
protocols, don’t panic is always number one on the list whether in the
hospital or in deep water. The drill when a riptide grabs you is not to try to swim against the current but turn parallel to shore
and escape the undertow by moving perpendicular to it. Most serious swimmers know this. It worked that particular day, and after that Ocean Beach belonged to me. Didn’t frighten me anymore and although walking the sand didn't solve my problems the sound of the surf did help me to work them out.
My experience of school, wherever
that school was, is that there are two different kinds of learning. One is
almost instinctive. See a task or read a passage and master it. Done.
The other kind requires time, not
merely for practice but to assimilate the new knowledge, to
conceptualize and then make it instinctive. This second kind is the most common
learning, for me personally but also for others, having watched students struggle, through
the years, to acquire new skills. It takes time. Unless you’re very fortunate
you need to absorb knowledge—and that
was the case at the School of Nursing as well, not just for me but for the
instructors and administrators too. These were very smart women but they were
in a profession where the views of the majority had not been challenged. The success of Women’s Liberation meant that women were not
just looking at new professions but men and minorities were suddenly looking at nursing, which had
been a mostly closed shop for anyone who was not a white woman. This was new for these
ladies, just as the concept of black equality was so hard for whites at the beginning of the civil rights movement, because they lived
in an insular setting, the American South where the existing values hadn't been challenged since the last shots of the Civil War.
Professor Duderstadt in particular worried me because she had so little
idea of a world that did not revolve around her or her needs. Still, everyone
would see the light eventually, it might not be a pretty process, it would take
a while—and while that assimilation unfolded my education was at risk. These
women were already beginning to act rashly, something they might regret later but later might be too late for me. The best approach to facilitate their
learning would be to give them some time and space and to remove
the source of their confusion, to allow for recognition of errors, and for healing.
Nursing is big on healing, especially the spiritual kind, and after initial reluctance on my part it’s become part
of my medicine bag as well. Mostly it takes time.
Which led to an easy decision, actually. For most of my life a road trip has seemed to be an answer even
to the most complex issues of existence. About that time, walking along Ocean Beach, South America began to call my name from across the water—Bolivia or Brazil, or both. A trip abroad would serve two
purposes, satisfying my wanderlust and at the same time giving the ladies of
the SON a chance to correct the error of their ways. My view was philosophical:
A grain of sand had been placed in the oyster and a pearl would result but only
after a lot of irritation. My plan was to do foreign aid work after graduation
so a likely scenario for “personal development” could be put together at the
drop of a hat, something that would sound totally convincing, without coming
right out and telling my instructors that the purpose of the trip was to escape
them. The only drawback: it wasn’t wholly my decision. Dean Dracup had to sign
off. My idea was to take a whole year off, the first few months spent working at
Children’s Hospital to put away cash to make the trip, and returning to classes
the same time next year, to pick up in my third quarter. A whole year—that’s a
long time—and if these ladies couldn’t read the writing on the wall by then, another
approach would have to come to me. In the meantime acquainting myself with the latest
style of bikini in Rio Grande do Sul or picking wild herb in
the Andean highlands seemed like a good use of my time. On short notice Dean Dracup graciously
agreed to see me. She probably wanted to get a look at the troublemaker in
person, and with me coming as a supplicant—that put her back in the driver’s
seat.
She wasn’t alone. Already waiting
in the inner office was one of the associate deans, Zina Mirsky, in
charge of “administration,” whom it hadn't been my
pleasure to meet previously. Mirsky was a short trim woman whose demeanor
screamed military nurse, Navy was my guess, which put me on alert
because my experience of military nurses is that they are not to be trifled
with. Not that my plan was to trifle with anyone but we weren’t coming together to sing Kumbaya either. Even my entry into the room had been choreographed
ahead of time. How one enters a room is
important, part of that critical first impression, and for my first appearance
before the dean of deans a “modified Denzel” seemed most appropriate, a
proud African-American male's step that stops just short of thug. Chewing gum was my principal prop. Not egregious chewing, just a discreet
motion of the jaws to show this was just another day—even though gum is not really a favorite of mine. Offered
both deans a stick of Juicy Fruit after sitting down but they declined, Dean
Dracup citing crowns. We were the same age and had that much in common. My agenda
was brief, getting the dean’s approval for my year off, but it’s not often you
get to beard the lioness in her den and my to-do list had a few late additions.
A good habit before going for the
jugular is to offer a kiss on the cheek first. While trying to decide whether or not to throw Professor Duderstadt
under this speeding bus—it seemed politic to start by praising her. Which was easy
to do because she was an exceptional person. Her book on pediatric assessment
was both accessible and complete, if only half the material could be retained—that’s
actually a lot in any formal course of study—it would place me perfectly
to continue my studies. Karen was exemplary in both her clinic practice and in
lecture and, that day, attempting to communicate some part of that, not faint praise at all but the real
thing, what surprised me was the response of Dean Dracup. Complete silence—just
as had been the response of Dean Martin-Holland to an unpleasant subject.
Most of the really smart women whom
it has been my pleasure to know, much more than the men, have wielded silence
as a weapon. Kathy Dracup was no different. She wasn’t sitting far from
me, we were all in comfortable chairs in a part of her office that was dedicated,
one presumes, to difficult conversations like this one. The silence was marked, as
people say, even though it is hard to conceive how the absence of anything, in
this case conversation, can be emphatic but it was. It might have been mere jealousy at
work, Professor Duderstadt was a formidable writer and the dean also had pretensions
along those lines, but something told me that Karen just wasn’t Kathy’s favorite
person. Would that present me with an advantage? Depended on if my analysis was
correct. There was a quick test to find out if my conclusion was valid.
The subject of my praise
turned next to Mary Lynch, overall leader of the pediatric programs, and the dean’s
demeanor changed completely.
“Her lectures are wonderful,” was
my comment, which was genuine. Mary L was administratively-challenged but gifted
at making pathology understandable.
The dean was suddenly all smiles.
“They are, aren’t they?” she agreed, which made me think again that now might
be a good time to introduce Karen to that oncoming bus. But my bet—wrong
again—was that Professor Duderstadt had been dealt with. She may not have seen
the light of equality but she recognized, it seemed clear, that she wouldn’t find me an
unresisting victim. Time to move on. When you have an important goal you
can’t let the extraneous get in the way. As it turned out though there's also something to be said for not leaving a half-defeated enemy at your back, in this case Karen Duderstadt. She would soon be involved in the single most racially-charged insult in my life.
The dean mentioned my open records request
to the university about the School of Nursing diversity numbers. “What did you
think?” she asked of the results released, which she’d obviously received a
copy of. She was pleased at what the numbers showed.
She pressed me to comment. There
was nothing to do but tell the truth:
“They’re better than I expected.”
The numbers were better than expected—not good, just as, to use a healthcare analogy, a patient can be “better” but still terminal. Specifically the UCSF
figures showed that in the SON something around nine percent of the students were
male while in nursing overall and in other schools of nursing that figure was something under nine
percent. So her figures were better but still not good in the context of a
planet-wide population half made up by men. Of course the dean completely ignored
the racial dynamic that my open records request also addressed, because her
numbers in that regard were abysmal. Mark Twain said famously that liars can
figure—so can university administrators. The dean was cherry-picking her
stats, something that she knew better than to do: Florence Nightingale invented
statistical analysis, right? Didn’t they tell us that back in class?
My attention had been fixed on lecture that day, Nightingale fascinated me, another tough military nurse—but it was especially interesting, after class, when someone whispered that Florence died of syphilis, something we didn't really believe but repeated among ourselves nonetheless. Because, despite claims otherwise, no one in nursing is perfect. That meant there was hope for me yet.
“Your grades are good,” Dean Dracup
said as if it were an epithet, which it was for her.
A year later, upon my return, as
conflict intensified, the first thing anyone ever asked about were my grades, as
if bad marks on my transcript would somehow mitigate the issue of a lack of Negroes on campus. If my
grades had been bad the dean could safely have ignored any issues about desegregation—as
being merely sour grapes by an unsuccessful student. In the dean's office we were still going to get to the
reason for our tete-a-tete but with Kathy Dracup dipping her toes in a whitewash, about stats, my game plan took a sharp turn towards provocation. First a few words on
provocation: It’s a completely acceptable tactic of social change. Advocates of change from MLK
to Gandhi have used provocation—to raise a point or hammer one home. It’s also
in Mao’s Little Red Book which gives it special credence with me. Women including women’s
liberationists, and the California Nurses Association, to mention just a
few—the CNA at that very moment was involved in a take-no-prisoners dispute
with Governor Schwarzenegger, marked by provocation on both sides—women provoked when it suited them. The only
requirement for provocation, it seemed to me, was an institutional wrong and an
institution, in this case nursing, which was fighting change or merely giving it lip service. That meant the rules of engagement were met. Lock and load, choose your words carefully—and aim for the heart. You have nothing to fear but
fear itself.
“Dean,” began my jab, aimed at her
very office, “this school is run just like an exclusive white women’s club.”
Silence again, also marked—and
nearly apocalyptic. Dean Dracup was too smart and too much of a veteran of
administrative wars, in the hospital and in the university, to reply in kind or
say anything dumb. Her expression did not even change but my comment still served a purpose because it was trenchant and true and the only reason to say
it, other than as a provocation, was because most schools of nursing are run like exclusive white women’s
clubs. In this one the club president was sitting across from me. The vice president for
membership, Zina Mirsky, was a little off to my left and turning now to look at
her—she did not have the poker face of her boss. Mirsky’s expression was
disdainful, a kind of “That’s so uncalled for” look as if a guest at the dinner
table let out a big belch at the end of the meal. Actually, in some cultures that used to
be a sign of respect after a good dinner, you let a big one rip. Diversity, Dean Mirsky. Check it out.
Probably it would have been smarter
to ask for my year’s leave before calling Dean Dracup out but whatever her faults she was not petty. When she came looking for payback it would
be to deliver a much worse blow and she would have been provoked again. Eventually she would completely lose her cool which was not cool and which would
turn out to be not just unpleasant but physically dangerous for me on campus. But at that point,
still sitting with her and Zina Mirsky, arranging the details of my leave, we were all nurses
and Kathy Dracup was still a university administrator responsible in some sense for my
future as a student, whatever her feelings towards the black race in general and black
men specifically. On some level, one that she may not have recognized explicitly,
she knew that nursing had race and gender issues that the profession—she
herself and Dean Mirsky included—were not addressing. And that it was killing
Negroes in the hospital. The care paradigm these women were so proud of
constituted worse care for minorities, it was that simple. But that was for
another day. Kathy Dracup walked me to the door. We shook hands and whispered diplomatic
nothings in each other’s ears. No kisses but no actual bloodshed either, we
were both ahead of the game.
Then she said something. She just
couldn’t resist.
“You’re not very dark,” she hissed.
She didn’t offend me but she did
surprise me because it showed how little Dean Dracup knew about black people in
this country. Uninitiated whites often think that an African-American’s skin
color is an indicator of how difficult they will be in terms of pushing a
racial equity agenda. Mean niggers, to use the vernacular, are by definition
the darkest ones. But some of the most radical black people of all time have had light skin, Malcolm X among them. If you want to explore the psychological
dynamic it’s very often so-called “bright” blacks who feel the most need to
speak up, to show we’re not passing. Besides, as her own instructors were saying in lecture, race is a sociological dynamic not merely an epithelial one.
That was not the case with me however, my
need to disrupt the status quo was actually congenital, built-in at birth. My mother used to tell me
about my ingrained “sense of right and wrong”: the sort of thing mothers
are expected to say about their own children but true in my case. Anyway, that was it for me and the dean.
Interesting woman. Wanting to cover my ass nonetheless, after our bonding
session was over my first stop was Starbucks to write a letter to the university Chancellor, Nobel-prizewinning discoverer of proto-oncogenes J. Michael Bishop,
to praise Dean Dracup as a “listener” or something like that, and anything else
good that came to me while sipping my americano.
The ink was barely dry on my letter before Bishop’s reply arrived in the mail.
He said that he was overwhelmed, being so used in his job to listening to
people bitch, to hear someone say something nice
about someone else on campus. Dr. Bishop was not progressive on matters of race or gender but he was well-mannered which seemed to be de riguer at the University of California. So, another lesson from
grad school, that also had nothing to do with the curriculum: Even if you’re going to cut someone off at the knees, still send a
thank you note (“for the opportunity to dialogue”) when you’re done. The ink was
barely dry on the chancellor’s letter before a small envelope arrived, also in
my post office box. It was some kind of social stationary, formal but designed for non-academic correspondence, a thank you
note—from Dean Dracup. The letterhead was engraved with her name
and title, the note handwritten, and surprisingly pleasant, thanking me for my kind words to the chancellor about our meeting, which Dr. Bishop had obviously
shared with her. So, like, Judy Martin-Holland wasn’t the only player in the
SON, in my modest opinion. Graduate school had taught me a few new moves. Just not enough to make much of a difference, events would prove.
A requirement laid down by Dean
Dracup in return for allowing me leave for a year was a sit-down with the whole crew: Deans
Fontaine and Martin-Holland, the Marys and me, everybody needed to kiss and
make up, hold hands, whatever, Dracup didn’t say it like that but healing was
her message. It seemed a small price to pay for a trip to Brazil. A few days
before the get-together, Mary Mac came to me and said that the meeting wasn’t
really necessary, that we could talk after my return. Mary was betting that my
request for leave was really a face-saving way of leaving the program
altogether. No way, not after paying a thousand a week for two quarters. That
was never my intent. We met in another conference room at another long table, the
deans on one side and me between the Marys on the other. One of my questions
was answered by seating. Judy Martin-Holland might have been the one to watch
but it was Dean Fontaine, in charge of academic affairs, sitting front and center and calling the shots. That
suited me.
This was going to be my opportunity
to vent. It’s probably all on tape somewhere if they were secretly
recording, at least they were listening even if they didn’t like what they heard.
In big organizations the higher you rise you really are
increasingly disconnected from what’s going on below, “on the ground,” as the
military brass likes to say, and what the higher-ups like to hear—they wanted in this instance to know an ordinary student’s perception of the program. Dean
Dracup had communicated the same curiosity, which was her job, not just budgets and appointments but knowing how the students see their educations unfolding. It’s a
great university, what’s not to like, but UC healthcare needed to treat the
poor correctly, and the SON needed to desegregate, those were my
messages “about the program,” that day. This was also my cue to start ragging Mary Mac, especially her failure to provide me a
clinical placement for the next quarter, an issue that was now resolved but
still pertinent for my return. Picked my
target and took my best shots—almost exclusively Mary McCulley since she was
program leader. The criticism was valid but it was criticism nonetheless and
she didn’t take it well. To me this was business, nothing personal, but that was a
distinction she didn’t seem to appreciate.
Mary began to cry. “I’m leaving,”
she said, starting to rise from her chair. It was pretty dramatic, may even
have been real emotion, but this was still the University of California and tears only get you so far.
Dean Fontaine said, “You need
to sit down and listen.”
Apparently Mary, the woman who held
my academic future in her hands and had already threatened my place in the
program the first day we'd talked, was more sensitive than
she’d led me to believe. But we were playing West Coast
rules—UC rules, worse than the fucking CIA’s. Mary had played rough with me and it was her program and she needed to take
responsibility for what she had and hadn't done.
The dean’s response to Mary Mac was
expected and unexpected. This may have merely been Fontaine, who seemed like a decent
person. My feeling was that we could have worked together, that Dorrie Fontaine had a practical spirit and basic fairness, but when my
year-long leave was over she was gone. My hopes had rested on two of the four
women in that room—Mary L, now alerted to a problem, keeping Mary Mac in line,
and Dean Fontaine offering practical solutions down the road, upon my
return. But a year later Mary L was on loan to the University of Hawaii, leaving Mary Mac unsupervised. Worse was that Dean
Fontaine had moved to Charlottesville to run the University of Virginia’s
nursing program, leaving Judy Martin-Holland as Associate Dean for academic affairs. Anyway, suddenly, while looking at the ladies around the table, each in turn, an idea occurred to me. In kind of an out-of-body experience my most imperious voice announced
to the Marys, “You may leave. I would like to speak to the deans alone.” It was my
right, they had to go, and it was fun too—not as humiliation, but to remind
them what it’s like to be an outsider.
Mary Mac was actually glad to be out of
there. She was gone before the words were fully out of my mouth. Mary L looked at me with
apprehension, as she was headed for the door, the expression on her
face asking, “What are you up to?” This was my last chance to do some good for myself and
that meant, as a practical matter, trying to knock Mary Mac out of the game.
Whether Mary McCully held actual racial prejudice or not was immaterial, probably not,
or there was no reason at that point to believe she did, but she was ignorant and her actions had been
inappropriate. We were playing girls’ rules, right, and my victim statement was
that Mary had been "hurtful." My rap was basically the same as before, with Dean
Dracup: Mary L was a talented instructor but needed to be more involved, on the subject of Mary
Mac however—speaking alone with the two deans, giving a big thumb down just
like in the Roman Coliseum—my assessment was that she was "intellectually unprepared" for her position, a polite was of saying bubblehead. Of course the
deans did not reply and would not, even if they were in 100% agreement which they
were not. Meeting over. Going over to shake hands with Dean Martin-Holland: if
looks could kill! She’d obviously promised her superiors my compliance, that she
had this guy under control. Which turned out not to be true. There was one last detail to be taken care of before my academic quarter ended. Karen Duderstadt found yet another room for us to go over my
evaluation from the clinic. Clinical practice was over but we still had business as preceptor and student. This time we were not at San
Francisco General Hospital but in a cavernous salon somewhere on a lower floor
of the SON building, with a table big enough to seat the U.N. My theory and
this is not an original theory on why the building had so many meeting
rooms? Because they had so many meetings! Not that there’s anything wrong with
that. For some of these ladies if they weren’t talking they weren’t breathing,
not that there’s anything wrong with that either. But as a black male my
words tended to be pithy and few.
Karen laid my evaluation down on
the table between us. There were categories for my professionalism, my collegiality
with clinic staff, my affability with the families we saw, and my competence.
She used a neatly-trimmed unvarnished index fingernail to tap the competence
part, to show me that she had given me the lowest possible passing grade. She
didn’t say why, nor would it be believable if she had. Nick Carraway said in the Great Gatsby, talking about the desirable but deceitful Jordan
Baker, that a man is never really disappointed by dishonesty in a woman. It’s a
sexist thing to say, but it’s the way it was for me and her. She had an agenda and that agenda was me.
“You have an ability to synthesize
information from various sources,” Karen told me.
Really? That seemed to be something
she’d said the quarter before, when she was teaching the pediatric assessment course and gave me an A in the course. Despite the compliment it was now her contention that the qualities she identified in me in class did not translate to the clinic.
Whatever. Karen had become the academic equivalent of a bad date—here’s my
signature, get me out of here, that was my feeling, like Mary Mac trying to leave the meeting a few days before, although in this case there were no tears and Karen remained
cordial through what seemed to be a very long half-hour. She knew about my year’s leave and she made clear she did
not approve.
“Taking a break will give me a
chance to let what I know settle. That’s my experience.”
She disagreed. Her eyes flashed in anger. “It’s best,” she said, “to follow
up on new learning right away.”
There was one other argument to
make but it seemed crass to make it, because it was also my experience that men like me win
very few arguments with women like Professor Duderstadt. What wasn’t being said here was that
it was none of her business. My decisions about my future and my education were
mine to make. My adult decisions were already being made before Karen was out of high school. This wasn’t a nursing decision—it was a life decision—my life, actually. She was
angry, which she kept under control, and straight up patronizing which she did not.
Then she said something that made clear why.
“You need to be shaped,” she told
me. It was my first time to hear the verb used in that context. It must have
been some kind of academic-speak.
This was the real problem, the nature of our conflict, her
desire to remake me into someone who more fit her needs or whom she felt more
comfortable with. The arrogance was astounding. Karen was my junior, not just
less experienced in life but less experienced in my life, certainly. Here was a
white woman telling an older African-American male that he needed to allow her to
make him over—to “shape” him, in her words. My shape suited me just fine, thank
you very much. Not to be difficult but my shape was my affair and
as long as my homework got done and my clinic obligations were met, my decisions did not have to be explained to faculty, especially not to someone who had been completely unknown to me for the first half-century of my life. For me, graduate school was not intended to be a “civilizing “experience, it was to
obtain a knowledge base, training in other words; it wasn’t that my behavior was poor, it just wasn’t
what Professor Duderstadt wanted. Interestingly, none of my sister students reported they were being told they needed to be shaped or getting quarrels about their professional goals.
Karen was inappropriate, selfish is
a good word, perhaps not racist by belief or as the word is traditionally defined
but her behavior had the same consequences as if she were. It was as if she’d
been rejected in a relationship and in a different context or a different era her response to that rejection could have been costly indeed for me. In the end we agreed to disagree about my life. She had
no idea she was dealing with anyone unlike herself, someone with different values and different goals which is, by the way, what
diversity means. Her condescension toward me and my identity as an individual was so heavy it felt like a weight. She was just as clueless as Mary Mac but in a better-educated way.
We ended on a good note however and Karen
actually thanked me for something: Elizabeth had found out the name of a restaurant Professor
Duderstadt and her husband liked and collected $50 from me. With her own contribution Elizabeth bought a $100
gift certificate. Giving the clinical instructor an end-of-term gift has always
seemed to me to be a particularly civilized custom. A good preceptor is a
jewel. Karen was a good healthcare provider, leave it at that. Told her, rising from my
chair, she’d get a post card from me from Buenos Aires—or from Brazil.
Having said that, my feeling
was, walking down the hallway of the School of Nursing, with a year off and a
road trip on the horizon, just get me out of here.
CHAPTER ELEVEN
So, if the patient is awake he or
she usually likes me as the caregiver and there’s something to be said for
that. We talk to each other, even if
it’s only after the pain medicine kicks in.
If the kid can’t talk yet, me
and mom or me and dad spend some time bonding. That’s the fundamental rule of
pediatrics and learning it is your first step to success in children's healthcare,
establishing a rapport with the parents. If the patient is down
for the count, asleep or in a coma, increasingly as an older and more
experienced nurse my skill is knowing when to worry—having that judgment. My
practice may not be streamlined and pretty like a sailboat but it may be less
likely to end up on the rocks, you feel me? And suddenly that was my feeling on
6 Long. With no class to attend, working a lot of shifts, putting away money
for my trip and feeling at ease—not that the work was easy, just doable. Being on the wards so much also
gave me a better view of “the enterprise,” as the hospital is called by University of California management:
not the faculties of nursing or medicine or the value of the instruction
offered there but the medical center itself and its level of professional
practice. The interplay of healthcare and prejudice continued to manifest itself
like a bad dream but one based upon the day to day reality at Children’s.
There was a patient on 6 Long who
was Chinese or Chinese-American and in report the off-going nurse told me the
kid needed a new IV. Fine. My first stop after hearing my assignment was to go
and see if he had any veins. Dad was actually a faculty anesthesiologist and he was dubious for
whatever reason about me re-starting the IV. His judgment may have been
correct. As a stick, working with a needle, my skills are moderate at best: my favorite spot on babies
is the saphenous vein, inside the ankle, and it’s still a roll of the dice, frankly. This Chinese-American dad sensed some hesitation on my part or felt something about me, a doubt, and he said
no without saying no. He may have made the right call, you never know until you
try but whether it was the right call or not it was his call to
make not as a physician but as a parent. Also working that night was a Chinese-American nurse, very nice, very
cute actually, not that that’s important, she was also kind of holy not that
that’s important either—a Christian woman who had previously declined my
suggestion that we pray together, in a secular way, but we were still colleagues if not
friends. We were still cool as coworkers and this was
work-related.
And the decision was to re-assign the
child to her. We were swapping patients, she came to tell me later which
was not her idea she said but the father’s and at first it seemed a little
insulting but this was actually the best illustration of the argument for
desegregating the staff of the UCSF Medical Center. A nurse who knows the culture better
and whom the family feels more comfortable with will provide better care. By
definition.
This wasn’t a question of choosing
a surgeon who would do a better job of removing the kid’s appendix, or whatever,
which is a more measurable skill
based upon rate of complications—or even starting that IV—the R.N. who took over
from me called someone else to come and do it—but “care,” which is nursing’s
paradigm and often means the patient’s comfort, both tangible and intangible.
At first my thought was that race was an issue, sure. The anesthesiologist
didn’t want a Negro to touch his child. But in retrospect that seems unlikely.
Two years of my otherwise misspent youth were passed in the People’s Republic back, back in the day, teaching in a rural shithole near the Vietnamese border and my
impression of the Chinese and their culture was that racism is not as big a
factor as it is in the U.S. To the Chinese, even to the Party members, what was important was class—read: money—and
education, and culture writ large, wenhua.
In my experience, limited though it may have been, the Chinese had little time
for anyone who didn’t have at least one of the three, wenhua, cash or higher training, no matter what the color of their
skin.
There was a hypocrisy factor
working here as well, my own double standard if you will. If our roles were
reversed, what would my response be? If this were an African-American child and
the parents felt more comfortable with a black nurse not an Asian R.N., not an Anglo or Latina—that’s their right, isn’t it?
If you’re in healthcare you may have noted a certain suspiciousness on the part
of black patients who have to deal with white staff, both doctors and nurses.
Maybe they’ve had a bad experience in the past, maybe they’re still tripping
about the syphilis experiments by the U.S Public Health Service back in Tuskegee and the
historic tendency of white scientists to use colored peoples for research. But
if you’re a caregiver and someone has a child in the hospital it’s probably not
the best time to argue the issue—if the parents want to change
nurses, even if the reason is unfounded. There’s already enough stress at
bedside. Besides, the care paradigm that we practice as nurses doesn’t recognize
racism but it does recognize race and culture. You do what the family wants,
hope it’s for the right reason and go and see another patient. Still, on 6 Long my eyes were peeled for white
sheets, not on beds but on heads—because my experience up until that point led
me to expect a certain kind of behavior in San Francisco, not
much more subtle than in the rural South. And it wasn’t just blacks who were at
risk, it seemed. In a moment of surprising candor one of my sister
students, a white girl who worked at Oakland Children’s and who was also
studying to be a nurse practitioner mentioned an ethnic group she did not much
care for: blacks and Hispanics were cool, she said, and Chinese, both from the
mainland and from Taiwan. But she didn’t like Indians. Not the Native American
variety, but those from the subcontinent, and what she didn’t like, she explained,
what got her panties in a bundle was they wrote down everything she did in the
patient’s room. “Oh, okay, that's interesting,” was my response, trying to be diplomatic, you want
to be empathetic with another student or another R.N., even if you think she's full of shit. She was telling me this before
class one day and my feeling, not having taken care of an Indian kid before but
knowing a thing or two about stereotyping was, like, this is a load of crap. That’s
racism, you ought to be ashamed of yourself. Kind of shaming the girl mentally
because she deserved it. And then one
day not long afterwards on 6 Long, lo and behold, my first meeting with an Indian
family.
This was like a month before
catching the bus to Bolivia and my thoughts were elsewhere, as you can imagine, me going to the
bedside to give another nurse’s med because she was on break—and the Indian
mother flipped open a notebook on the bedside table and asked me the name of
the medication, the dosage and the frequency. No problem so far. Then she looked at
the name on my badge and wrote that down too. Acted like next she was going to
pull out an inkpad and ask for fingerprints.
She looked up at me as she wrote.
“I’m sorry,” this Indian mom said, “I have to do this.”
And that was proof, too: Of the
need to desegregate healthcare, not on the receiving end—although there too—but
on the providing end. Because some stereotypes are true and this probably
wasn’t even a stereotype, it was just a practice. Here was a mother who may
have been accustomed to hospitals outside this country where perhaps the
controls aren’t as strict and parents have to be more wary. And they move to America
which in many respects is a bitch for immigrants but in healthcare is okay, if
expensive, and the Indian moms continue the practice of writing down what
happens to their child, together with times and med names—which is not a bad
idea generally in a hospital, as patient or family, keeping a record. The mistake you
make is letting your ego get involved. It’s a job—this is work—be professional and above all keep moving. Clean up around the bedside while you're listening to mom. At
Children’s you couldn’t afford to get distracted because there was no time. It made the job a lot easier when you remembered it's not nearly so much about you the caregiver as it is about the
child who is the patient. And the
parents. Sometimes you just misread the situation entirely: In another report
on 6 Long, at 6 a.m. before beginning my shift, listening as the night nurse described a teenaged patient who happened to be black as a
“gangster from Oakland.” She actually used the word, gangster. From Oakland,
the East Bay—the other side of the bridge where Negroes were known to predominate. Come on, now. Did you really just say that about a black child?
That was the look on my face.
Wrong!
It turned out he was a gangster, and proud of it, from
Oakland, yeah. He’d been shot and was being treated in S.F. because the
authorities were afraid that whoever tried to kill him in the East Bay would
try again and he’d be too easy to locate if he were at Oakland
Children’s. This kid had a messy wound and the dressing change was a mofo, and
we rapped, Black Male to Black Male—some of the most meaningful
conversations in my life have been during a wet to dry dressing change, you're talking at first because you want to keep the patient’s mind off the
pain and then you just get into the conversation, you know? Anyway, the little fuckhead scared the hell out of me too, actually, and it had
nothing to do with race. He was a thug whatever his color and proud of
it. If you’re wondering, by the way, the rapport
between us in the hospital room was instant and strong, that dynamic was not missing at all, our mutual Negritude, our
roots going back to the voyage from Africa, the Middle Passage
and all, that was the historical context. While in the moment we were two black
males both dealing day to day with the abuses and insults of The Man—and in my
case, The Woman—and me, admittedly a strong black guy, "uber-masculine," some would say, not to brag or anything. But having beaucoup street
credibility not to shame those who have less, and having seen some serious
shit in my time—and this kid still frightened the holy bejesus out of me, even
flat on his back and without a gun in his hand. The point is that individuals
vary, yes, we are all different but some stereotypes are pertinent, gangbanger from Oakland being one.
Cultures do
differ in tangible and predictable ways which, it seems to me now, means that a
one-size, one-gender, one-color-fits-all approach to healthcare is a mistake.
And to the degree you can pick one color it should probably be black or
brown—or yellow, ideally—because as minorities we’re used to dealing with the
majority culture. We speak Caucasian, you might say. We understand white
people. It’s usually the Caucasians who don’t understand us.
A friend of a friend of mine worked with me at Children’s. She was a bitch.
Put another way her behavior was
bitchy. That would be a more professional description. As a male in nursing you
have to be careful using the B-word because working with ninety percent females
there are so many opportunities to make that particular call, if you start to
generalize. So, as a male at a nurse’s station anyone you don’t like or
anything you disagree with can be bitchy or done by a bitch if you’re not
careful. Men do things among ourselves that we consider normal but women call
bestial or “insensitive.” Which is a word you hear a lot, as a guy,
insensitive. Or unfeeling. Which can
be a female’s favorite judgment of a male, but this chick, on 6 Long, the friend of my
friend was just, it seemed to me, a bitch—after careful consideration, weighing the pros and
cons the call was made and it still seems to me to be the right one to make. We’re not
placing her on the wrong end of the scale of good and evil, not a Lady Macbeth for example,
not a Mrs. Attila-the-Hun, not that level of unpleasantness but bad enough in a
busy environment where there’s little time for bullshit. In this profession, women have often asked me about my feelings. Now you know.
My friend—my homegirl—was named
Darcy, a cool lady, also a student in the pediatric nursing program. Kind of hot although that’s
not important, and very nice which is. Her friend was one of my coworkers and
although Darcy’s friend did not seem like a very interesting or congenial
young woman, as is often the case when dealing with the friend of a friend the
expectation was that we were friends too, transitively, like from math class
when you were a kid, if a = b and b = c then a = c. If she’s your friend and
you’re my friend, she must be my friend too. Which she was not and it was never clear exactly why: whether it was a girl thing,
some sort of jealousy, that’s my belief, or because Darcy’s friend correctly
sensed she was not my favorite person in the world. Or she was just acting like
an idiot which is a condition you find among women as well as guys. Idiocy, that is. We can all agree that there are a lot of stupid men in the world, many of them in
leadership positions, but it’s my thesis that there are just as many stupid
women although they may not have been promoted due to the glass ceiling.
Nursing has its share and some of them, just like in a man's world, have risen higher than they should have.
About talking: Being an insensitive
male you don’t want to make a habit of it but in a clinical setting a sit-down
conversation may have its uses. This tactic had worked for me twice before,
both times in Texas, once in a pediatric emergency room and once on a pediatric
ward. You may say, well, it sounds like you’ve had a lot of personality
conflicts and my response would be, probably not any more than any other nurse
but females might just take abuse, or retaliate in some way, and my approach as
a black male in a white female environment is simply to call the perp out,
sooner rather than later, with a supervisor present, so that a bad situation
doesn’t get worse, which protects my ass. Because
this is a much more dangerous situation for me than for the bully, whatever
the nature of the bullying. My response as a Negro male will be watched more
closely than the original behavior by the white female because she is the majority culture both in society and in nursing. As a professional you
have to “choose appropriate options,” like they preached at the beginning of my nursing education. Talking it out may be one. And my bet going into the meeting on 6 Long
one afternoon was that the meeting itself would solve the problem with Darcy’s
friend. The mere fact of calling a meeting would do the trick. This was The
City—San Francisco, California—probably even more touchy-feely than Austin and
at a university where people ought to be able to sit down and talk. The
backstory was simple: one of my patients, a toddler, had a central line going
into his chest and he was a puller—nurses had come to his bedside a couple of
times before and found him twirling on his fingertips the feeding tube into his stomach after he’d
pulled it out. If he did the same thing with the line into his heart the risk
was a bed full of blood not baby formula and my solution to that risk was to put him
in a onesy, zipped up to his neck, to keep the line’s insertion site away from
prying fingers. Darcy’s friend kept changing him back into a gown because she said
it was more aesthetic.
So, gathering my wits about me and
putting together everything learned in my past non-confrontational
confrontations in healthcare, it seemed best to start by complimenting Darcy’s friend, telling her that her intentions were
good and how good a nurse she was—but she interrupted me before my spiel had
barely begun. “That’s so condescending!” she said. Which stopped me dead. Honey
was not going to do the trick—how about a little venom instead?
Various options passed through my
mind, one of them being a direct approach. Let's see, how about: “Keep your fucking hands off my patient”? Would that work? Probably. But that wouldn’t have been cool or professional and Darcy
would not have been pleased when it got back to her as it inevitably would.
That afternoon with Darcy’s friend, moving forward, gingerly, to suggest the
prominence of my own role in making decisions about a child under my care—the
“it’s my call” argument that most healthcare workers accept even if they don’t
agree with the decision itself—this chick stopped me again: “We all take care of him when he’s here,”
she said, speaking of my patient. She simply did not believe there
was a risk to the child, or so she said, and that’s one thing that age and
experience has taught me which makes me good at my job: not only can anything
happen, at any time, everything does eventually happen and the idea as a R.N. is
for it not to happen on your shift or to your patient. The issue was also professional boundaries.
After working in a half-dozen hospitals it would never occur to me to insert
myself in a sister nurse’s practice without being asked. Never.
Unless a patient is being abused or a R.N. is doing something clearly unsafe,
it’s not my business. As the instructors told us in my original training,
wisdom that applies in other spheres of life as well, there are different ways to reach
an end, the goal in this case is good care—and everyone approaches that in
their own way. So, our talk in the break room dissolved more than it concluded, a
lack of interest on both sides to go forward, and my final revised, revised plan was to mark time until the
end of the shift and hope for the best. Sometimes you can’t win. Some days, as
hunters like to say, you get the bear and some days the bear gets you.
It was still an interesting environment. On 6 Long we had staff nurses from
Russia, Switzerland, Mexico and New Zealand. Nursing pays more in the U.S. than
in any other Western country and more in Northern California than in any other
part of the state, or so the union rep told me. He was the only other African-American male working as a staff nurse who crossed my path at UCSF. Of 2,500 nurses, not to repeat myself or anything. On our unit there were a
couple of Latinas on days who were both Spanish-speaking, and four or five guys
out of what was said to be sixty nurses total. That was 6 Long’s diversity—outside
the Asian R.N.s who appeared to be well-represented, including several Filipinas
or Filipina-Americans. The only African-Americans were me and the black chick
who came to work an occasional shift from Oakland. The clinical manager was a
Latina or had a Latino last name.
The assistant manager was a gay guy
who had been my classmate Elizabeth’s preceptor in the ICU at D.C. Children’s
and, like Elizabeth, was very good. Small world. Blake was a joy to work for
because he had the ability to cut all problems down to their most fundamental
elements. You want men on nursing units not because we’re better problem
solvers but because we see the problem differently: Women open a box, it’s
said, and stop to read the directions whereas men immediately start pulling out
the pieces and trying to fit them together.
Both approaches may be necessary
for a solution. Once again, it's called diversity.
One night in the nurse’s lounge a
couple of my co-workers were talking about shopping. They planned to go London, to Harrod’s, to buy purses and
shoes. That anyone could fly to another country to go shopping on a nurse’s
salary was mind-blowing but the UC pay was that good.
We were unionized employees and
even if our dues were high the California Nurses Association was a force to be
reckoned with in contract negotiations. The CNA brought home the bacon. There was a story in the S.F. newspaper about a nurse working in the UCSF surgical suites who made $300,000
in one year. The article described her as one of the highest-paid employees
on any University of California campus. We jealously did the math, sitting in
the lounge that night, and even if she was a more experienced R.N. making,
let’s say, $50 an hour base pay, she still had to be working almost as many overtime
hours every week as her regular shifts. It might not be safe for the patients
but it was lucrative for her. Which is my point. These were very good jobs and they were mostly held by white women. It wasn’t a
meritocracy, it was a club, and working on 6 Long not just improved my skills as a nurse but completed my healthcare education in an unexpected way. So, one
night and one patient and one task on 6 Long taught me a fundamental lesson about nursing
and about American medicine and at the same time pointed to a culture of
corruption on campus that combined racism, greed, malpractice and hypocrisy. Walking into
the patient’s room was like looking into a microscope for the first time, to
get a close-up view of what's really going on. It would still be a while
before everything came completely into focus but when it did it was ugly, indeed.
The patient in this case was not
problematic. He or she was not the issue: A child obviously but that’s the only
detail that stays in mind. The important fact was that he had a central line, into his heart, for medicine and blood draws, and it had clotted off. Instead of pulling it out as a nurse might with an
ordinary IV and sticking the patient somewhere else—you first try to unclot it
because starting another central line is, basically, a surgical procedure. It’s
going straight into the heart and you have to run all the risks of the procedure
all over again. Better to fix the one you already have in place.
To unclot a line you infuse a
medicine that goes by a couple of names but is usually called Cathflo or
Altepase, to use the brand names, no product recommendation intended. The
procedure takes a while, you inject the medicine, give it time to work, infuse
some more of the clot-buster—it was taking me a while that night to do just
that when the charge nurse, who was passing by the room, saw my technique and
decided to intervene.
“Do you want to cause a
hemorrhage?” she asked me, taking over.
She took the syringe from my hand
and pushed a little medicine in and immediately pulled back on the plunger,
making a pumping motion, as she explained to me, to be sure that the medicine
didn’t go out into the general circulation. She pushed in, pulled out, pushed
in, pulled out again, slowly advancing and retracting the plunger. Cathflo is the same med used in the emergency room for
people who’ve had a stroke. It breaks up the clot whether it’s a central line
or in your brain. It worked that night. Granted that my knowledge of
fluid dynamics is modest, the charge nurse’s logic that you could pull back on
the syringe quickly and prevent the chemical from going out into the body
seemed a little dubious. But she was in charge and it was her call. Later
though, in the med room, looking at the package the Cathflo had come in,
something struck me. A lot of my time on 6 Long was
spent in the med room and it was, for me, a place to catch my breath and get my
bearings: a secure room that only nurses could enter, where family members or doctors couldn’t follow you as they could almost everywhere else. Taking a rest among the vials and syringes that night my eye fell
upon the Cathflo box and the wrapper the med had come in. The box of this very
expensive medication said that the company that produced it was located in
South San Francisco, actually not so far from the Medical Center. Small world, again. The company name was Genentech, part
of what’s euphemistically called Big Pharma, the group of businesses that,
like the Seven Sisters of the energy industry of my own Texas is large and
dominant and controls a good-sized chunk of industry dollars, in this country
and abroad. The S.F. coincidence struck me—although at the moment it wasn’t clear
why it might be important. “Big Pharma” wasn’t yet even in my lexicon. Anyway, as
it turned out that was one of my final shifts. A week or so later:
my last night on 6 Long. But the name Genentech stayed on my mind.
For once we weren’t so busy and the
charge nurse let me go home early, like five o’clock in the morning. The N Judah line that usually took me home wasn’t running yet. San Francisco may be geographically compact but
even going a short way—all those hills can get old really quickly. Going
downhill can be just as tiring as going up. Like many other UCSF students my place
was an in-laws apartment below an Outer Sunset row house, owned by a nice
Chinese lady named Wendy who worked as a travel agent and whose husband was
some kind of entrepreneur. They had two piano-playing kids. My apartment was
actually shared with a couple of artsy San Francisco State students, both guys,
one with a cute girlfriend and one with good weed, and playing house with them
was a joy.
So, like, about a block from my
crib that morning, leaving Children's for the last time, my antennae started to
vibrate. It was just light, the streets deserted, and cold, the ugly weather
the city is famous for, bronchitis literally in the air. Looking over my left
shoulder on the corner parallel to my path—there was a coyote.
My first guess was that he was
looking for a meal, maybe hoping to grab an unleashed poodle or a tabby cat that hadn’t been brought in for the night. It was almost certain he
was coming from Golden Gate Park. There were a lot of stories about the
wildlife, on two legs and four, that inhabits Golden Gate. My second guess was
that he was lost. The coyote’s nose was pointed west which would take him to
the Pacific, while the park was a mile or two north. One second he was there
and the next he was gone. But that look on his face when our eyes first met, it
wasn’t hostile, it was more disoriented.
Like he’d made a wrong turn and ended up in a place he didn't understand and shouldn’t be. Couldn't help wondering if others might be seeing the same look on me.
Part Two
CHAPTER TWELVE
In school you see every experience as a lesson. At the end
of my year abroad, in the final weeks of escape, a handful of events
served as insights that would be valuable for the return to San Francisco.
Lessons you could call them. Premonitions you could say if you believe in the inherent
spirituality of the American Negro. Oh-shit moments or foreboding of
oh-shit moments to come. A brother can never be too careful around white women, that's my mantra. That's where my head was at on my way back to California, headed north. Not south on the
downward leg toward Brazil when my preoccupation was mostly with having fun and busting a big nut. Which happened with an accidental hooker in a beach town in Peru, eventually, on the way home.
On that long journey north by land and by sea, with a return to
conflict looming, or not, my thoughts turned to my professors individually and how to
survive the next year. Not because the coursework was particularly difficult
but because of an environment that was unwelcoming to men and especially black men, “hostile,” according to the sociological literature, not to go all civil
libertarian on you or anything. The first lesson was on the Atlantic side of the southern continent,
in Montevideo, capital of Uruguay, squeezed between the two giants Argentina
and Brazil. It was nighttime and walking back to my hostel there was a game
under lights, like Friday night football in Texas except it was soccer and the
parents in the stands were all shouting in Spanish.
Uruguay is an idyllic setting known for once being the richest
country in the world, from ranching, and remains one of the best-educated and
most peaceful societies on earth. The chicks can be smoking hot too, not that that's important here. Montevideo has
charm, laidback and highbrow, with a reputation as the most liberated city for
women in Latin America—you’ll have to ask women themselves whether that's true.
One thing is sure. Tthe locals are crazy about soccer. Everyone in Latin America
is crazy about soccer but in Montevideo that madness is taken to a further
extreme. Tiny Uruguay was winner of the very first World Cup, in 1930, and once
again after the Second World War, and has been trying to get back to the final
ever since. Sport is one of the few areas where the country’s 3 million
inhabitants can compete successfully with their monster neighbors north and
south. Anyway, there was a game that night. six- or seven-year-olds mostly,
boys and girls, coed not guys against girls but because of the luck of the draw
more boys on one team and more girls on the other. My mind wasn’t really on the
action. The field was almost on the beach and across the River Plate glittered
Buenos Aires. Still on my to do list, for one thing, was to send Karen a
postcard from B.A. Half-watching the kids coming onto the field, the boys all
had their chests puffed out, like the hombrecitos they were,
proud and cocky the way their fathers might have looked if they were shrunken
down, no doubt in preparation for giving the girls a thrashing. That turned out
not to be what happened.
My focus was not on the game but very soon my everyone's attention
turned to the field, twice, for nasty fouls that were met by gasps from the
crowd and by the referee’s intervention. In both cases the victims were boys
and the aggressors were little girls. Watching the aftermath of the second foul.
what struck me most was not the boy, maybe eight years old and small, waiting
for his growth spurt, at the moment bent over and crying like a little bitch. Not
that there’s anything wrong with that. The girl, slightly larger—with a
look on her face, not merely a what-did-I-do kind of innocence but a complete
misunderstanding of the referee’s penalty card, an expression of confusion
clouding her features, like, “Did someone get hurt here?” This was Lesson 1,
something that was already known to me but was driven home that night on beach
and would be plenty important back on campus: Girls can play dirty,
especially when the opponent is a boy.
The second lesson came a week later, on
the Pacific side of South America, crossing Chile’s northern border. Made thissame trip
on a couple of earlier occasions—the first time almost twenty years before, going the
opposite way, leaving indigenous Peru and entering Caucasian Chile. My surprise
at that time was that, unlike in Peru, where most of the people had indigenous ancestry, there seemed to be mostly white bloodlines among the Chileans. At a bathroom stall in the
border station, twenty years earlier, a white Chilean immigration officer,
standing up peeing being one of the best locations for sharing information—just
keep your eyes straight ahead, that’s my only rule—in answer to my question
about Chile’s indigenous population, he said, “We killed them all,” and smiled. This time my trajectory was reversed and the cop was an indigenous
Peruvian border guard whose skin was darker than my own. The election in the
U.S. had just taken place and Barack Obama would be the next President of the
United States. “Obama won!” the Peruvian guy said to me as he looked up from my
passport. The expression on his face was the disbelief probably being mirrored
everywhere in the world where non-white peoples met and greeted. That a
country—the most dominant country in the world actually—known for a history of
slavery and widespread racial discrimination, the same people who gave birth to
Jim Crow—just turned over the keys to the corporation to a black man—that
just blew this Peruvian cat’s mind. It blew mine too. A few days later
though, a taxi driver in Lima brought me back down to earth. This would be
Lesson 3 and it was less sanguine about Obamaworld than had been the border
guard and Lesson 2. The taxi driver predicted, as we moved across his foggy
metropolis, that Obama would not be the boon to the dark peoples of the earth
that everyone believed he would be. What the election really showed was that a black man
with the same values as whites could be placed in a position of great power, “nothing
more,” the worldly-wise taxi driver assured me. Whatever the leadership of the
United States, the USA was not likely to become particularly user-friendly to all
the darker-skinned peoples. That was his message to me. Those were Lessons 1, 2 and 3 and each in its own
way was important in understanding what was about to happen at the University of
California San Francisco School of Nursing. But Lessons 4, 5 and 6 would be the real bellwethers
in the aborted last year of my graduate studies.
In a small port town on Panama’s coast, served only by boat
traffic, while still on my way north, there was another American waiting for a panga to
take him somewhere up river. We fell into conversation, two gringos, one black,
one white. He was a tech guy from Seattle who had made a fortune,
literally, and decided on early retirement. He was seeing the world at the
moment or preparing to see the world—on the Pacific coast of Central America,
having a yacht built from hardwoods taken, one presumes illegally, from
Panama’s remaining forests. The guy had a massive roll of twenty-dollar bills
in his pocket and as we sat at dockside, me waiting for the boat to the capital
city, every time this ex-techie asked one of the locals to do something, even
something minor, he reached into his pocket and peeled off another twenty. Which as you can imagine was making him unusually popular with the local
population. He told me about life in the technology world in Seattle and
values there, a discussion which included he himself, by extension. It was a
valuable conversation because my instinct, before talking to him, was to lump all the tech people in Seattle
and in Silicon Valley with the medical entrepreneurs in San Francisco and at
the University of California. Because it was my belief that both groups viewed the
world through the same competitive lens. Which was not exactly true, but close
enough, if you could understand tech you could understand entrepreneurial
healthcare which was pretty much all of what UCSF was or was soon to be. That
was my theory at the time.
The yachtsman said that in Seattle he had known and
done business with Bill Gates, at the time of our conversation still the
world’s richest man. The view that all tech people and by extension all the
medical entrepreneurs are greedy was mistaken, this ex-techie told me. “Bill
Gates doesn’t care anything about money,” the boat-builder said. “Bill just
wants more of it than anybody else.” What he was saying or at least my
understanding of what he was saying was that to some folks—many of them the
superrich who never live to spend the money they already have, yet are always trying to make a whole lot more—wealth is not a means to living as it is to a
wage slave like myself. Instead it's a marker. It’s how they compare themselves
to everyone else. Somewhere in the back of my mind that knowledge already
existed: one of my earliest memories of working life was the response of a
prior supervisor, in a prior work environment, in answer to why he was doing
thus-and-so for a few pennies more per widget sold, “That’s how you measure
success in this business,” he answered. This business is code for any business,
it seems. Like the ladies at the School of
Nursing talking about the federal grants they'd collected, it was all about the
dollar figure not necessarily the research that the money would pay for. The amount
was an end in itself.
What the former tech guy in Panama was saying was just a little
deeper. Subliminally he was reminding me not to come between these people and
their income streams, even accidentally. Unless of course you wanted to fuck
with them, in which case that would be exactly the thing to do. That was Lesson
4. Lesson 5 took place in San Francisco before classes began.
Home was now Bayview Hunter’s Point, the minority end of town,
where the Navy had previously dumped radioactive waste back in the day, not
that that’s important here, and which was suddenly being gentrified in a big
way—especially by the University of California, which is important. My
roommates in a large second-story apartment were four: Marie, a native French-speaking
girl from the Ivory Coast whose job was to stop people on street corners with a
petition to help sick children or to save the environment. She had been cheated
out of her wages by a non-profit and was about to start work in a hip clothing
store where her exotic beauty would be a plus. She was super-hot by the way, again, not
that that’s important here. My other roomies included a gay black Brazilian guy
who was studying Chinese at City College, don’t ask me why, and a Chicano from
somewhere around Sacramento who was just out of prison and saw himself as a
professional boxer. Both of these guys ate my food which is always a risk of
shared housing but the Brazilian guy also used my utensils to cook it and left
the dirty dishes for me to wash. At least we all had a roof over our heads, at
reasonable cost, which was no sure thing in the Bay Area, even in the
ghetto. We each lived in cubicles that the original two-bedroom apartment
had been subdivided into, like, six or even eight people. There was another white guy, also gay, from somewhere
in the Midwest, finishing up a volunteer project in the city who informed me
one day that using two condoms for anal sex was actually a mistake because
putting on the second somehow increased the risk the first would break.
The things one learns from housemates! He also seemed to have certain designs
on my ass—something that my every word and gesture made clear was not going to
happen, by the way. To describe myself at that point coming back from South
America, the black man in repose so to speak, relaxed and with a satisfyingly high level of THC still in my blood, my personal self-assessment—looking in the
mirror, literally—would not have been “hot” but instead cool. When
a man reaches a certain age—an age that at that point included me, he can
become more attractive and that was what had happened. In part it was
merely having survived, you feel me? Calmer, surer of myself, and with a
certain wry sense of humor—some people found that combination attractive,
especially in the highly-sexed atmosphere of San Francisco where even a billy
goat on his last legs could expect a certain level of action. And guys,
frankly, don't try so much for being hot, do we, being cool gets you just as much
pussy. Maybe more. Anyway, the fact about condom usage wasn’t Lesson 5. That
would come on the first day of class.
Living in my new neighborhood the trip to Mount Parnassus was more arduous
than when my crib was in Outer Sunset. Living in the Sunset my first year of
class, it was possible, depending on my energy level, to walk
home after a shift at Children’s Hospital. Or instead a short ride on the
N-Judah train, arriving at the School of Nursing now involved a long bus
ride through downtown S.F.. My plan was to get to class early to escape rush hour too and that first morning of Spring Quarter, back in Baghdad by the Bay, in the
Year of Our Lord 2009, required me to catch a bus which began its route a few
blocks from our apartment, just after 6 a.m. The rule on
all bus travel wherever you may be is to get there five minutes early—and that
morning the bus driver who was African-American like a lot of Muni drivers
was parked on the corner waiting to start the engine. He was having a
conversation with another brother dressed in construction gear who was heading
to a site downtown. The Obamas were just moving into the White House
and the conversation, probably like tens of millions of other conversations
that morning across the country, across the globe, was about what a black
man in the Oval Office would really mean. Not much, according to the bus
driver who seemed to agree with the taxista in Lima. The bus driver called
President Obama, “The new black face of the same old white world order.” He
laughed cynically at his own turn of phrase which was pretty sophisticated at 6
a.m. but that is the city. Writing his words now, after Barack Obama has left
office, that’s my evaluation as well. Only the way we say it is different—showing respect, on my part, for an awesome performance in the Oval Office, while the bus
driver was showing premature scorn.
President Obama failed me or was about to fail me in his
responsibilities—his administration was about to fail me, that day as the bus
rolled towards the heights of Mount Parnassus. But President Obama was no failure to my
eyes. He was perfect in performance of his duties. He did not
re-create the machinery of governance but he did show that a person of color
was just as capable of managing the levers of power as anyone else. Did he
always do the right thing? No—and “my case” became a good example of that. He
didn’t make the right choice for me, the legal or correct one. His
administration actually became a hindrance to racial justice. But it’s
still hard to fault him, since he didn’t know what was happening and had he
known, given the reality on the ground in California at the time, he probably
would have done nothing different. Nothing. That’s politics. That was Lesson 5.
“You have a nice tan!” Mary Mac said. My reintegration into
the SON required making the rounds and telling everyone hello. My skin color was
indeed darker, all that melanin came out in the tropical sun, it still seemed a
kind of clueless thing to say, not to be judgmental, in line with Mary's
reputation. The point was that Mary Mac not liking me and not wanting me in
her program, was under orders to make nice. In my absence Dean Judy and
Dean Dorrie had also published a learned paper in the Journal
of Transcultural Nursing about the lack of diversity in nursing education, that
started to put me to sleep practically that first night back after class. In which
they discussed UCSF’s own enrollments and came to the startling conclusion
that there was a diversity deficit in nursing education. Oh, really? “It is
surprising,” Dean Judy et al wrote of the UCSF’s own nursing students, “that
students rated clinical courses, particularly those in which students are in
diverse settings, low on how well diversity was integrated into the course.”
Surprising to who? That sounded a lot like General Hospital which, had they
asked me, would not have required much study to accurately describe. The
article quoted a recent graduate of our SON: “Largely, nursing faculty here do
not know how to talk about race/ethnicity factors, except when talking about
disease prevalence. They are very uncomfortable with discussions of stigma,
racism, discrimination or unequal treatment. And, faculty largely are
uncomfortable hearing the difficulty nurses of color face in educational and
health care institutions.” That woke me up. Most striking was that only race
was examined and the other 300-pound gorilla in the room—gender—was not really
considered. This was in contrast to my visit with Dean Dracup who wanted to
talk gender not race. Somewhere in there was Lesson 6. White women in nursing
leadership still believe that they are not bound by rules that everyone else
is bound by, equality of opportunity, in gender and color.
In her effort to get down with a brother, Mary went further. “Obama
won!” she told me at our next encounter as if that news had escaped me in Latin
America. Mary Mac was actually taking the same tack all the other whites of my
acquaintance were choosing, in those first halcyon days of the Obama era. The
belief that a black man in the White House signaled an end to or winding down
of the race wars in America and that by voting for a black president, white liberals
had made up for past misdeeds. Excuse me, that would be wrong
actually. Caucasians wouldn’t get off the hook that easily. And it just
wasn’t true. The Obama Presidency—looking back—brought race to the fore but did
little to resolve it as an issue. In the coming months in my every interaction
with the powers that be at the University of California, which is to say white
people, most of them self-described liberals, the same unspoken question seemed
always to be: "What's the problem, I voted for Obama, didn’t I?" And
while the environment at the School of Nursing might have changed during my time
away, it was not all for the better. Dorrie Fontaine helped write the study on
diversity and then split for the University of Virginia to be Dean of Deans,
leaving Judy Martin-Holland in charge of academic affairs. That alone was a
scary thought. Mary L was away at the University of Hawaii helping to establish
some program or other, leaving Mary Mac in absolute charge of me and my class.
That was scarier still. Oh well. Barack Obama in office or not, the prudent
male Negro R.N. still needed to watch his ass. The desire to turn a new page in
my relationship with the university was contagious however. That was the
purpose of leaving in the first place, wasn’t it—coming back meant trying to
see things with new eyes, for me as well as for faculty. We were all
disappointed with how that particular experiment turned out but you have to try.
That’s what it means, it seemed to me, to be open-minded. To be liberal. You
try to bridge gaps with others. If that doesn’t work, only
then do you try to bust balls. That was actually another lesson that UCSF nursing
faculty taught me.
Making nice is not as easy as it seems. My own effort at healing
meant that my first stop after seeing Mary was to talk to Naomi Schapiro, who
taught in the primary care track but was somehow now in the administration,
during Mary L’s absence. Naomi was my new advisor. Again the instructors had
traded me down the river without consulting me, not that there's anything wrong
with that. Went to Naomi's little office that was not much bigger than Mary
Mac’s closet, actually. Spilled out my heart to her about my wish to have a new
relationship with the SON, yada yada yada. In retrospect it seems like b.s. but
at the time was reasonably sincere. Naomi looked at me for a moment like she
didn’t know what to say and she didn’t actually contribute any concrete
suggestions,but she did tell me, “as a Jew, with all these WASP
women,” she didn’t always feel welcome either. It was a curious thing to
say, first and foremost because, unlike black people, Jews were already very well-represented on campus. Indeed, over-represented at the University of
California. Most of the Regents were Jewish too, in fact, Democratic Party money
people, who now, with Arnold Schwarzenegger in the governo's office, included a few
Republican supporters, and were part of a Jewish super-majority on the Board. As was the new UC President Mark Yudof who had just arrived from the University
of Texas and whose wife was a big deal in Reform Judaism. Yudof was a known
quantity to me from Texas, Mark not his wife. We’d moved in some of the same
professional circles during my prior career, you might say. Anyway, Naomi
suggesting that the SON was inhospitable to Jews seemed odd considering the
power dynamics at work, with Jewish representation in UC's student body and
among faculty/administrators more than twice the Jewish population of the
state,. While black and Latino representation on campus was minimal, single
digits and nowhere near our population numbers in California. Naomi’s claim was
actually the beginning of a refrain that would be repeated over and over again
in coming months. Her protestations notwithstanding. As what would be
titled “my case” progressed, almost every door for me to pass through at
UC—every hoop to jump through—was guarded by an official who just happened to
be Jewish and was there to tell me that no race issues existed at UC, or if
there were, they were anti-Semitism, not anti-black prejudice. That particular
mantra was actually going to start in just a few days, actually. And, by
the way, Karen Duderstadt stepped back into my life, suddenly, in front of the
post office at the foot of Mount Parnassus, across from the Starbucks, which had such meaning in my life, like, my
first or second day back in town. She’d gotten my post card from B.A., she
said, which had taken several minutes at a newsstand to choose a card that
was not tacky or merely tango-related, the stereotypical view of
Buenos Aires. Iinstead finding something to please her higher artistic
sensibilities, you feel me? She added, still a woman on a mission: “I hope you’ve done some
maturing in your time away.” My determination to keep liking her was going to
be challenged but it was a new day, full of bright promise. Like those other
first days of school, back in the day, opening a new notebook, you might
say—full of blank pages—ready to record my thoughts, my fears and my journey through the University of California.
CHAPTER THIRTEEN
Returning
to class meant returning to General Hospital where Karen worked, just a few
doors down from her office in fact—to an asthma sub-clinic that met the
third-quarter requirement of chronic care. Wasn’t just me. There was another
third-quarter pediatrics student we'll call Q who was one of the
certificate-in-nursing students, with a bachelor’s from Berkeley in another field.
Very smart, very capable and also black. Mary Mac told me she was
returning me to General Hospital because of my Spanish skills and Q had just
finished working with Karen the prior quarter and only had to walk down the
hall for her new placement. The atmosphere of the General Hospital pediatric
operation, called the Children’s Healthcare Center but which to me was simply
“the clinic,” as in “Oh shit today is clinic day,” had not changed much. It was
still staffed by a group of earnest young white women doing what black people
call white savior work. You know, the whole Dr. Schweitzer-I-presume among the
natives, in this case in the Mission District of San Francisco. In this case
Dr. Schweitzer was Dr. Shannon Thyne, the clinic director who was also a professor
at the med school and an expert on asthma. Very smart, very competent and
very white. Not that there's anything wrong with that.
Googling
revealed that Shannon Thyne was a Yale grad who did her medical training at
Brown University and was a former chief resident at UCSF. Along with some
social news about her in San Francisco's healthcare community that didn’t seem
pertinent. In her mid to late-30s, that would have been my guess, the only time
our paths had crossed previously, during my time working with Karen second
semester, it seemed to me that Dr. Thyne was pregnant which she was no longer. My
bet, completely out of the blue, was that Shannon Thyne had played soccer when
she was younger. It may have just been my imagination but those young white
women running around the clinic? They all looked like Dr. Thyne who had hired
them. Not that all white people look alike or anything. There were no men, no
minorities except a Latina nurse and a black R.N.—all the doctors and nurse
practitioners with the exception of a native-Chinese American and a
half-Chinese N.P. were white women who—it was also my bet—included a fair
number of graduates from private schools on the East Coast like Dr. Thyne
herself. Yet the patient base was almost exclusively minority. The Mission
District at that point had not yet been bought up by engineers from Google or
coders from Facebook and was still highly working class and Latino.
We
had a staff meeting the first morning in a conference room and we all hung on
Dr. Thyne’s every word. She had just come back from a junket to the Caribbean,
paid for by the pharmaceutical industry. “Big Pharma!” Dr. Thyne said
disdainfully and rolled her eyes but she had still taken the free trip, hadn’t
she? It was my first time actually hearing the moniker Big Pharma but would not
be the last. From that point on, my first morning in clinic, the proverbial
shit hit the proverbial fan pretty quickly. The first day was supposed to be
merely an introduction to the two nurse practitioners who worked with asthma
patients, the young and presumably half-Chinese lady named Andrea Crosby and a
middle-aged white lady named Nan Madden who was the team leader. Nan had
interviewed me by phone before accepting me as a student and she’d sounded as
if she were busy and the interview was a mere formality, which it was. Andrea
was another matter. Not knowing her, she worried me because her reputation
proceeded her. There was another older guy among the nurse practitioner
students, not as old as me but old enough, who had worked for a time in
academia in Chicago before coming to the University of California as a nursing grad
student. He’d already spent time in this General Hospital children’s clinic for
his own specialty and he described Andrea as hostile. Although he didn’t use
that word. That didn’t seem to me to be
an accurate description. My own take would have been unhappy.
When
you reach a certain age you should be a pretty decent judge of character, not
to go all old wise Uncle Ben on you, whether you've used that skill wisely or
not. You don’t always have to know a person well to know what they’re about, at
least as regards whatever you’re interested in, within a limited range so to
speak. San Francisco’s competitive environment for a heterosexual young woman,
which Andrea presumably was, played a part. She needed to get laid was my best
guess—and nothing that came to my ears about her in later days and months and
years has led me to change that opinion. She practically oozed
dissatisfaction. The way only a white girl can, like it’s due her. There was
something missing in her life, some sort of companionship to say nothing of
sex—and it was written all over her face. How do you know that, you may ask?
Because
she was suddenly all smiles and all in my space. She was hitting on me, not in
violent way, it was not offensive at first, the African American male is used
to white chicks wanting to share his body. Generally, guys view all interest as
good. It might lead to pussy later—let’s be honest here. She was letting me
know that she liked me and was trying to be “helpful,” the same way a male
would behave toward a woman he wanted to get close to, nothing wrong with that.
But what if you’re not interested? What if someone of the opposite sex is
hanging over you, too close for comfort, in a professional environment where
you can't just walk away? It makes you uncomfortable. Which it did to me. One
of the few times but yeah. We were in the charting area that first motherfucking
day, back from Brazil and in clinicals, me sitting there and Andrea leaning
over me, and it was necessary to, well, make clear she was too close. Not
that Andrea wasn’t an attractive young woman. But besides “unhappy” there was a
good chance she was part of a complicated/crazy demographic, sometimes found
among young women, especially young white women frankly, who have no sense, and
that sensible middle-aged men like myself—especially sensible middle-aged black
men like myself—try to avoid. Crazy white chicks had led to the untimely demise
of a few of my friends and acquaintances, you may say that’s sexist, or racist,
or whatever—but is that any different from what white women do all day long?
Suppose
you’re a white chick walking down a street and on the sidewalk ahead there’s a
group of young brothers laughing and joking or strutting their stuff. Do you
keep walking straight or do you clutch your bag a little tighter and cross the
street? Black men cross the street too. We take evasive measures sometimes just
like chicks do. The only difference was that Andrea Crosby was Chinese or
half-Chinese not white. Unluckily for me, crazy complicated Chinese-American
chick was pretty much the same thing as crazy complicated white chick. Andrea
appeared unsatisfied and unhappy and therefore dangerous in a professional
and/or personal setting like San Francisco General Hospital. The sex might be
good—that often goes along with the crazy part, in this black man's humble
opinion—but you would pay for it later. Again, in my modest opinion, not as a
ladies’ man or anything, nor as a player, but as guy having studied the
competition.
Andrea
was bent over me telling me how to sit in a chair, literally, what posture to
take, when my annoyance became apparent. We jousted after that, one point about
writing out a prescription that she was wrong on and one mistake of mine about
an asthma maintenance med. She backed off but her feelings were clearly hurt.
So what? Guys are trained not to care about feelings like that, we get rejected
all the time, but women don't take it as well, if my memory of Shakespeare is
correct. Even Q who was sitting nearby and not being told what posture to adopt—she
turned to watch us—and laughed at the confrontation, not at us.
Women
protest all the time if a man is too close or if his attentions are unwarranted
but a man saying the same thing to a woman in power is placing his future, or
his career—or in my case, his studies—in danger. And it wasn’t like asthma
clinic was a difficult gig. You had to lay a stethoscope on a kid’s chest, literally,
that was it from the standpoint of a physical exam. Take a history. Which
inevitably led to a discussion of allergens like pets or dust or pollution in
the big bad city. With asthma there was inevitably a maintenance med to
prescribe and a rescue inhaler. And you were done. The heavy atmosphere in
the charting room was only cleared when Nan came in to tell us about a morning
conference on our next clinical day, not mandatory but that we might find
interesting. A medical student was going to present a difficult case and pediatric
faculty and students were going to try to work it up. As it turned out there
was only one nursing student in attendance. Moi. Planting the black
flag, in the home soil of the racist American medical system, not to sound
noble or anything.
Someone gave me bad directions to the meeting room and walking
in a few minutes after seven the discussion had already begun. More interesting
than the diagnosis was watching the interplay among the hierarchies present. There
were a couple of medical students, in short white coats, the clinic’s nurse
practitioners sitting in silence at the back, and the attending physicians
grouped in the center around a table, including Dr. Thyne who was actually standing
at a blackboard writing down symptoms described by the med student’s case. With
the exception of Andrea, and the other Chinese-American N.P.—and the medical
student making the presentation, who looked as if he were, like Andrea, half
white and half Asian, everyone in the room, maybe twenty people, was white.
Again, except moi. But this was not the time or place for that
discussion. Later that morning things didn’t go badly in clinic, at least for
the next hour or two, but Andrea was still prickly and rejected and since this
was just the second clinical day of a ten-week quarter it seemed best to take
the bull by the horns. It wasn't a macho thing, it's just that men are direct,
you feel me? We're taught to confront a problem. Using the favorite tool of the
ladies of the School of Nursing this time, actually. Call a meeting! Let
everyone put their cards on the table and work out any possible
misunderstandings. Nan agreed. Indeed the student handbook required me to give
a frank and factual account of my impression of the clinic and about the level
of care—learning is a two-way street, or so we are told. This would be that
opportunity. In the actual meeting, held in Nan Madden’s office, two hours into
my second clinical day.
Nan was sitting at the back at her desk by a window while Andrea
was closest to me in a rolling chair. We were about five feet apart which was a
distance that suited me. Any distance was comfortable as long
as she wasn’t hanging over me or correcting my posture. There was nothing to do
but be real, it seemed to me, and my first comment was about not liking to be
told how to sit in a chair. “I’m not trying to control you,” Andrea said. Whoa.
It didn’t matter what Andrea’s intentions were, frankly, whether she wanted to
control me or not, what was important was my perception, that’s
nursing—and it’s a man’s call as it is for women. This is Nursing 101,
actually, the right to express discomfort in any circumstance. The gist of
Andrea’s reply was that my comment was an unwarranted view by black men that white
women are trying to control them. Well, speaking as one of the few black men in
the SON—it certainly seemed that way last quarter. But we
weren't going to get into that. This may have been mere hubris on my part. The
black man saw himself as a healer.
The question is still an interesting one. How does a man tell a
woman to back off—which is something women have a right to tell men? Like,
without making a lifelong enemy? Biting my tongue—something that is hard for me
to do, best to move on to another subject, the lack of diversity among the
clinic providers, which was something pertinent to patient care. “As a black
man I feel uncomfortable with the makeup of the clinic staff.” Some shit like
that, a set phrase, not very original but true. The place did make me
uncomfortable. And guess what? That was my right too, as a student and as a
nurse licensed by the State of California whose legal responsibility even as a
student is to represent the patient's interests, not those of the
facility or of the school. This black R.N. knew his shit, you feel me? There
was a reason the Board required a license for advanced students. And last but
not least, as an African-American who was just suddenly tired,
frankly, of all the bullshit. They got me on a day when my hormone were going
the wrong way. Saying that clinic made me uncomfortable was a polite way of
saying the staffing was inappropriate.
Andrea’s response was extraordinary. Her face lit up with a big
smile, she repeated, “as a black male” or “as a black man,” whichever it
was—and rolled her eyes at me. It wasn't what she said, it was the look on her
face. It struck me exactly the way the diversity facilitator Mr. Adams had
warned us at orientation—an incredible insult. Fuck this bitch in other words, me
feeling that in reply, but without saying the fuck-this-bitch part.
Of all non-diverse behaviors, during our diversity exercise in
Cole Hall, Mr. Adams had specifically depicted eye-rolling as the most
demeaning and most dangerous. This was not the first time someone had rolled
their eyes in my direction—it was just the wrong time, you
feel me? The proverbial last straw, especially since Andrea then turned in her
chair, at an angle that was still in my line of sight, and smiled and rolled
her eyes at Nan, as if to say, “He’s not black enough to say that,” or what a
load of shit, to that effect, depending on the interpretation, but mocking,
certainly, oh please. As nurses you can't do that. People's
feelings have to be validated. Didn't she learn anything in nursing
school? Which, in Andrea's case, was at Mount Parnassus. Nan said nothing but
didn’t look particularly comfortable. Andrea was on a roll. You could tell she
wanted to say something more, as Dean Dracup had. It was my cue to go. Standing
up and addressing Nan alone, “She’s rolling her eyes at me. I’m
leaving.” That was it. Meeting over.
Looking back those five minutes would have a lasting effect on
all of our lives—mine, Nan’s and Andrea’s—as well as a bad effect on the lives
and careers of a dozen or so other people across campus, and across the bay, in
Oakland at the Office of the President or UCOP. Langley, Virginia, in a higher
education context. The sequelae of those five minutes would include my
departure from the SON, with tens of thousands of dollars in debt, comforted
only the inner joy that a handful of high officials lost their jobs too. No
regrets on my part, merely a sense of wonder. This is race in America which
remains an unsettled affair and can still be risky business indeed. Outside in
the hallway Nan followed me to the door. “
Take the rest of the afternoon off,” she said. Reluctantly she
gave me Thyne’s email address. Got my bag and was headed out but had to walk
around Nan, again, who was now making a show of embracing a black mother who’d
brought her child for a check-up. The show of affection wasn’t Overly
impressive. Nan could hug that black mom until hell froze over—this wasn’t
about her personal relationship with patients. It was about getting minority
providers involved in care of minority patients. Dr. Thyne was not of the same
opinion, however. In the evening she replied to me almost immediately, which
meant that Nan had alerted her ahead of time, not that there’s anything wrong
with that, Nan would have been a fool if she had not alerted her superior of
trouble in clinic. The question was what she’d told her.
“Thank you for sharing your concerns,” Dr. Thyne wrote in a
polished, persuasive reply. “This is an important issue that warrants further
discussion. We work very hard to provide culturally competent care in the
Children’s Health Center. As you know, the paucity of African American
clinicians (as well as those from other underrepresented groups such as Latino,
LGBT, etc.) is an issue in our community. However, I feel strongly that we can provide
excellent, sensitive care even when not from the same background as our
patients. There is only one Caucasian NP in our clinic—Nan Madden. Alice Chan
and Andrea Crosby are Chinese-American, and they provide very important support
for our Spanish and Cantonese speaking patients, as both are fluent in these
languages. All our MD providers—Andi Marmor and myself—also speak Spanish (as
does Nan). While none of us is African American or male, we have attempted to
include team members (ranging from allergy MD specialists to health workers)
who are from diverse backgrounds, including African Americans and men, in order
to provide a comfortable environment for our patients. Given that both
pediatrics and nursing are largely supported by female nurses, support staff,
nurse practitioners, and physicians, it is likely that you will find yourself
in a largely female environment on rotations with children. Keep in mind that
it is most often mothers who bring children for care, and it has only been a
decade or so that women have advanced to higher positions in medicine (so that
people like Nan and myself now have the opportunity to serve in leadership
roles). I would like to think that many mothers are inspired by the care they
receive from other mothers and other women. While I cannot represent myself as
anything but who I am, I do hope that, as a Caucasian female doctor committed
to high quality care for underserved children and families, my patients will
find me a sensitive, culturally aware clinician.” Then there was the subject of
Andrea. “In the years I have worked with Andrea, I have never found her to be
insensitive to cultural issues among our patients. In fact, she started at a
satellite of our clinic at Southeast Health Center, which serves a largely African-American
population, and Andrea and her team were very well received. Of course, I will
discuss the interaction you have described and will seriously address your
concerns. That said, I feel confident that she did not intend her ‘eye rolling’
as a comment on your race or gender. Medicine (and our culture in general) has
a long way to go before we are able to represent all of the cultural, social,
and personal experiences of our patients. However, our patients need care now
and we are the providers who exist. I look forward to the day when I can
include more clinicians from diverse backgrounds on our medical staff. I would
be happy to talk to you further, and I would appreciate any ideas you have on
how to improve patient care in our clinic. Additionally, I am committed to
working with the leadership in your program to help further your educational
and personal needs.” The message was signed, “Shannon.”
There were a lot of things to say about Dr. Thyne’s response,
first and foremost being that she was wrong. The paucity of African-American
clinicians sounded a lot like “a lack of qualified minorities,” an old argument,
the best retort to which could only be made after finding out how hard she had
tried to recruit black nurses or M.D.s. California was almost exactly half
Hispanic at that point and she couldn’t find Latinos to be on staff? Men?
Weren’t we half the population? Again, having been around this clinic the prior
quarter, there were no men, hello, much less black or Latino men, except
the occasional parent. The first non-white professional male my eyes had fallen
upon was the medical student making the presentation of the case conference. It
was Dr. Thyne’s argument, which seemed elegant but strained, then, and still
seems strained now, that the prestigious and rich University of California
could not recruit people of color or men to work as regular staff at the
equally-prestigious San Francisco General Hospital? And contrary to Dr. Thyne’s
belief, this wasn’t my first experience in pediatrics, and knowing that nursing
and professional childcare are both heavily populated by women, white nurses
mostly, actually, didn’t mean conceding the issue of an all-white staff. A lack
of diversity was improper care, by definition, despite whatever inner joy the
mothers might have felt having a woman in charge. Shannon Thyne was trying to
be diplomatic but there was still an issue—a patient need not being addressed.
This was my second quarter in her clinic and my eyes had yet to fall upon any
minority advanced provider, either sex, except Andrea and Alice Chan. And moi. In
training of course. Like Dean Dracup, Dr. Thyne was dipping her toes in
whitewash, using selective stats, and it made me not want to go along. If she
wanted someone to work with, that was great. If she wanted someone to bullshit
that was not. At that moment the black man chose to embrace his black manhood
and stand tall, balls to the wall so to speak. For example Alice was working
with asthma patients, so two minorities out of five providers on the asthma
staff was quasi-diverse staffing. But Thyne was fudging her numbers. Those two
Asian-American women in the asthma unit were also the only
non-Caucasians in the entire Center’s regular provider staff,
numbering, what, a couple of dozen women? Which was my point. And so what, if
they spoke Spanish? The clinic needed Latino providers because culture is a big
part of healthcare. Hello. The reason using this argument was particularly
gratifying at General Hospital was because it was being taught at the School of
Nursing. Hello again. That meant the Center needed black medical staff.
There’s a long tradition of blacks in this country not trusting
white providers, especially at academic institutions like UC—my own distrust
was prompted by my own care as a child at UCSF. And if that had suddenly
changed, no one had told me. Dr. Thyne was trying to defuse a situation, both
commendable and understandable on her part, but she was intentionally clouding
the existence of an important healthcare liability as well. Lying about it, you
could say. General Hospital had inappropriate staffing. It was that
simple. That’s how medicine is supposed to work, by the way, best practices are
best, for black patients as well as for whites. Which was the gist of my reply
to Dr. Thyne, without calling her a liar but, yes, saying her response was
insufficient. How long do you think, for example, a pediatric clinic serving
all white kids would have survived with all black doctors? Staffing was a
matter that Dr. Thyne’s superiors should take up. That was my message to her in
response. Since that morning in conference as the med student presented his
case, Shannon Thyne’s path and my own have never crossed. And there was only
one other email a couple of years later, after her correspondence that night
was released by the university. That alone took two years, getting my hands on
the documentation and taking my first tentative steps on the paper trail. My
path and Andrea Crosby’s have never crossed again either, since the moment in
Nan Madden’s office when the bitch rolled her eyes. Not that there’s anything
wrong with that. No email, no telephone calls, no hugs, no kisses, no nada.
Ditto for Nan herself, after she told me to take the afternoon off. This is all
important to note especially since, a week or so later, UC police were
following me on campus. Not that there's anything wrong with that either.
And you’ve heard the phrase, “I didn’t think anything of it?”
Famous last words.
It was true—not thinking anything of it, really, going about my black
business the next day which was devoted to lecture. A plan was developing about
how to approach diversity at General Hospital. When the issue of race, in the
Chancellor’s Office, on Mount Parnassus—it landed in my lap like a bomb.
We had a couple of cool bar tables in the apartment, tall and
round with high stools, the tables just large enough for two people or one
person and a computer. San Francisco is wealthy enough that most of our
furniture was picked up on street corners in affluent neighborhoods, Russian
Hill and places like that where you didn't see many niggers, actually, as rich white
people cast off last year’s fashion in home decorations. Anyway, drinking
Trader Joe’s wine and cruising through my email the next night there was a note
from Professor Schapiro. Started off innocuously but then she said she didn’t
know if anyone had informed me but, speaking of General Hospital, “They don’t
want you back.” A day or two later Andrea failed me in clinicals for a
wide variety of mistakes with patients. Up until that point only three patients
had actually come under my care and in the case of a fourth, a Latino family, Q
had asked me to interpret for her. The school would tell me the exact details
of my deficiencies at a later date, according to the subsequent messages from
faculty. Seeing this for what it was, and without skipping a beat, my first
outgoing message was to the Chancellor of the University of California San
Francisco, J. Michael Bishop, the Nobel-prizewinning co-discoverer of
proto-oncogenes whom it had been my pleasure to correspond with previously.
Told him what had happened—said it was retaliation—asked for a university assistance
to defend my interests in what was likely to be a nasty fight. He wrote back
immediately. He said nothing about my request for representation to protect the
student’s interests. Instead he told me that he was assigning investigation of
what had happened in the peds clinic of General Hospital to Michael Adams, the
facilitator from my orientation, the same black man of whom an African student
had remarked, “should be a lion but isn’t.” Oh God. It was going to be a
long quarter.
The Starbucks at the foot of Mt. Parnassus on the N-Judah train
line, cater-cornered to the post office where Karen had asked about my
maturity, became my crib away from crib. My roommates were fine but the
apartment was crowded. Ten weeks which is how long a quarter lasts is a blink
of an eye if you’re going to class and have clinical responsibilities but for
me there were suddenly only lectures and a certain amount of downtime. Which
made a café as likely a place as any to wait out the School of Nursing.
The SON said that Andrea had failed me for cause—it just so
happened the failing grade followed by hours my raising improper staffing with
her superiors. My reply was that it was retaliation, since the meeting had
been my idea, and neither Andrea nor Nan had said anything about my
performance until the issue of inclusivity came into play. Isn’t that the
definition of retaliation? Apparently not at UC. There’s a higher bar although
no one could ever tell me exactly what it was. Our meeting in Nan’s office took
place six hours into my clinical rotation, there literally wasn't time
for me to screw up, and this wasn’t my first rodeo, an argument you didn't want
to make actually, but since the hardest part of the asthma sub-clinic involved
brief use of a stethoscope it seemed unlikely this was anything more than it
appeared to be, revenge. A charge that would be hard to prove. The school
refused to give me any details of what exactly led to my failure. Dr. Sally
Rankin, chair of Family Health Care Nursing, which included the mother and
child programs that included my own, wrote in an email that she would only
reveal the causes for my failure in a meeting at which time my reply would be
heard. On the subject of maternal-child values, my mother may have raised some dumb
kids but none of her children was stupid enough to go into a meeting blindly,
in this case without having seen the evaluation and without having prepared a
defense. We were at an impasse. “This is how we do it,” Dr. Rankin emailed me,
refusing to allow inspection of the evaluation in order to prepare a defense.
They would have to have the meeting without me. “You require remediation,” Dr.
Rankin told me in another message, while my equitable response was that was not
correct—this was retaliation and nothing else. At some point during the
exchanges, in order to butter up the dragon-lady, it’s still embarrassing to
admit writing to Naomi, “I’ve heard good things about her,” meaning about
Grunhilda, which was complete bullshit but Naomi might pass on. Dr. Rankin
was actually the Wicked White Witch, that was her reputation in my circle,
among a handful of black men. In her department there was only one black male
student, moi, and a handful of black females—no black instructors and
only one Latina associate professor, a lady from Colombia. We're talking, like,
thirty faculty members on both the practice and theory sides in Family Health
alone. Almost every one a white women, in other words, not that there's
anything wrong with that. The department looked a lot like the clinic at
General Hospital, actually. My sources of inside information were limited. Of
600 nursing students in the SON at last count only six were African American
men. One of them told me he’d met Dr. Rankin and he described her as someone
who did not appear to hold the black race in high esteem, especially not the
male gender. Both Mary Mac and Dr. Rankin had come to California from the
Carolinas, Appalachian State University and Duke, respectively, where they may
have picked up some of the quaint racial customs of the Old South.
Before my eyes Mary was going from bubblehead to Bubba, while in
the case of Dr. Rankin there appeared to be no change whatsoever. She started
out cracker and went from strength to strength. Oh well. Back to Starbucks to
sip my americano. The café was super-crowded and in a high-traffic area
where often, as in cafes in Europe—or restaurant cars on trains—you have to
share a table with a stranger. There were a lot of regulars from the
surrounding neighborhood who swooped down on any vacated seat and spent hours
reading—suddenly now that was a description that included me. It felt like
being a retiree with too much time on my hands. One afternoon my sister student
Carina was there doing schoolwork. Not wanting to be a bother—but seeing her
was cool.
Carina was now my upperclassman in her last quarter and in her
final clinical rotation, at Stanford University's pediatric ICU. She said her
experience as a provider writing orders was completely different from being a
nurse carrying them out. “It’s a lot of responsibility,” she told me, but
Carina was the real deal and would be a fine practitioner. She knew that the
SON had pulled me from my clinicals and did not volunteer an opinion. There was
nothing she could say—it was what it was. A table suddenly became empty at the
back near a wall lined with bags of coffee.
My preference is always to sit facing the door even though there
are the distractions of people coming and going. It’s a café and it seems to me
you have to people-watch, right? This time someone sat down across from me
almost immediately, blocking my view. It was a doctor, or researcher, long
white coat and all. Caucasian obviously—this café served UCSF—about my age,
bespectacled and out of shape. Not a surgeon, that was my guess because he was
too soft and uncared for, but not someone who lived in a lab, either. One of
the diagnostic specialties would have been my guess—someone who found illness
but didn’t necessarily cure it. As he sat down uninvited, he had a very tall
coffee with him and the Times in his hand. Both bad signs.
Liking my privacy my hope was he’d drink his coffee and move on.
But with the Times in hand—some of the retirees could spend
hours on the front page alone. On this front page there was a big headline
about something that had happened in the Occupied Territories and he finished
reading the page and was moving on to the jump, straightening the newspaper
methodically, folding pages back, and muttered, “Damn PLO.” Actually at
that point in time the Palestine Liberation Organization was the least of
Israel’s problems.
This guy was definitely Old School. What he was reading about
was the work of Hamas or someone more hardcore. And that was what came out of
my mouth, “Israel should pray for the PLO,” something thoughtful like that,
ironic but true, you know? He looked at me over the rim of his glasses. It
was a speculative evaluation, like a woman deciding whether to talk to a guy
who has addressed her in a bar.
“That would presuppose,” he said, shaking the newspaper, “that
you know something of what you’re talking about.”
“I lived there for a while, not in the Territories but in the
Western Galilee up near the Lebanese border.”
“Cama zman gar-ta shama?” he asked. “How long did you
live there?”
“Shalosha shanim,” was my response, with a better accent.
While he had studied the language in Hebrew school, probably,
and probably never much used it, for me there’d been a six-month course at a
kibbutz language school in-country, me ditching about month four, and
off-and-on use of the language for some time thereafter. Neither of us would be
mistaken for anything other than Americans speaking bad Hebrew but suddenly
he accepted me. It wasn’t my cultural competence, that hadn’t
come in my time in the Holy Land, but cultural credibility from someone who had
at least made the effort. His view of the “damn PLO” simply turned into “damn
Hamas” or whoever did the deed, but his view of me tilted toward acceptance.
Our political views differed but at least mine had been shaped by experience
which is a value that people our age share, as opposed to correct political
theory that is more important to the young. Palestine was dropped as a
subject.
“We won’t talk about it,” he said, “because we’ll argue.” We
talked instead about something we both knew better, the University of
California.
My request to the Chancellor for protection had fallen on deaf
ears and this guy would turn into the next best thing. He listened to my rap
about General Hospital without asking any questions. “If what you’re saying is
accurate,” he told me, drawing out the “if,” because he didn’t know me, “then
of course it was retaliation. UC lives by retaliation. You run that risk every
day.” He was surprisingly non-PC. “Women want to be liberated,” he added,
addressing the gender dynamic on campus, and also how women deal with
rejection, “but there’s always a gotcha moment if you piss them off. I learned
that early on from my own wife, who I love more than life itself.” He gave me
an ironic smile. Hey, this guy and me? We could be friends.
Turned out he had practical advice too. He said just go to the
meeting with the Department Chair, get a copy of the evaluation which the SON
would have to release at that point—and tell her that it had to be studied
before an accurate response could be made. He said they couldn’t force me to
respond right away, “What are they going to do, pull out your fingernails if
you don’t talk?” He didn’t know any of the figures from the School of Nursing
but he knew Michael Adams the director of diversity to whom my case had been
assigned. My appointment with Mr. Adams was fast approaching. “Mike Adams
is a not going to make any finding that Mike Bishop doesn’t want him to make.”
He said that Chancellor Bishop had just been dragged through the
pages of the very Times lying on our table over a financial
scandal in the School of Medicine and would not be looking for more scrutiny in
what were probably the final days of the Nobel prizewinner's tenure in the Big
Office. White Coat advised me, after Adams ruled against me, which he described
as a given, to take my case to the University of California Regents, at a Board
meeting.
Even though he said it was a losing proposition with the
Regents, too. “Why?” “Because the majority of the Regents are Jewish,
as is President Yudof. Your people”—he didn’t say “you people,” he said your people
which made it okay—“have burned a lot of bridges with us recently,” meaning
Jews. Well, fuck me.
“I know Yudof,” was my defensive reply.
“How is that?” he asked, which led to a short version of my
history with the new UC President, back in Texas. Our paths had crossed in
Austin where Mark Yudof enjoyed a decent reputation on race, dealing with the
WASP-led, oil-driven University of Texas Board of Regents. Where his rep was
considerably less impressive was on issues of influence-peddling, which is how
we’d met. Me burning him on insider moves involving UT medical patents. My
criticism hadn’t reflected any particular animus on my part toward Mark Yudof
himself. It was just part of my job at the time. “Yudof was brought in by
Blum,” White Coat said, speaking of Richard Blum, a rich real estate investor
and chair of the Board of Regents, who also happened to be married to Dianne
Feinstein, the senior U.S. Senator from California. These were two of the most
important people in the state.
“I don’t know Yudof personally but I know people who know him.
He seems competent. A very big ego. He was at the University of Minnesota
before Texas,” a fact that was also at the back of my mind. President Yudof's
trajectory and my own were parallel, including Austin, Minneapolis and now the
Bay Area. White Coat said that back in the day Jews were second-class citizens
at UC but now they ran the university system, from the Academic Senate across
“the enterprise,” from Oakland to San Diego, San Francisco and L.A. There was
that word again, the enterprise, which as yet no one had defined clearly for
me. He said that Blum and Feinstein were California’s premier power couple and
weren’t going to let anything blemish the university’s reputation.
“DiFi—”
“Who?”
“DiFi, that’s what they call her, Dianne Feinstein was
mayor here, did you know that?”
“Maybe she’s not a fan of UCSF.”
“Her father was one of the first Jewish surgeons at UCSF. You’ll
get no sympathy from her or her husband.”
“What about Barbara Boxer?” the other U.S. senator from
California.
“One, she’s Jewish too. Two, she’s not going to do anything to
upset her colleague in the Senate. What I’ve heard is that they’ve kind of
divided up the state. Anything that happens in L.A., the movie industry or San
Diego is Boxer’s call. Anything in the Bay Area or Silicon Valley is
Feinstein’s. The dividing line on spheres of interest is somewhere around
Bakersfield. They both are in service to Big Ag,” meaning the state's big and
still powerful growers. He said that the only people who could intervene would
be the Office of Civil Rights of the U.S. Department of Education, feared by
all universities across the country. A finding of discrimination or retaliation
against a minority student would be especially loathsome to a research school
like UCSF, he said, because it might lead to a curtailing of federal funds,
which would spell doom for any major research.
Doc, which was one of my names for him at that point or White
Coat which sounded more dramatic, pointed along the N-Judah tracks to the east.
He said that the regional Office of Civil Rights covering all the western
states of the U.S. was in downtown San Francisco. Surprise. “But they won’t
help you either,” he said. He told me there was a book to read about the
struggle for control of the Region 10 Office of Civil Rights that would be
enlightening in any struggle with UC. White Coat’s wife knew the OCR
director’s wife as being active in the local Jewish community. “He won’t help
you either. And I know what you’re thinking. Obama, right? Good luck with that.
The president will never hear about your case and even if he did hear he’s not
going to piss off one of the most powerful leaders of his own party by
embarrassing a school to which she has ties.”
He didn't even pause for a breath. “And we haven’t even
talked about Nancy Pelosi. She’s Speaker of the House and this is her district.
She spends a good deal of her working day bringing home the bacon to UCSF. You
really think she’s going to allow you to embarrass her in front of the
Republicans or get a federal funding cut at the principal institution in her
district? That’s what we’re talking about here. That’s what power means.” At
some point, he said, “people like that,” meaning the rich and
politically potent, like Dianne Feinstein, don’t get arrested, they don’t get
fined and they don’t get findings of discrimination or retaliation against
them.
“I could go to the district attorney. She’s black and
retaliation is against the law in California. I’ve read the statute—”
“The D.A. is Senator Feinstein’s protégé, Kamala Harris. She’s a
graduate of UC and her mother is a professor at Berkeley. UC is the most
powerful institution in the state. You could sue, but Feinstein’s daughter is
presiding judge of the San Francisco Superior Court.” He must have sympathized
with the look on my face. “Make a deal. If it is as you say and you’re being
screwed they’ll come at you with a deal. That's the UC way,” he said. “They’ll
never admit wrongdoing but they’ll throw a bone your way one day and heads may
roll, sooner or later. The way they’ll do it is to ask to speak to you by phone
so there’s no record and there’s deniability. But be careful. That’s what
they’ll also do if they’re trying to trick you [too]. Tell you something on the
phone that they can deny later. It’s your fault, you know. You never should
have told your Dr. Thyne that you were going to her superiors. Either do
something or don’t do it but never never never threaten or warn anyone. That’s
what I taught my kids!” He was kind of enjoying this. White Coat was at an age
when he was past caring, his career may already have peaked or was in decline.
Our conversation allowed him to display hard-won insider knowledge that he
might not otherwise get the chance to use. “If you think you’ll win a
confrontation with the University of California you’re dreaming. It’s more
omnipotent than the CIA and with worse ethics.” He’d put aside his interest in
the newspaper entirely at this point. “I’ve had intimate acquaintance now
with four major academic institutions, the first where I did my undergraduate
study.” He named a large East Coast state school. “The second where I did my
medical study and my residency, the third where I was first on faculty, and
here at UC. All universities are hotbeds of intrigue and malfeasance. Because
of its size and importance UC is worse than most, it’s a difference of kind in
bad behavior at UC as well as a difference in degree. I know you think this is
a lynching, that’s your people’s favorite metaphor. If what you say is correct
it is a lynching although your race was probably immaterial at
the beginning. They didn’t fail you because you’re African American, they
failed you because you threatened to raise an issue that no one wants to
confront. It wasn’t a race issue yet but threatened to become one.” He drew a
schematic on a napkin. Railroad tracks. He described race as the third rail in
higher education. Touch it and your career will end. “I’m not so sure about
your gender though, I’ve heard of some witches’ rites at the School of Nursing
before, those women can be dangerous. But where your race will really be at
play is how they say no to your case. Black is just the wrong color right now,
my friend. I’m saying that in all honesty. Right now everyone’s concern at UC
is anti-Semitism and well it should be.” Well fuck me, again.
My meeting with faculty did not in fact involve Dr. Rankin,
although she was apparently calling the shots. Only Mary Mac and Naomi Schapiro
were there. Right before we began there was a revelation. Naomi let her mask drop.
My African-born friend Umia from first quarter, who was now
about to finish her program, offered to sit in on the meeting along with Q. She
and Q had also remarked on the lack of minority providers in General Hospital’s
center caring for mostly minority children. Both wanted to show support for me
and my position. This is the black way, by the way, nothing special, something
that it would have been my responsibility to do for them, if our positions were
reversed, although my gratitude was sincere. We know the risks of speaking out,
you might say, but usually still support each other because somebody has
supported us. Naomi said no.
“Privacy rights,” she told me as an explanation. No one could be
with me in the meeting. The thing was though that the only privacy rights
in the room that afternoon would be mine. If having Dumbo the Elephant sitting
next to me was my wish—that was my right. The SON just didn’t want any
witnesses. And really, why drag the few other people of color in the program
into my conflict?
That was my feeling at the time, if we were at the nurses
station and you were asking my feelings and all. Men like to go it alone, again
it doesn't mean we're bad people, it’s the hardwiring, actually. Anyway it gave
me an insight into Naomi, my advisor. Despite her claims of feeling out of
place with the waspy white women in the school she had no problem doing their
bidding. She’d already sold me out, in other words. Which wasn’t unexpected but
was nonetheless good to know.
For the meeting Naomi hijacked one of the larger offices in the
Family Health Care Department. We three sat at the same table, Mary and Naomi
flanking me. Mary started by sliding over my evaluation like it was a form she
wanted me to sign, just routine. There had already been a lot of talk from
faculty about the best way for me to “move forward” with my studies and signing
in black ink was being proposed as the best way to do that. Mary watched
me read the scores—the form was filled out and signed by Andrea. Of note was
what was there and what was missing.
Andrea accused me of being rude to patient families, an
interesting complaint because we were just six hours into the new quarter—that
was the totality of her time to evaluate me. Even Karen who had me for an
entire quarter in this same clinic had given me 5 out of 5 for my rapport with
patients and families. Let’s see. Andrea also found me incompetent in my
technical skills and she dinged me for arriving late at the case presentation
by the medical student. Noting that my attendance was not required, she wrote
in the margin of the evaluation, “If you chose to come, you should have been on
time.” Which could be a valid remark to make about a nursing student—punctuality is important—but
was obviously bullshit in the greater scheme of things here. She said nothing
about my asking her to get out of my space, which was what had led to her
I’m-not-trying-to-control-you comment in the meeting with Nan. Instead Andrea
had written on my evaluation, “Does not like women.”
This is absolutely true. That was what she wrote on my form. That
was literally part of her written evaluation: “Does not like women,” half the
population of the planet. At that point we hand spoken maybe half a dozen times
and she had never asked me my feelings about the opposite sex.
“This is retaliation.”
My comment was addressed to both Naomi and Mary, who were on
either side of me, you know, like the damn police. And then, turning to Mary
alone, “You’re at the bottom of this.”
“Not so!” she said.
Of course she was lying but she looked cute doing it, in a
soccer-mom kind of way, not to be inappropriate. Not that that's relevant here.
The only accessory missing was sunglasses perched atop a ponytail.
“I’ll look at this,” was my only promise, as White Coat had
suggested, “and get back to you with a detailed response.” After leaving the
two ladies—who before the echo of my footsteps moved into the hallway were
probably already on the phone to Dr. Rankin. After leaving them my first trip
was to the library to write down what was said. Then a call to the guy from
Chicago who had worked in academia previously and first warned me about Andrea.
In the meeting Mary mentioned the SON’s wish to have “a learning agreement that
will allow all of us to move forward.” Mary said she was going to send a copy
for me to review and sign. She acted like it was no big deal.
“Don’t sign!” said my friend. “It goes by a lot of different
names but what it’s mostly called is a behavior agreement. If you sign and you
utter the merest peep during the rest of your studies that they don’t want to
hear, you’re gone. They can kick you out without any further ado.”
It was all good. The black man does not scare easily in his
dealings with the white power structure. My advisor Naomi had shown where she
was coming from and that was cool and the SON had made clear that the faculty
wanted to play hardball. Actually that’s one of my favorite games. With women,
it seemed to me, as a fascinated observer of the opposite sex, in my modest
opinion, conflict is only a last resort. With guys it's where we like to begin.
CHAPTER FOURTEEN
Even with time on my hands, not working and not going to clinic, seeing
San Francisco didn't interest me in the details. Sightseeing just became a
fall-back plan. And one inadvertent sight left me speechless.
It’d been a long day that included a visit to Whole Foods which began
life as a tiny organic foodstore in a white part of Austin and conquered far
and wide. The Whole Foods in the Financial District was a poor imitation
of the mothership at home and did not remind of grazing the aisles in
Texas. Sometimes, when you’re sightseeing you’re looking not for the new but for
the familiar, you feel me? The San Francisco store didn’t evoke anything except the usual shock
at the prices.
There was another Starbucks, somewhere, me working my way towards
China Basin for no particular reason other than it’s a cool name. Studying in the cafe was funny because in this high-tech city the people on their
laptops at neighboring tables watched me move a pen across paper as if writing by hand was some kind
of new technology. A couple of motorcycle cops sat in the corner drinking
coffee and chatting the whole while, hours after hour. The
cops in Baghdad by the Bay seemed a less oppressive presence than in Texas, although only
superficially so, as it would turn out, if you counted the university pigs. Walking, after finishing my coffee, led to a cool network of canals and houseboats, an outwardly bohemian lifestyle
that was probably still very cash-intensive. Looking down into the canal—couldn’t believe my
eyes, a big manta ray making its way just below
the surface, moving like a butterfly through the water. Seemed like an ecologically-friendly sign that the
water was clean enough to host a large marine animal but a houseboat owner came
off his deck and looked down and shook his head.
“That’s good, right?”
“No,” he said. “Rays are warm water fish. The sea here should be too
cold for them.”
That depressed me even more than the talk with White Coat.
The black man's greatest concern beyond racial justice is the environment. The motivated black
male has two high priorities, three if you include chicks. The water temperature was really just another reason to worry
about my present quality of life. You feel me? In my mind the manta turned from a harbinger
of global warning into a sign of alienation, like the coyote in
Outer Sunset.
Some of the bullshit quasi-sociology that we’d been forced to read as students came back to me suddenly as true, especially as regards a sense of alienation—“otherness” in nursing literature, which usually describes race or illness but in this
case was race and gender.
“You don’t
belong,” the ladies of the School of Nursing had said and it upset me for about
half an hour. This is the nature of being black in America and was not new to
me except in the context of graduate school. Race is a social construct, as the ladies in
the SON liked to say, and blacks live
in a world of otherness—unless we chose to be white or serve whites as Dean
Judy and Michael Adams did or do. This wasn’t my first rodeo in other words. Dr.
Rankin and Dean Dracup were going to have to start playing their A game if they thought they were
going to beat a militant Negro. Instead, while planning my defenses, Karen’s idea of taking advantage of
the opportunity for an education hit me in the head. Surprise! UC is a university
not a plantation, right, there were always lectures and in-services taking
place, featuring topics in medicine and in science, and that seemed to me a
better use of my time than wandering the streets of the big bad city. As
you get smarter—you get stronger. Seem to have heard that mentioned somewhere
else, maybe even on Mount Parnassus. The idea of an education took shape, the very next day in fact. A master’s trained nurse from Stanford University, who was an expert in central lines, came to give an in-service about the mechanics of placing and using these
very invasive devices. She was kind of hot, actually, not that that's important here. She half-filled one of the lecture halls in a science
building on campus, and having nothing better to do—it was a more productive way for me to spend an afternoon than on the sidewalk or hanging out in Golden Gate Park, although those were good ideas too.
A central line is intended for long or
intensive use and goes into a great vessel of the heart, while a peripheral IV started
by a nurse or paramedic, in a patient’s hand for example, enter smaller veins. After her talk, as this
expert was packing up—she had started the lecture by saying she was a paid
consultant for Genentech, by the way, the company that made the de-clotting medicine used in the hospital, to unblock central lines—she
answered a question for me, actually from my last night working at Children’s.
“No, that’s not right,” she said of what the charge nurse told me.
The chances of “causing a hemorrhage” were minimal, the Stanford lady
said. The medicine itself had a half-life of like five seconds, or so, which meant it wouldn’t survive long enough in the general circulation to cause systemic harm.
Most important, she said, it was impossible to stop this med from going out
the other end of the line because it needed
to diffuse outside, where many clots form, outside the tip, on the very end of
the catheter. That’s where Cath-Flo does its job, she said.
Even after my return to the Bay Area the comment made by my supervisor on 6 Long had stayed with me and this very question had been put, out of curiosity, through succeeding months, to a half-dozen or so very good nurses who all said the same thing
my supervisor told me that night, before my meeting with the coyote. The real authority had now spoken and everyone else was wrong. This was the weakness of our profession, it seemed to me, there was a
lot of bad information out there. Education levels were not as high as in
medicine, obviously, where the real effect of a treatment would likely be well-known as a matter of practice.
This was instead “nursing wisdom,” in a profession where many of the
practitioners did not have bachelor's degrees and were entirely new to the work. Nursing made enormous strides over the decades but that mostly
appeared to be due to numbers and sheer scope of practice, not individual
accuracy per se. There was still a lot of inherited wisdom—old wives’s tales literally—that may or may not have been true. They were passed down from generation to
generation in a profession where evidence-based practice was talked about but
was still a long way from commonplace. You never knew which was which—what was
bad information and what was the beauty of real inherited knowledge. One piece of
old girl’s wisdom in the same vein did
turn out to be true however and it always struck me. Early in my career a veteran RN told me that
to de-clot a feeding tube use Coca Cola. Pepsi wouldn’t do, nor would Mountain
Dew, not Sprite nor Big Red. It has to be real Coca Cola, used in the feeding tube the way the Genentech clot-buster was used on the blocked central
line. Tried the Coca-Cola trick on a dozen or so occasions, in clotted-off stomach tubes, adults and kids, in hospitals over
the years, and it worked every time, yeah. Made you wonder what it was doing to
your stomach.
Mary wrote to me that despite my complaint of retaliation the School of
Nursing had decided not to wait for the results of Mr. Adams' investigation. “We’re
proceeding with communication,” she said, which meant they didn’t like my way of
communicating with faculty and were failing me for that. My response
was that it wasn’t an a la carte menu—they couldn’t decide to fail me and
search for a reason to suit that end. Meanwhile, responding to my email request for a record of Andrea's training, Associate Dean Zina Mirsky, the military nurse who’d
been in the meeting the year before with Dean Dracup, and did not much approve of black men, especially not black warriors like me, replied that Andrea had been properly-trained,
period, and suggesting that my best response was to accept failure and move
forward. Everybody wanted me to move forward. You make a request like that you're not really expecting an answer but you want to have asked, you feel me? A second meeting with the powers-that-be was looming.
So far, there’d already been a trek to
meet the diversity guru Michael Adams and his investigator, a woman named DeSouza
who listened gravely and took notes and would do the actual due diligence. The
timing of retaliation is critical and my timing was perfect, despite White
Coat’s claim. Having raised an issue in clinic and told Dr. Thyne of my plan to
approach her superiors—next stop a failing grade. Adams’ job included
both promoting diversity and investigating claims like mine. That morning,
still looking dapper, he wrote out the timeline on the blackboard in his office and then turned to face me, smiling like a child who has correctly done a math problem.
“Like this?” he asked, like it was a game.
There was no chance he or Ms. DeSouza were going to rule in my favor but
knowing that beforehand made it easier to go to see him. It was
just something that had to be done. You had to check all the boxes. In the meantime my classwork was becoming easier for the simple reason that there was more time to study. Karen was the instructor
for something forgettable, which included her prompting to exercise
political power as nurses in regards healthcare and humanism. My present
exercise in civic engagement was not
what she meant, however, and she shot one or two dirty looks at me in the course of the
quarter, my maturity was still lacking. This is one of the principal reasons, it seemed to me,
women get mad at men, whether husbands or boyfriends. Women don’t tilt at
windmills as much and they get impatient with guys who do. You feel me?
This was pretty cool: One of the guest lecturers in Karen’s class was another
professor on the purely academic side who, unlike Karen, was a researcher not a clinician. The lady’s name was Rehm and she came
in and started her rap and touched on something regarding race and one of the
other black students ripped Professor Rehm a new one, before my very eyes, which was kind of cool to watch as a proud black man. The young sister used a scalpel, not to repeat myself. There was absolutely no involvement on my part beforehand, in case you're wondering. Actually her comment caught me by surprise like everyone else. There was a lot of talk about race and diversity in the School of Nursing but it mostly
took the form of tea party chatter, no one really challenged the status quo, in
healthcare or on campus, in part because women don’t tilt at windmills, you could say, you
come to nursing school to get a degree not to challenge what's being done in
the hospital or how it's being taught. Until that point. The good Professor Rehm looked
uncomfortable like she had wandered into a minefield which she had and needed
rescuing.There was only one gentleman in the room, it seemed. My hand shot up
in an effort to get Professor Rehm where she needed to go. But my contribution
wasn’t what she had in mind. “I agree totally,” speaking of my classmate, not Dr. Rehm, and proceeding to take off a little more of the white lady professor's skin. It was one episode of ganging up that, unlike my most recent experiences, felt really good.
The sister who started the conversation came up to me after class. She was an ICU nurse from Stanford Children's and was kind of hot. Not that that's important here. “Thanks for having my back,” she told me.
“It was a pleasure.”
And it was.
My other classes included adolescent development and among our
assignments was to do an in-depth interview with a teenager, none of whom were
of my acquaintance in the Bay Area. Studying at the library in Hunter’s Point
one afternoon, lo and behold there was a 15-year-old black girl who accepted
$20 to pour out her soul to me, both teenaged angst and her dreams, which seemed like quite a good deal.
When the interview was over she tried to hit me up for more money. Paying her was against the rules but my belief is that it’s counterproductive
in a society where black people were once slaves to ask any of us to do
anything for free.
The instructor in the class was another pediatrics
researcher, by the way, named Kools, another white woman who was actually supposed to be the School of
Nursing’s academic expert on race relations and diversity, writ large. She was
noticeably distant in her encounters with me—that was unexpected, because of her in-class protestations of empathy with the colored peoples of the earth. Much later it would become clear why. Meanwhile, my second meeting with faculty finally took place one evening, at 6
p.m., the only hour everyone’s schedules permitted. The halls of the School of Nursing were empty. An honored guest would be joining us. To my surprise there was
also a doorkeeper. A big white guy sitting at the front desk of the Department of Family
Health Care Nursing, outside our meeting room, he was someone’s assistant, although not familiar to me, and the explanation was that he just happened to be there, not having finished one task or
another during the day. The others in attendance were Mary, Naomi and Dr. Rankin: me and Grunhilda meeting for the first time, by the way. Heading back together the conference room Dr. Rankin made a point of leaving the door open with the white
guy still out front, in earshot.
Something in Dr. Rankin’s manner made it clear that the open door was not coincidence. Actually it didn't even bother me if he heard, but curiously, a couple of days before, using free time
to hit the weight room, walking
to the gym across from Cole Hall, a sixth sense told me to look back over
my shoulder, where three UC cops in uniform were trailing a few steps behind.
This was so not mere paranoia. A white woman with two stripes on her arm and
two guys—this was so not my imagination.
They followed me into the gym where one of the officers took a post at the door
and the two others stood over me during part of my routine. It must have
looked a little strange but my presumption at the time was that the cops had
simply mistaken me for someone else. That other nigger, you know? Whoever it
was because it wasn’t me.
As my workout progressed my eyes met the female’s,
like she was still expecting something to happen, and when it didn’t she
shrugged and she and her partner left. But the third officer, an bulky Asian guy, followed
me from the gym back to the doors of the library. Only two years later did a release of email reveal that the morning after failing me, Dr. Thyne had asked the university to place a
restraining order against me, profiling me as violent, and asking the pigs to keep me off the grounds of General Hospital. Dean Dracup described me in an email as a physically-threatening presence in the School of Nursing. Nan and Andrea joined in after the fact, not that there's anything wrong with that, first calling me rude, but then describing me, to investigators, as a “threatening” presence in
clinic. Someone had talked to UCPD. At the meeting in the SON, not knowing
any of these details my feeling was nonetheless that the deans were trying to
portray me as a thug, that's why the guy outside was there, part of an effort to undermine my credibility. These ladies, you couldn't underestimate them.
My request that the door to the room be closed was met by Dr. Rankin’s
objection.
“I’m not asking you,” was my next comment, polite but firm. “In a discussion of my academic progress the law
requires you to provide me privacy. Close the door.”
Dr. Rankin gathered her shawl around her shoulders and got up and looked at me again
with this expression on her face that you half-expected her to say, like the
white matron she was, “Well, I never!” She and Dean Mirsky were the same
generation. Their reaction to black men in the profession was much the same: Who let them in?
She shut the door and sat back down, but it had given me a chance to check Sally Rankin out more closely. The department chair was pale, not that there's anything wrong with that, with reddish hair, if that was her natural
color, not to be bitchy or anything, and was completely lacking in any discernible charm of manner or appearance.
She did however have what looked like a new, smart haircut, which at a prior point in my career might have led me to compliment her, as an icebreaker.
Those days were over, forever, dead. KIA, you feel me, in the fighting on Mount Parnassus. Mary slid a piece of paper across the table to me, yet another evaluation, also by Andrea, still failing me but without some of the more objectionable
details from the first time around. Then Mary said something that left me in shock. If we could find “a
way forward,” she told me, she would make sure my final rotation in the
program—my capstone as a nurse practitioner student—would take place in the
cardiac ICU at Lucile Packard Children’s Hospital at Stanford University, where
Carina was completing her clinicals. “I know that’s what interests you,” she
said as if we were BFF. Going forward meant, as it turned out, signing that behavior contract.
She pointed at the paperwork. Tapped it with that well-varnished and practical fingernail.
“Judy Martin-Holland says this is the way it should be.”
My voice returned. “Then Judy Martin-Holland can sign it. I’m not
signing anything, Mary.”
To quote President Kennedy, speaking of the Cuban Missile Crisis and the
face-off against the dastardly Soviet Union, the other guy just blinked. The nursing
school wanted this over.
My guess was they had instructions from above, the Chancellor's Office. Mary’s proposal could be
viewed as just a preliminary offer, one that they might not really expect me
to accept. There was some desultory talk after that while the ladies waited
for me to show sign of compromise, which was not forthcoming.
At our first
meeting weeks before my offer was that everyone just call it a day, they wound return
me to clinicals at General Hospital and my retaliation complaint would be forgotten. We would
return to the status quo, in other words. They were waiting now to hear that gain but it was sadly no longer on the table. They had shamed me in front of
my fellow students, which really pissed me off, as the only one to be pulled from clinical practice. To the
black man—honor is everything, like, black pride, you dig? The university police were
following me on campus and although the connection had not been explicitly
made in my mind, there was institutional evil afoot. Mostly, what they failed to realize, having a policeman standing behind you was not known to make African-Americans more accommodating to white demands. These ladies were racists—and sexists—and they could kiss my black ass, not to be crude or anything.
“All right,” Dr. Rankin said, having waited long enough. She pressed her
hands flat on the table. “You’ll have to go to summer school and make up your
clinical time there.” The failure was still in effect. “Karen,” Naomi chimed
in, hoping to make that more palatable, “has offered to precept you this
summer.”
That was like having Lucrezia Borgia offer you tea. You don't know whether to swallow or spit.
It meant Karen was playing an active part, which was not really a surprise but still disappointing. We had wiped baby butts together and not a little drool. There was a connection. Later releases of documents showed that
when Nan and Andrea decided to fail me they went first to Karen, as the senior
nursing faculty in the Children's Health Center, and asked her permission and
she gave it—without ever speaking with me and without ever asking me what had
happened. After failing me, now she was offering to be my preceptor in the
summer, in that extra quarter. Karen continued to have an agenda for my
future that she had not discussed with me but in any case the damage was already done. Even if the
ladies changed their minds next week, the quarter was too far advanced. There
was no time for me to make up my clinical hours which meant summer school would be
necessary, regardless, another $10,000 out of my pocket. No way that was going to happen.
Already, for a variety of reasons, an inner voice was telling me my studies at the University of California were finished. There was very little compromise in me at that point, frankly, and absolutely none thereafter. Then came my
best moment at the university, actually, that evening with the three witches of the SON.
Looked at each one of them in turn and uttered a beautiful line, completely spontaneous and totally appropriate.
“I will never even say the word diversity again. But I will finish this.”
The black man had spoken. Not as a victim. It was fun to watch the reactions of the women around the table.
To my left, Mary was too unaware to know what it might mean. She still did not
believe she had done anything wrong, or she still saw a way out, a way to move
forward if you will, even if her superiors were becoming anxious. On my right, Dr.
Rankin was no longer showing any emotion at all. Of all the faculty who took part in
this academic lynching she was the one who most resembled an Old South racist,
a woman who would have thought nothing of cheering on a mob of white men,
except in this case it was white women. Indeed Sally Rankin resembled the female version of a stereotypical small-town Southern sheriff: bigoted, self-righteous and dumb. It had never occurred to either of these women, who spent a good part of their day musing over the fate of minorities living in majority cultures, and how it impacted their health, that they themselves were prejudiced and hurtful. Excuse me but that's the first rule of cultural humility. It's nursing dogma. Even Karen who was a very well-educated and thoughtful woman was clueless. She was a cracker. Karen was as much of a cracker as Dr. Rankin and that's saying a lot. Only Naomi was different. As a Jew she
knew the possible outcome of any confrontation over race or ethnicity in America, in San Francisco or anywhere else. She
wasn’t looking very happy about the prospects or how things had already turned out. Despite her protestations to me, she was
now on the side of the fascists.
If someone had been looking in my
eyes, they would have seen a kind of calm, thank you very much. The black man was focused, too, like his noble ancestors were when they hunted on the savannah.
All along, from my first day on campus, the SON had expected me to act like a 25-year-old white woman
who bends to the will of older and wiser women. But men and especially black
men are not like that. That’s the point of diversity, actually. Other people
may not behave or think as you do. Diversity does not mean
different colors and different kinds of people who all still think alike—that’s the fundamental error of workplace
training and the mistake liberal Caucasians most often make. They believe that
diversity means people of different races or different sexual persuasions or
different whatever who still behave as white heterosexuals do. As a
general rule—and this is not said as bragging, but as our reality, black men
are not afraid of confrontation. It’s a fact of our lives. The women present
that evening in the School of Nursing, as we had our polite smackdown, were just beginning to understand that. And it was a harder lesson
for Dr. Rankin and the ladies of the School of Nursing than anything about they were
teaching me.
As the quarter wound down there were two more episodes with the police.
Looking up from my meal in the cafeteria one afternoon two officers were standing
over me, one of them the white female who had followed me to the gym. Best to be direct, that's my mantra.
“What can I do for you, Officer?”
She didn’t answer. The second pig was not one of the ones from before
and he seemed slightly disconcerted—as if he didn’t know what he was doing
watching me eat lunch. They both stared for a moment longer and then walked
away. A similar scene a few days later in the library: if this was meant to be
intimidation, it was a poor substitute for Texas. These cops were not there on their own
initiative, however, that seemed clear. As a general rule pigs aren’t that
creative. These particular ones were following someone’s orders to make the campus an uncomfortable
environment for a Negro. Undeterred, my trajectory continued toward the
end of Spring Quarter. The black man has style, one likes to think, if the ship is sinking, you'll find me at the bar.
There were more free classes and in-services including one at San
Francisco General on online methods foe searching healthcare databases. That one was held in a small building detached from the main hospital so there was no reason for me to set foot
in General Hospital proper, which would not be a good place to be.
We also had skills
instruction on campus—suturing—this time chicken breasts instead of the
chicken legs used for osseous line placement in Pediatric Advanced Life
Support. Sewing chicken flesh was relatively easy and super-gross, that was my feeling as a vegetarian.
Intubation was difficult for me because the stiff plastic of the mannequins was
harder to manipulate than a real child’s airway. There was a lab for staining
slides. And Mary Mac was with us, for the first time, for a late-term seminar on palliative care. When it
came time to discuss the things that might be on the minds of parents whose child is in the hospital, my response
was cost of illness, and Mary shook her head. “Why always so negative?” she
asked. If she couldn’t understand that the cost of health care might be worrisome, well, it wasn’t clear how to explain it to her. The prior year, still working at Children’s, the price of a bed for the night—before the charge for nursing
care, or medications, or the doctors’ services, just the bed—was $6,000. One
night. You would probably worry about that as a parent in a hospital room, it
seemed to me, in addition to your child’s illness. Mary didn’t think so.
Q sent me an email that she had been interviewed by the Office of Diversity
investigator Ms. DeSouza and was under a lot of pressure, she said, but she had
remained faithful to me and told the truth, she said. Interestingly the day after my
failure the women of the clinic had come to her and offered sympathy, she said,
as if something had happened to her not me. My grades for the quarter were all A’s but it seemed likely that Naomi had adjusted one of my assignments upward, the thinking being that having done well in class my decision to slug it
out would be revisited. Mostly, in times of trial, you have to keep busy. My spare hours were now
devoted to learning more about the School of Nursing than would otherwise have
been the case. Even attended a public interview for the SON’s associate
diversity officer, the two candidates being a Latina and a black woman, and although
it would have never occurred to me to go to diversity tryouts in any other
circumstances, watching these women was informative. The Latina was better-trained and better-educated, but the sister was a friend of Dean Judy’s
and got the job. In the very last week of the quarter there was another
in-service, you could call it, on stress, in one of the big lecture halls, and
present were instructors as well as students. Stress reduction? That sounded even more useful than library search methods.
Across the hall on the opposite side of the aisle from me were Professors
Kools and Kennedy, both from my department, covering families & children. Dr. Kennedy had taught us child psychology the previous quarter. Her favorite expression in class was “drill down,” as a synonym for research. Like Dr. Thyne she was a Brown
graduate—so many UCSF faculty had started in the Ivy League but come to the
West Coast. Like Berkeley, the University of Virginia and Penn, UCSF is
state-funded but considered Ivy League or ivy leaguish.
In that vein, Dr.
Kennedy had regaled our class with tales of the horses she kept at a stable
outside town. On my term paper the prior quarter she gave me a mediocre grade, not that that’s
important here, and wrote, “This seems a little light.” But when it came time
to do her evaluation, knowing that we were likely to be
critical of a course that was also a little light, she told us, “Now, be kind!” Eventually both Professors Kennedy and Kools would leave for the University of Virginia, to join their friend
Dorrie Fontaine—Kennedy, incredibly, as associate dean of academic affairs, the
number two, and Kools’ as the University of Virginia School of Nursing’s diversity
guru. That explained their attitude towards me in class, someone they hardly knew, apparently Dorrie Fontaine had put in a
bad word for me. This was an aspect of the girls system: Once you got in trouble with one,
word spread, and women who had no personal reason for animus showed animus too. It was a herd defense. That was also the system on hospital units, or that was my experience. Once you had a dispute
with one woman her friends were likely to become adversaries as well. Guys, it
seemed to me, picked our enemies less by word of mouth. Not a better system,
necessarily—just different. As a male in nursing you just had to accept the way women bond and defend themselves as the facts on the ground.
In the in-service on stress Professor Kennedy kept her attention glued to
the front of the lecture hall despite a few non-diverse looks on my
part—couldn’t help myself, really, she’d been such a douche in class. Kools on the
other hand shot me a few longing glances, like, “Isn’t it time for us to come together?” That was a common theme in my last weeks on Mount Parnassus, me having gone from pariah to someone whom the ladies
wanted to show was welcome after all. The open-mindedness of nursing, nonetheless, appeared much overstated to me after a decade in the profession. There was an
orthodoxy of thought and of expression that as a male or a minority you challenged only at great risk.
In Kools’ class on adolescent development there’d been a transgender student, who had started life as a guy in Colombia. No one talked to her. But we sat
together and bonded as the two outsiders, while others stayed away.
In the stress presentation one of the other pediatric faculty, a bitch named Angel, actually, arrived late accompanied
by her school-age kids. There were open seats just to my left and Angel
made a big show of sending her kids to sit next to the big bad Negro, as if to
show—like Professor Kools—that it was time to come together and that we all had
kids in common. Which was true. But my feeling at that point was, kind of, fuck that. You feel me? Angel was part of my faculty from the
start of the program and she had been unpleasant even before what happened at General
Hospital. And one of my friends among the students was a mainland Chinese girl whose
life, Angel—being from Taiwan—was allegedly trying to make hell.
Much of the same thing that had happened to me happened to the young woman from
the People’s Republic on the apparent basis that her English was poor, “communication”
once again as a reason for failure. It’s unclear if that was true but
it was certainly possible, the SON’s
unsupervised structure and clublike atmosphere allowed instructors' antipathy free rein, because so
many of the evaluations were subjective. Women used power, just
as men do, to suit their own ends. Surprise. The idea that we would come together now, during the in-service on stress, and
sing harmony, was misplaced. That would have been a Hollywood ending. We were
actually a couple of hundred miles north of Tinseltown, in Baghdad by the Bay.
At home, in the ‘hood, after the last day of class there was a telephone
message waiting for me. It was from Ms. DeSouza, the investigator for the
Office of Affirmative Action, Equal Opportunity and Diversity.
It was now two months after my complaint had been made. She had
resisted my requests that she work quickly in order to arrive at her
conclusions in time—theoretically—to clear me to
continue my clinical studies. Instead she was calling on the Friday of the last
week of class.
“We were unable,” she said in the
telephone message, “to corroborate your complaint of retaliation.” She added,
“If you would like someone to talk to, please call me,” as if she were there
for counseling. That would be a no, thank you. My need to talk would be
satisfied at the next meeting of the University of California Board of Regents. The black man had a plan.
CHAPTER FIFTEEN
Controlling a meeting’s agenda is the same as controlling the meeting.
Asking to address the Regents you couldn’t tell the Secretary of the
Board that you wanted to rag the university on race and retaliation, because
you wouldn’t be allowed to speak. Luckily there was a lot of noise and
dissatisfaction at that point in the University of California’s history. The Board’s assumption must have been that mine would just be one more
voice of the mob.
It wasn’t only UC by the way, the State of California was in freefall as
the Great Recession took its toll from San Diego to the High Sierras.
Everywhere people were bitching about taxes, entitlements, pensions and jobs. At UC the complaints were high tuition, high administration
salaries, low transparency and a shrinking contribution from Sacramento.
Exactly the environment to lob a few inconvenient facts about race at the Board of Regents. Every speaker—the Board secretary informed me by email—would get two
minutes. In that short time you had to make it good because you wouldn’t get
another shot. Going to Mission Bay my target audience would be the Regents but
also President Mark Yudof who was a voting member of the Board too. We actually ran into each other that morning at the site of the meeting, in Genentech Hall.
The meeting was at UCSF’s Mission Bay campus in the
aforementioned Genentech Hall named after the company that made the clot-buster
and was founded by a UCSF scientist but, as the meeting began, had just been sold
to the Swiss pharmaceutical giant Roche, for billions. That's some necessary background. Everywhere you went on
campus you heard the name Genentech because many of the scientists employed by
the university had second gigs at Big Pharma or vice versa. What first struck me outside the Board's meeting room was a series of huge sculptures in the lobby, done in
wood by a German artist and that were basically four big white people—like,
really big, standing over me. It was an amazingly tone-deaf display that needed a paint-over, you feel me? What was also impressive that day
was security. UCPD was everywhere, mostly white guys in ill-fitting suits—that
was how President Yudof passed my way, in fact, arriving for the meeting with
two undercover cops, one on either side but back a tad, not like he was being escorted but like he was being followed in, these two pigs might as
well have been wearing uniforms and carrying billy clubs, Tasers and all. As we
passed each other Yudof looked at me in recognition. We had had a few
bureaucratic run-ins in Texas, the last time when he was leader of UT System,
the same role he was now playing in Oakland. To my memory we had never been
introduced. He knew me—because his displeasure had been made known to me
previously by his assistants in Austin.
We were now both in the Bay Area and although he may have felt pursued
when he heard my name called as a speaker, my arrival at the University of
California preceded his own, thank you very much. There was no embarrassment on
my part either, no discomfiture at all, really, Yudof had been called out in
River City for facilitating corruption at the University of Texas, something that was in my job
description at the time—calling public officials out for conflict of interest—his
problem not mine. Or so it seemed. Our acquaintanceship, you could call it, went back thirty years to a time when he was at the UT Law School. Our paths had almost crossed in Minneapolis as well, him leaving his post as president of the University of Minneapolis and me arriving as a staff nurse on the pediatrics unit of Hennepin County Medical Center. Interesting that in Austin, in my circle at
least, Yudof’s reputation would have been more as a thug than a racist.
The University of Texas System is the richest public institution in the state,
with tens of billions in oil & gas holdings—and for politicians to tap even
a tiny percentage of that wealth requires the acquiescence of UT
administration, which meant Mark Yudof at the time. He’d been moderately
obliging: Yudof was only worse than what came before, and what followed,
because he was smarter than his predecessor or his successor. In
Oakland now, on the subject of race and identity—encouraged by the Board of
Regents—he was about to spread his wings into a different realm of wrongdoing.
My number on the speaker’s list was down a ways and with time to kill,
looking around for something to do—why not a phone call, to make pleasant use
of the long wait?
To my mother, actually.
In a week she would have her ninety-third birthday and her voice
resounded weakly in the lobby where giant white people stood. She sounded
alert but frail—nonetheless, good to hear. We had the same discussion most
black people were having those days, not about our own family or about
finances—if you were in California, as both of us were, watching the Golden
State lose its glow. But about Michele and Barack Obama, actually, especially Michele. The
Obamas were, like, half the conversation, as if they were part of our family.
It would be trite to say that my mother, who was born in Galveston during World
War I, with antecedents who included a rabbi and a slave—and who in her long life had survived the
depths of Jim Crow, as well as the heights of the civil rights struggle in the
Old South—could now rest easy that a black man was in the White House. Not
likely. That was a white narrative,
or the kind of thing black folk tell white people to make them feel better and
that whites repeat with gusto. But it’s a little too neat and Mother was never that
sanguine about the Caucasian race, although she was certainly proud enough of
Barack and especially of Michelle. During our talk my intention was not to
mention my situation at UC, although being a mother she knew something was going
on and it wasn’t good. She told me to contact Senator Feinstein, whatever the problem was, and to use my mother's name.
Mother always claimed to have been the only reporter to show up at the
press conference, back in the day, when young lawyer Dianne Feinstein announced
her first run for the San Francisco Board of Supervisors. Impossible to know if that was
true, my mother’s powers of recollection were variable even before old age, and
even if correct there was no way to explain to her now that the young dewey-eyed
political aspirant she’d known in the City back in the day was a completely
different woman after decades in Washington as United States Senator. Anyway, during our conversation,
with no prompting from me, Mother also suggested getting in contact with
Attorney General Jerry Brown whom she also claimed connections to—having worked
to get his father elected governor. Neither of these suggestions was useful. At
least if White Coat was to be believed: black was now the wrong color at the OCR. But that’s what mothers do, they give advice that
their children don’t take, no matter how well-meaning. My time as speaker was
coming up. The call ended with us promising to get together soon. It was the last time we spoke.
My mother always called the California system of public higher education “Cal”
whatever the campus. She had paid enough tuition to the state over the years to
have that right. Not all of us had attended Cal, the original
behemoth, Berkeley. In order, the six kids in my family had a history in the
system, so to speak—kind of like having a history in the criminal justice
system—suddenly, that was my way to see it, at Mission Bay that morning preparing to speak. My oldest sister was the smartest of us all but had the least formal
education: She had started work as a messenger at the Oakland newspaper and
eventually, with my mother’s help, networking or nepotism depending on your
point of view, Michelle became the film critic at one of the S.F. dailies. She attended San
Francisco State sporadically over the years without ever getting a degree. In
those turbulent Sixties and early Seventies, Michelle used to have a favorite
T-shirt, completely white with black letters across the front that read, “Rated
X by an All-White Jury,” a message that was completely undecipherable until, sitting there waiting to approach the microphone and address the Regents,
an epiphany took place and the T-shirt suddenly made complete sense to me.
My oldest male sibling stayed in the South during one of our
excursions for Mother’s work and graduated Morehouse College and then Columbia University,
training as an English professor and eventually serving as president of a
historically-black college. My next two sisters Melanie and Mia both went to
Berkeley during “the troubles,” the People’s Park protests and beyond—the War
in Vietnam—when race tensions, radicalism and bank robberies were the norm
in the Bay Area. Mia and Melanie got A’s just showing up for class, which
they always did, like me, not to repeat myself, their professors were thrilled that anyone braved tear gas and
police batons to come to hear them speak. Melanie graduated from Berkeley, God
knows she was not the best student, and went to L.A. for law school, while Mia
transferred to the private liberal arts Mills College to finish her bachelor’s degree
and went to UCLA for a master’s. We were all UC products, one way or another.
Mark, my next oldest sibling, dropped out of Harvard. He was the least adept of the six of us and it wasn’t such a surprise that he
left Harvard but that he was ever accepted in the first place. Arriving in
Cambridge as the best student from his high school, and a master of rote learning,
he discovered that every other student at Harvard was pretty good in high
school too. His grades were bad enough in Cambridge that he could not get into Cal, try as he might. The last child, me—well, our family already having an account with the state,
so to speak—and with acceptances to USC and UCLA in hand, UC became my destiny
too, the L.A. version.
We all knew a good deal about UC even when we were kids in high school,
looking ahead to higher education. We were the first generation of my mother’s
family to finish college, if that means anything. After leaving San Francisco,
during a conservative phase brought on by the chaos she’d seen in the Bay Area,
Mother was even appointed by Governor Reagan to a commission to reform the
state’s system of higher ed. UC was in our pool of knowledge, in other words. This familial history is mentioned for a reason. We knew the University
of California long before my arrival at Genentech Hall to address the Regents.
At UCLA as a freshman, back in the day—they ushered me into a composition class
called Subject A, composed of mostly minority students, on the
assumption that black kids could not write white English. At UCSF they
were about to usher me out the gate. It was the same University of
California, still racially clueless, only the real estate was different.
That day at Genentech Hall if anyone had asked me the source of UC’s
ills my response would have been a lack of openness. Blue and gold may be UC’s
official colors but opaque is its favorite shade. UCOP was especially behind the times: it was only
during my graduate schooling in San Francisco that, after numerous complaints
from the public, the Regents finally allowed recordings of their meetings. This
was like the second decade of the 21st Century, mind you: totally
behind the times—totally non-transparent—totally UC.
The Regents still decided what parts of their
proceedings were open to the public and routinely held a non-controversial
version of a committee meeting, for public consumption, before going into
executive session when people spoke freely, to have the same hearing a second
time. There are therefore two official versions of the truth at the University
of California—whatever is done for public consumption, especially the students,
and what is decided in private afterwards. Which is why this was the best
way for me to approach the Regents, in an open session that was not dependent
upon UC’s version of transparency. Again, everybody got two minutes.
Immediately preceeding my turn at the microphone the speaker was a respiratory
therapist who worked on Mount Parnassus, still wearing her scrubs from the night shift. She represented the union of healthcare
workers in UC hospitals. She seemed familiar but may have worked
adultside in the medical center, and there in the World of Adults the staff
was mostly unknown to me. She was kind of hot, actually, not that that’s
important here.
The respiratory lady was just one of a string of speakers demanding
no cutbacks on pensions or slashed pay for common employees, as the Regents prepared to
“trim fat,” a belated effort at belt-tightening. Practically the whole period of
public comment was like an extended union meeting, with rhythmic shouting and cat calls. The Regents and President Yudof just sat there,
listening and not looking particularly happy but professional and
polite.
After my remarks there was a muted roar from the crowd—from people who
obviously hadn’t listened to a word that was said and thought my brief
message was an extension of UC employees’ quarrel with their employer. The
presentation took me just under my allotted time and, as it was recorded in the
minutes of the meeting by the Board secretary: “[R.N.], a
nurse practitioner student at UCSF, asked to appeal disciplinary action taken
against him by UCSF. In April, [R.N.] wrote an email complaining about
diversity issues at his clinical site, and was failed in his clinical
assignment the next day. He has appealed unsuccessfully at UCSF, although he
did acknowledge assistance from Chancellor Bishop, who transferred his case to
the Affirmative Action office of UCSF. [R.N.] offered documentation related to
his plea, and asked that someone outside of UCSF investigate the issue.” This was cutting Mike Bishop a
little slack at the end, you may say, and that’s true. He really hadn't done shit. It was purely out of respect for the
Nobel Prize and proto-oncogenes and all.
Someone told me that Dr. Bishop was stepping down and this
would be his last meeting. He served ten years as chancellor and
fucked up pretty dramatically on both race and gender, to say nothing of
ethics—he’d had an especially rough ride recently, it seemed. Call me sentimental but it just didn’t
seem right to rag him on his way to the door, you feel me?
CHAPTER SIXTEEN
Five months passed and there no word from the Regents or the Office of
the President, UCOP as it is called. After inquiring politely of the Board secretary a reply actually came
from diversity chief Michael Adams telling me that the Regents did not “customarily” respond to what they heard during public comment. Oh, okay. If you say so.
“We have consulted with our General Counsel,” the correspondence
secretary in the Office of the Regents eventually informed me, “who advises that
the University does not have a process for appeal of student dismissals to the
Regents.” But that wasn’t the request. My request of the Board was for an
inquiry which the Regents did have the authority to order, or to push the
President to perform, because they were soon calling for investigations of
anti-Semitism on other campuses. My visit to the Board had turned out merely to
be a piece of theater—a necessary act but theater nonetheless. One other step
had to be taken, just in case. As a student, my rights included appeal to
the Academic Senate. You’re building a file, literally, in an administrative appeal. In a
revolt against a powerhouse like the University of California you can win, but
usually only at high cost—Churchill’s famous trinity of blood, sweat and tears, UC's version being ink, smoke and mirrors.
Mostly, win or lose, you have to pay attention to the details and not skip any
steps. Appeal to the Academic Senate was one of those. The School of Nursing did not reply to my request for Academic Senate review. That was the reply in itself. The next step was to file with the Office of Civil
Rights of the U.S. Department of Education, White Coat’s warning that rights of African-Americans were no longer important notwithstanding.
The book about the OCR that the good doctor had referred to was online
and entitled Jewish Identity and Civil
Rights in America by a Baruch College professor named Kenneth Marcus (who,
incidentally, has just been named by President Trump to head the very same U.S. Department of Education's Office of Civil Rights.) The deck did appear stacked as
White Coat had said. “In the education world,” Professor Marcus wrote, “OCR is
more important than either the U.S. Department of Justice or private-party
litigation. DOJ handles few education cases . . . . OCR has jurisdiction over virtually all federal
civil rights cases involving education…. Given the discretionary nature of
DOJ’s jurisdiction in this area and the costs of private-party litigation, a
determination by OCR to decline jurisdiction frequently constitutes a death
sentence for potential civil rights claims.”
It got worse. In the book Professor Marcus described a war for influence
in the San Francisco regional headquarters of the Office of Civil Rights, in Baghdad on the Bay, U.S.A. The
book was practically all about the OCR in S.F.: It seemed there’d been an in-house
bureaucratic struggle in the Region 10 headquarters which had recently been won
by Jews, who felt they themselves or their opinions were not valued in the past
under the formerly black-focused regional command. Marcus’s description of the
new S.F. chief, an ex-Army lawyer named Arthur Zeidman, was also exactly as
White Coat said: “A deeply religious man,” Professor Marcus wrote, “Zeidman is
an adherent to the Lubavitcher school
of ultra-Orthodox Judaism. At the time, Zeidman had just left military service
to accept his appointment to OCR, and he maintained the clean-shaven appearance
that military discipline had required. Only a black kippah and tzitzit (inconspicuous
under a suit jacket) revealed Zeidman’s religious inclinations. Over time
Zeidman would return to the traditional Lubavitcher
appearance, growing his beard out to considerable lengths and donning tallit as a regular part of his business
attire.” That was cool with me, actually, those guys were all over Jerusalem, back in my day, in the Holy Land. Some of the Orthodox chicks were pretty hot, actually, not that
that’s important and not that they were impressed by my urban Negro game. You gotta try, you feel me? In my mind this Col. Zeidman cat would just be like a brother with a big
‘fro in the same position, you know, back in my mother's era on the City Desk here, circa the Sixties. What did
worry me was that Colonel Zeidman would see me as
merely a schwarzer. That’s what White
Coat implied. “You should have made your complaint a year earlier,” he told me, buying me coffee one afternoon, assuming that money was a
problem, which it soon would be, “when blacks were still in charge.” A funny guy.
He was funny and smart and he knew the University of California, in all of its
incarnations. Meanwhile the ladies at the School of Nursing were busy! You
just couldn’t keep those women down. They removed me as a student for failing
to register for the fall even though the School’s bylaws dictated that a student in good
standing, a category that included me—you had to fail two clinical placements to be in any real shit—could not be withdrawn
without the student’s consent. They were trying to get rid of me permanently, not that there's anything wrong with that. Three months
after my appearance before the Regents the School of Nursing’s bylaws were changed to allow automatic withdrawal for failure to register. That same afternoon
the plug was pulled on my studies. The black man had been lynched yet again.
Following are two email messages that the university only released years after the fact and that explain some of what was going on behind the
scenes, and in Mary Mac’s mind. The first is from a SON staffer who worked with the
university registrar and the second is from Mary herself, my program leader. “I
was just informed by Mary McCulley, advisor to [R.N.] that he will NEVER be
returning to UCSF.” Mary, who was cc’d in that email, was not my advisor, Naomi
was, actually, they had passed me off after my year abroad, remember, but not passed me back yet again. So, Mary had misrepresented herself, not that there's anything wrong with that. This was the old girls' mob at work. And correspondence from Mary Mac to Karen G., and to the deans, the faculty's strong suit was not telling the truth. For instance Mary response to the
Registrar lady a few hours later: “Oh dear, I didn’t say ‘never,’” she wrote.
“I just said he had withdrawn last spring and would not be returning. I had
assumed all of this was taken care of last spring. This is a very sensitive
issue and we need to be careful of emails.” Does the black man have to say more? Those people! Anglos are just so dishonest, not at all noble in spirit like the black man. That is my sad conclusion. Mary was right about the need to be careful with email, including the one she’d
just written. Somehow still none of it fazed me. UC is a huge, rich
organization, with lots of lawyers who are well-schooled in playing hardball
and in delay-of-game but as long as you didn’t try to attack head-on and
instead applied pressure where the beast was weakest, the knees would be my analogy on a human being, or most sensitive like the monster's balls, you
had a chance. It was like judo, the University of California’s very size could
be used against it, or that was my theory at the time, not knowing anything about judo. With that strategy in mind it was time for a second complaint
to the Office of Affirmative Action, Equal Opportunity and Diversity—made in
the winter after my dismissal, just as the Regents were telling me, basically, to
fuck off. So far things were kind of happening according to plan. This was just going to take time.
Officially UCSF was now under new management. The university had been sold metaphorically-speaking if not in fact to Roche Pharmaceuticals by President Yudof and the cash-strapped Board of Regents.
The incoming chancellor was Susan Desmond-Hellmann, a cancer specialist who was leaving Genentech, headquartered in South San Francisco, where she was in charge of product development. Like Dr.
Thyne she was a former chief resident at UCSF and a golden girl who everybody
called Sue: A very smart woman and uber-competent was the word on the Parnassus
grapevine. Her number two would be a UCSF researcher named Jeffrey Bluestone—Ph.D not M.D.—a scientist by trade who had worked previously
at the University of Chicago and graduated from Rutgers and Cornell. He was supposed to have been short-listed for a Nobel Prize, not that that's important here, because he turned out to have the ethics of a nematode. Among
Bluestone’s many new titles as Sue’s new right hand were Provost and “Chief
Education Officer,” whatever that meant, and my guess was that whatever it meant that would include me. He responded to an email message right away. For the record, it wasn’t like me setting him
up or anything. He could have done the ethical thing from the beginning, nobody was
stopping him from being honest just because he worked for UC. Freshly-minted Executive Vice Chancellor Bluestone asked me if
my object in contacting him was because of his new position? What did he think,
this was spam?
He said he would look right into it, the matter of my failure and
removal from my studies. At some point in our burgeoning correspondence he began signing his messages “Jeff,” like we were old friends.
Potentially Bluestone was more important to a righteous outcome than Dr. Desmond-Hellmann
herself. Once again White Coat poured cold water on my idea. He said
don’t hold your breath waiting for Jeffrey Bluestone to do
the right thing. Probity and judgement were apparently not on this scientist's resume.
“A solid-gold dick,” he said.
White Coat said that instead of Dr. Bluestone, whom he claimed to know “too well,” rather than relying on the executive vice chancellor, my trust was better placed in the rules of the Academic Senate.
“You have a right to A.S. review. They can’t deny that,” he said. Which turned
out not to be entirely correct, they did deny me A.S. review, twice, but White Coat was absolutely right about
something else he’d said. Suddenly there were job offers coming at me from a
private recruitment agency. UC was reaching out either officially or unofficially, apparently trying the carrot after pretty liberal application of the stick. The
first message invited me to apply for a job as a staff nurse at Oakland Children’s Hospital.
Being as cocky as the next R.N. on the subject of my clinical skills it
nonetheless struck me as strange since Oakland Children’s had never been on my
list of possible employers. San Francisco might have limited charm but it was still more than Oakland. There was no Ocean Beach in the East Bay, either. The offer actually arrived in my personal email at my new home, the Pacific
Northwest. My crib was now in Seattle: started as an agency nurse at Swedish
Hospital, the city’s main non-profit provider, working in adult neurosurgery,
and ended up on nights as regular staff on the neuro floor. Seattle was a natural next stop for me. The city had a big healthcare
scene with plenty of jobs, it was moderately close to the Bay Area and less expensive than San Francisco. Even if adult patients were not my favorite population, bills
had to be paid including, suddenly, school loans. You have to be realistic and whichever way my dispute
with the university turned out, California was, suddenly, just the wrong place to be. Didn’t
respond to the job offer, actually—then, a week or so later there was another invitation, from the same
recruitment agency, this time presenting the opportunity to apply to UCSF’s
Pediatric Intensive Care Unit. The same PICU where the manager had told me they never looked at the online applications. It meant they would look at mine now. Ignored that one too, but understood it for what
it was, throwing a bone my way. The black man is not ungrateful to master, or, in this case, mistress, Miss Anne as we used to say, down South on the plantation. Again, see it from my standpoint as an
African-American male. The university had cost me tens of thousands of dollars
in lost tuition, slandered me about something the Regents and President Yudof knew was not true, denied due process and there was the original insult, so to speak—a lack of diversity
among UC providers caring for the black man's children. UC was the fourth largest healthcare system in the state of
California and eighth in the country. By the way. Not feeling very forgiving about anything at that point and regardless
of what the university might promise—let bygones be bygones for example, take this job as our way of making amends—not
trusting the University of California on any level anymore, my thinking was, no way, motherfucker, that would be a big NFW, as in no fucking way. Men believe in confrontation, that is correct and sometimes wrongheaded,
but women believe in retaliation and that's always wrong. Don't trust them bitches, that's the best advice, that was the first thought that popped into my mind, actually. All it would take, working at UCSF again, would be a charge nurse who thought that the black man was too pushy, or who didn’t like niggers in general or on
the unit, for whatever reason. All it would take would be one bad assignment in
the ICU—three patients instead of two. Or a complaint that my work was substandard. My nursing license would be a thing of the past. This was my livelihood and you don’t fuck with that, you feel me? Finally, a week after the last email, there was an invitation to apply at
UCSF Children’s Cardiac ICU, my dream job. No shit. The message said that if my reply was not received in ten days the offer would be withdrawn.
The women in the School of Nursing probably called this healing. To me, it
was more a potential set-up whether intended to be or not. We had differing world views, you can say that, the ladies in the Dean’s Office and me. But it wasn’t mainly race. It was gender. The black man had found himself on the
front lines of the War Between the Sexes which, last time he looked, men were losing. My dick was hard, metaphorically-speaking, you might say, and my spirit was willing. But you had to be careful, these women were dangerous.
CHAPTER SEVENTEEN
What happened that summer may be distasteful to some people. Some might call my actions “over the top,” or provocative—or even
a betrayal of university ties. Be that as it may. As a Negro fighting for black pride and
an education, in an uprising that began with Brother Malcolm and continued with Dr. King—the goal being to see the mountaintop, even knowing you’d never
get there—extreme measures were called for. What happened therefore has to be viewed through the lens of the struggle against racism in
America, me serving merely as a foot soldier on the higher education front.
Chancellor Desmond-Hellmann was ignoring my correspondence. So was
everyone else. Two weeks after questioning my removal from the SON, the
ubiquitous Ms. De Souza wrote to me, “The complaint has been forwarded to
the School and interviews are being scheduled.” A month later Michael Adams
told me that he would contact me “when Ms. De Souza has something of substance to
report.” Four months later an assistant chancellor informed me that everything
was “under review.” Her name was Deborah Brennan and she’d been Mike Bishop’s
enforcer on campus and apparently was trying out for the same job for Sue, although the
word was that, as a veteran of Big Pharma, Dr. Desmond-Hellmann liked to do her own kneecapping.
In her email Ms. Brennan added that if dissatisfied with the pace of
progress, it was my right to go outside the university which meant, reading
between the lines, that UCSF had already been informed by the Office of Civil
Rights that they were refusing jurisdiction. She wouldn’t have dared me to go
elsewhere unless there was nowhere else to go. Six months had, in fact, passed before my OCR appeal was made because of the delay in hearing from the Regents. It made sense to me—waiting to heard from the Board—but not to Colonel Zeidman, the new head of the Region 10 office, somewhere downtown. He said that six months was too long and my appeal to the OCR was "no longer timely." if my complaint to his office had been earlier he would died by saying the case was "not ripe." Of course Col. Zeidman had the right to waive his self-imposed six-month time limit—his
mandate was very broad—but he chose not to, and instead began interventions on
UC campuses related to anti-Semitism. Not that there's anything wrong with that. Zeidman admitted later in an email
that he had contacted UCSF about me and “did everything that I could,” for me,
without explaining exactly what that was. Like accepting scraps at the back
door you were expected to be grateful for second or third-class treatment.
Later, a Freedom of Information Act request to the Department of Education
revealed dozens of pages of material from the university, related to me, all
carefully-chosen and supporting Andrea Crosby’s view of a threatening Negro,
together with an equal number of pages of redacted material apparently written
by Zeidman himself—none of it from me or defending me. So much for OCR's promise, made to all students, not
to reveal complaints to the university complained against, unless the complaint was accepted for investigation which mine was not. The result was the university knew that OCR had already refused to get involved, refused "jurisdiction" as the book about the OCR explained. For me personally this was a low point in the
struggle, frankly, losing on every front, buffeted by headwinds and pushed back by strong currents. But the defeats only served to give this black
revolutionary a laser focus. And actually there was one victory, early that spring.
Knocked Kathy Dracup out of the game. That was kind of cool. It was like taking down the queen.
The School of Nursing was UC’s baby but also regulated by a D.C.-based, nurse-run
body that is responsible for accreditation, the Continuing Commission on Nursing
Education. The CCNE also had a complaint process. There was no chance of winning in Washington—the
Commission is funded by payments from the nursing schools themselves and you don’t bite the
hand that funds you, or you certainly don’t bite hard. The commission was not going to find fault with this school of nursing, second-ranked in the country. Still, a big envelope winged its way to the East Coast,
mostly containing previous evidence submitted to Michael Adams. The boon to me was not
the ruling made by the commission, which favored the university as expected. CCNE’s
executive director even praised UCSF and told the School of Nursing literally to
continue doing what it had been doing before. Instead, Dean Dracup made a
mistake. It was a forced error, you might call it. She wrote a very detailed
defense of school’s handling of diversity, which left her open for attack.
The Commission sent me a copy.
Dean Dracup met my challenge issue by issue, five in all. Numbers 2, 3 and 4
turned out to be big winners for me. “[R.N.] is misinformed in
terms of having access to an appeal processing involving the Academic Senate,”
she wrote. “The grievance process is not intended to be used in cases in which
a student disputes a grade, and the text describing the Grievance Procedure
clearly states this. Rather, it is intended to be used ‘for resolution of
grievances in academic matters that result in injuries to students’ or in cases
in which a student believes ‘there has been bias or wrongdoing on the part of
faculty.’” Excuse me but wasn’t that the allegation? That the failed grade was discrimination? Don’t racism and
sexism sound like injuries? Retaliation isn’t wrongdoing on the part of
faculty? Really? It got better. In #3, relating to the makeup of the School of Nursing, both students
and instructors, the Dean-of-Deans offered an amazingly tone-deaf response. Remember, this was
2010, not 1965. “We acknowledge that our faculty and instructional staff are
predominantly white women; a characteristic in common with the majority of
schools of nursing in higher education in the US. We have endeavored to recruit
for diversity in students, faculty, and staff in ways that enable us to reflect
the face of California. To this end, we have established mechanisms within our
recruitment efforts at all levels, to keep constant attention to our needs.”
She still had a faculty and student body that was 90% white women. The dean told the commission that she had no data on the race or
gender of former students who had been removed from their studies. My guess was that there were probably very few brothers—only because there were very few black men in the School of Nursing to kick out. But it was fun asking. And if you reduced the sample to those students who had been removed, the majority would be men and minorities, that was my theory. It would have made a great research subject for a learned paper, you feel me? The next paragraph was the zinger. Regarding
California where more than half the population was minority she wrote: “The
fact that we do not fully reflect that face [of California] in our faculty
composition does not mean that we do not include consideration of diverse
populations in our curriculum and our clinical experiences. Each student, over
the course of his/her studies, is placed at numerous clinical agencies and
community practices, among the hundreds with which we contract, representing
multi-cultural populations. In each student’s program of studies, we require
activities and readings to enhance these experiences and ensure that students
are oriented toward provision of culturally competent care for all patient
populations regardless of the student’s particular culture or ethnicity.”
Context was the killer. There was now a black family living in the White
House. As the argument went in the black community—and still seems very
persuasive today—if you can find a competent black person to be President of
the United States you can find people of color to see patients at General Hospital and for every other position at UC, including instructor in the
School of Nursing, on Mount Parnassus.
Barack's election had
not defused the race issue in America, as many whites hoped, instead it lit the
fuse on minority dissatisfaction, not the least in the world of
higher education. “Activities and readings” were no longer good enough and even the UC Regents,
as un-diverse an institution as the Board itself was, had to act. They knew
about Dean Dracup’s letter because they got a copy from me: Copied it,
highlighted important passages using the same yellow marker that had served me so well
in school and mailed same to each Regent—at a home or office address
preferably, when it could be found online, instead of mailing the material to
the Secretary of the Board in Oakland who might place the envelope in the round
file. The documents had the desired effect. A few weeks later the university
announced that Kathy Dracup was stepping down as dean. She herself sent out an email to the SON saying she was "rising up" to faculty, as a professor, turned out to be a good thing she had kept her second office. Her own fancy footwork had
tripped her up and then the black man stepped in and delivered the KO. Not to use violent imagery or anything, she was a great lady but her time was up. The
Regents had no choice but to count her out. She was given a long while to clear out
her desk, even though Sue immediately announced the formation of a search committee for a new dean. The Office of the President also announced a new student Regent who
was—surprise—a Hispanic male nursing student at UCSF. Isn’t it a small world?
No one had yet said they were sorry—that’s literally all it would have
taken—that and a big check. No steps were being taken to return me to my studies, either. In her
letter to the CCNE the dean had however waived the olive branch. It seemed the
SON wanted peace. “Students take leaves of absence for health, family, work, or
other reasons, and then return to successfully complete the degree. This former
student may do the same. He has not been ‘kicked out,’ nor have others who have
withdrawn from the program.” Although this appeared to be a superficial display of healing, Dean
Dracup was still being too clever. What she wasn’t saying was that there was still a
behavior agreement, sans the black man's signature. And who would pay
those tens of thousands of dollars of extra tuition, for a clinical failure
that never happened? Not me, sister. It simply wasn’t going to happen that way. Conflict
continued, which was fine with me. You have to embrace the struggle and come to love it. Time to pick a new target, actually.
Kathy down, what about Sam or Sue? Remember: revenge is just another word for justice.
Choosing a target depends on what ammunition you're using. And to
paraphrase an old dictum from the Civil Rights movement, the revolution will not be
televised. In more modern terms, it can be digitized though. Got most of my ammunition from the UCSF and
UC websites, actually. You could get lost online at the University of California, especially
if you were hunting any of the outsized egos who worked at Parnassus.
There’s a routine or protocol to be followed in making revolution, it seems to
me now, just like baking a cake. This revolt required
a series of email messages and letters to the Regents, keeping up a barrage—but
also a laser focus on one person at a time, one target if you will, in order to remind
the university of my presence and that UC couldn’t just roll over dissent. This
wasn’t my first trip to the rodeo but, critically, it wasn’t the University of California’s
either. There was always a certain level of dissent from the campuses, discontent
from students or faculty, and you had to raise your voice or take someone down
administratively in a big, messy way, if you expected any attention from the Board. UC has one of the most
politically-active student bodies in the world and the Board of Regents was used to all kinds of bitching and moaning and, with all those lawyers, and the Governor at their back, the Regents didn’t pee their pants the first time a student called
them out. UC is also an environment where practically everybody thinks they're
smarter than everyone else. No one gives up easily. That said, my possible
targets narrowed very quickly to two figures, Dean Sam Hawgood of the School of
Medicine and the new chancellor herself, Dr. Susan Desmond-Hellmann, aka SDH, or unofficially Sue. If either one could be taken down the
Regents would have to sit up and notice.
Dean Hawgood was Dr. Thyne’s primary enabler which got him on my list in
the first place. He was the second person contacted by me, that night, drinking Trader Joe's, after my message to Chancellor
Bishop, the night Naomi first informed me of my failure.
Shannon Thyne was under Hawgood's supervision and as Dean of Medicine he was in some
sense responsible for her performance at General Hospital. “I have received and reviewed your
response,” he'd written to me the day after my removal, or that night, actully. My original
plan was to draw as many officials in as possible and see if someone had a
conscience or see if someone made a mistake. Hawgood didn’t have the former and
didn’t make the latter. Or so it seemed from his response. “I am also aware that you have been in contact with the Chancellor’s
Office which has referred the matter to Michael Adams in his role as Director
of the Office of Affirmative Action, Equal Opportunity and Diversity. I believe
that that is the appropriate resource to review the concerns that you have
communicated to me.” My message to him had been probing—to see where Sam Hawgood stood on the issue of race on campus and to see whether there was
any daylight between the members of leadership on Mount Parnassus. Sam Hawgood would
soon be promoting Dr. Thyne to full professor, which would show what he thought of
her performance. Somehow however, at that point frankly, Dr. Hawgood still seemed to be a marginal target.
Unethical but uninteresting too, and hard to get at. That was how he had
prospered at UC through the decades, by being nondescript, the last man
standing as White Coat had said. If you’re going to hold someone responsible,
hmmmm—why not the big guy or big girl herself? In this case the chancellor, Dr. Desmond-Hellmann, Sue for short.
So, this is going to get ugly, not for me but for her. Finding out about Sue, “digging dirt” although that would not be my choice of words, was
easy because she had an outsized ego and loved publicity. Unlike her
predecessor Michael Bishop of Nobel Prize fame who kept a low profile, Sue was on the university’s
website daily and moved outside the university in a circle where she
got a lot of press, as the go-to girl in the science and business of medicine.
Very smart, to repeat, and very competent—she’d been a big earner for Genentech and
was described in many ways but not as shy. Forbes called her one of
the world’s top scientific innovators. She was on the board of the
multinational Proctor and Gamble already, about to be picked by Mark
Zuckerberg (whose wife was a UCSF pediatric resident, by the way, and did rotations at General Hospital) for the board
of Facebook. Her back story was easy to outline because Sue talked a lot about
herself: If you spent any time on the university website you got a general idea
of her career trajectory without even trying. Medical school in Las Vegas, a
very successful residency in oncology in San Francisco followed by two years in
Uganda doing research that she portrayed as—and well may have been—a genuine
effort to help. But which may also have been a first step in another career
trajectory entirely: Big Pharma, making big bucks may already have been on her
radar even in Africa, where the black man's noble ancestors originated.
Upon return to the U.S. she and her husband, also a physician, worked for a time in her
chosen field, in the South, and then she went for the money, first at Bristol
Myers Squibb in New Jersey and later at Genentech in South San Francisco. When she came back to UCSF as chancellor she had just cashed in her Genentech
stocks and received $30 million, per press
reports. Her husband was already independently wealthy. Suddenly, Nicholas Hellmann and Susan Desmond-Hellmann
were a S.F. power couple with most of the influence in Sue’s hands. She was
very powerful but very exposed and her exposure made her vulnerable to attack
which was, frankly, the whole idea. Why? Because she was blocking my appeal. She
knew what had really happened in clinic and was waiting me out. Time to get her
attention.
In Texas back in the day, as part of my effort to understand the rich and
powerful, at least those in governmental posts—there’d been one particularly
useful tool. It was the personal financial disclosure form that individuals appointed
to state boards and commissions and even some high-level bureaucrats and all politicians filled out. Which was public. The statements showed stock ownership and real estate
holdings, loans and bank accounts, and were designed to avoid conflicts of interest
and served well enough in that context, but also had a different role. They
cast a light on the individual’s soul—that was my view, not to get deep and
meaningful or anything. What you own, it seemed to me, was
as good a sign of what kind of person you were as any speech or press release.
Sometimes there was a slip between what a public official was telling the world
about him or herself and what he or she was really like, if only in terms of cash flow.
That turned out to be true of Sue.
My initial request for her financial disclosure form did not appear to
set off any alarms in Oakland, at the Office of the President where the document
was kept. It arrived promptly as an email attachment from a UCOP lawyer named
Smith.
Sorting through page after page was difficult but doable, although it was not as
doable with some of the Regents themselves whose disclosures were also sent to
me upon request. Some of the Regents’ financial resources were even
greater than Sue’s and more complex. A few members of the Board like Senator
Feinstein’s husband were fantastically wealthy, in fact, which is how they got
on the Board in the first place, they represented big money in real estate, or
in Hollywood, or were part of Big Agriculture from California’s central valley:
the growers still surprisingly powerful players in a high-tech world. Big Medicine too. These were powerful people who either gave money to the governor or were needed by him politically. One or two of the Regents’ bundles eclipsed Sue’s considerable wealth, as already mentioned.
Anyway, a flash of a memory from the year before, still in San Francisco at my bar stool and computer, hit me again one morning in Seattle. Leaving the Board meeting at Mission Bay after saying my say—the Regents had moved
on and were discussing a relationship between UC and a biotech company, just
down the block in Mission Bay, UC’s new medical research complex. As the hearing was piped into the Genentech Hall lobby—me headed for
the door after asking for intervention on campus—there’d been the self-satisfied voice, overhead, of one of the Regents, “I invested in that company!” Something like that, something that would have raised eyebrows in Austin but not in San Francisco.
Surprisingly UC’s protections against insiderism were not as strong as those
in Texas, a state that was viewed as backward and corrupt in the sophisticated
Bay Area but actually crossed more t's and dotted more i's than Sacramento or Oakland. As it turned out Sue may not have been investing in companies doing
business with UCSF which is the typical definition of conflict of interest. She was
guilty of something worse than greed: hypocrisy.
Deciding to have a smack-down with Parnassus's leadership was a
serious step and made me hesitate for a moment. The actual decision only turned
out to be easy because Sue's mistake was such a big one. Finishing work that morning in Seattle, bleary-eyed and tired, not being a night-person by choice
or temperament but working nights because that was the job: my routine most
mornings was not to go straight to bed. Not to close my eyes—not
right away at least. Either exercise or reading seemed a better way to ease into rest, rather than collapsing
on a bed, something that didn’t seem, well, healthy. Statistically, nurses who work nights lose five years from their lives. Anyway, that morning it was reading. There
was a mini-Starbucks in the hospital lobby. all of my major life events, by the way,
seemed to be occurring with a blond roast in my hand. On a table in Starbucks there was a discarded New York
Times that had a story mentioning the University of California’s
anti-tobacco stance. Specifically the San Francisco campus was the university's primary research and training center for health care and held a trove of tobacco industry documents that were being mined for nasty details on the cigarette companies. So, digging dirt put me in good company, actually. It’s odd that what was on Sue’s disclosure
form had not struck me right away, originally looking at the form itself, a year earlier, in Baghdad by the Bay. Only on a rainy morning in Seattle, reading the Times and drinking coffee, the gears finally start turning in a foggy brain.
Dug my phone out of my backpack, got the number for the newsroom in New York—and called and asked for the
reporter who had written the tobacco piece. The rest is history. Ratted out Sue and felt pretty good doing it.
The next day the Times guy sent me an email, he said he’d made an
appointment to talk to Sue in person and was on his way to the Left Coast. The
story appeared a day or two later, a little more sympathetic than would have
been my take,
but that was the Times’ call. A
bombshell, nonetheless. This one landed in Sue’s lap.
When Dr. Susan Desmond-Hellmann was named chancellor of
the University of California, San Francisco, last summer, she took over a
medical institution focused on world health generally and tobacco control in
particular.
But she
forgot one thing in adjusting to her new role: personal stock holdings listed
last year in the range of $100,000 to $1 million in Altria, owner of Philip
Morris USA, the maker of Marlboro cigarettes. Altria has been blamed for
thousands of deaths and repeatedly criticized by the Center for Tobacco Control
Research and Education at the university.
Last week, a
day after The New York Times inquired about the Altria stock, Dr. Desmond-Hellmann
and her husband, also a doctor, ordered it to be immediately sold and imposed
''values screening'' on their personal investments.
’I'd been
focused on compliance, dutifully writing down every stock,’ she said in an
interview on Monday, ‘and we didn't focus on what are the stocks in our
holdings and what message does that give to people who care about your values.’
In an
updated filing, she listed the value within the range of $10,000 to $100,000,
but would not explain the reason for the change in amounts.
Dr. Stanton
A. Glantz, director of the university's tobacco control center, said he was
unaware of Dr. Desmond-Hellmann's Altria stock, which was contained in a
university filing but not made public until now, after a public records request
by a former student who passed it on to The Times.
'I do find
that kind of shocking, but at least she got rid of it,’ Dr. Glantz said on
Monday, adding that Dr. Desmond-Hellmann had been very supportive of the
center.
Dr. Kenneth
E. Warner, dean of the school of public health at the University of Michigan
and a national antitobacco leader, said, ‘I find it frankly a bit appalling
that the chancellor of a major medical center would have held such stock. It
strikes me as unthinking, frankly. Tobacco stocks have been divested over
the last two decades by a number of public officials and organizations, like
churches, pension funds and universities -- including the University of
California in 2001.’
Dr.
Desmond-Hellmann made a fortune during 14 years at the biotech company
Genentech. She said she had not been aware that her investment adviser had
bought Altria. Last summer, she said, she noticed the Altria stock while
hand-writing it on a list of 133 stock holdings for a state disclosure report. It
was valued at $100,000 to $1 million. ‘I thought, 'Hmm, I didn't know about
Altria. We should go back and think about that,' she said.
But she said
it slipped her mind. Then on Thursday, a reporter called with questions. ‘'When
this came up, we thought, 'Gee, what are we thinking?' Dr. Desmond-Hellmann said of the resulting
discussion with her husband. ‘I'm an oncologist, he's an AIDS doctor, we're
both physicians, and I'm in charge of a public university. So we both said that
isn't consistent with our values.’
An Altria
spokesman declined to comment.
Dr. Neal L.
Benowitz, a medical professor at the university and a nicotine expert, was
surprised that Dr. Desmond-Hellmann owned the stock. ’I don't think people in
public health should personally hold tobacco stock because it's antithetical to
the public health mission,’ he said.
The
University of California, San Francisco, is the second-largest recipient of
National Institutes of Health funding in the nation, behind Johns Hopkins
University, and it also keeps a database of more than 50 million pages of
tobacco industry files unearthed in litigation and investigation.
Dr.
Desmond-Hellmann has now ordered her investment adviser to screen for holdings
in tobacco, alcohol and firearms.”
The former student was me.
The reporter asked to use my name but crazy is not the same as stupid.
When the chancellor’s disclosure form first arrived in my inbox, the email
and attachment were cc’d to Sue herself and also to the chief campus attorney, a
woman named Canning who was a big player involved in shutting down my appeals.
Ms. Canning and Dr. Desmond-Hellmann knew who the former student was and that
was all that was important, that they knew their stonewalling had a cost. The
whole campus didn’t need to know. What's interesting here, from a psychosocial standpoint, in his heart of hearts the black man
is actually a collaborator, a team player, like Barack, it’s just that
sometimes, as distasteful as it may be, he is forced to make a tough call.
Sometimes, reluctantly, he has to decide to go toe to toe with the white man,
or white woman. This was not one of
those cases. Fingering Sue was easy. She got in the way of my education.
This was a power play and the point was to show her that she wasn’t the only one
with the power to play. Information is power, too, didn’t they tell us that in class?
The Times guy also requested
her disclosure form and it was my even greater pleasure to point out a
discrepancy. On these forms, both the Texas and California versions, the amount of
stock ownership is indicated in broad categories. In the case of Sue’s tobacco
assets she had listed her Altria shares’ value as over $100,000, on the form that came to me, while the form the Times
received, after UC was alerted to press interest, showed less than $100,000. Someone had doctored the paperwork. Overall the
Times guy gave Sue the benefit of the
doubt, she was new to the job, she hadn’t looked closely at what she bought
with the thirty mil she pocketed from her Genentech holdings, yada yada—he
sympathized, and although that might not have been my choice, it was his. But if
you’re going to revolt you may as well go all the way, right? Sent an email to the higher education reporter at the S.F. Chronicle, my mother’s former employer,
to give the local beat person a heads up about the New York story which the Chronicle chick hadn't seen. She wrote a piece ragging
Dr. Desmond-Hellmann for her ownership of junk food stocks like McDonald’s,
too. All in all, a good day's work in healthcare, for this black male RN. In my mind's eye was the image of the black man as noble warrior, alone and armed only with his spear, standing proudly looking out on the savannah where Simba the lion also roamed. You feel me? And if you’re going to make war on the very powerful you shouldn’t try half
measures, right? Shouldn't that be a warrior's mantra? What’s the old saying—you go after the king, or
queen, you better not miss.
You may ask nonetheless what was the point in costing the Chancellor of the University of California San Francisco $134,000? Which was the value of her tobacco stock that she donated to
charity after being embarrassed nationwide by yours truly. How exactly did those thousands, none of which ended up in my pocket,
help my cause? The answer is once again power. Power is the alternative to
powerlessness, to being a victim. If you can bust the balls or ovaries of the person who busted yours, you're ahead of the game. It was payback and that was
sweet too, let’s be honest here, the black man is all too human and has weaknesses too. Mostly it made Sue
fear me—not physical fear—administrative fear which is something different
altogether and much much more effective. This was business,
like they said in The Godfather before taking someone on a long ride with no return. Racism is economic activity
and very often that’s the best way to fight it, hitting white people in their
wallets. My rights were being violated with impunity on a campus that Sue was
running. Fuck her, in other words. And she knew
my rights were being violated. Fuck her again.
Later, White Coat told me that women on campus bitched when the Times story ran—they believed it was an
effort to embarrass the first female chancellor of the University of California San Francisco. That had absolutely nothing to
do with it. You're hearing this from the horse's mouth. It was a consequence for her violation of my civil rights. Nothing
more and nothing less.
Susan Desmond-Hellmann meant nothing more to me than anyone else
stopping me from completing my education. If she had been male the story still
would have appeared. If she’d been black the Times would have still gotten a call. Believe what you will.
CHAPTER EIGHTEEN
In July, six months after Mr. Adams said that he had started the second inquiry, a letter arrived in my mailbox
from Mark Yudof himself. The President of the University of California said the case was still under way.
“I am advised,” President Yudof wrote, “that your complaint regarding a lack of
diversity at UCSF is being investigated according to campus policy by the UCSF
Office of Affirmative Action, Equal Opportunity and Diversity. I am further
advised that the investigation is in process and has not been completed.” Yudof also told me about all the initiatives he and the Regents were undertaking to
increase the number of colored peoples at the University of California’s ten
campuses.
Then, a month after Yudof’s message—six months after Mr. Adams promised to
keep me informed of progress—an email arrived from Executive
Vice Chancellor and so-called Chief Education Officer Jeffrey Bluestone. He said that that my
fears the case had been buried were unfounded—but he promised to look into that
possibility nonetheless. “The UCSF Campus and I take issues such as the one you
raise very seriously and I will look into this matter. I will need to contact a
number of people and given the vacation schedules of several key individuals, I
will not be able to provide you an answer this week or perhaps even next, but I
believe that soon thereafter I will be able to get back to you with a response.
Thank you for bringing this matter to my attention.” Actually, he never got
back to me. Seemed like bullshit then and still seems like bullshit now. My
response to him even at the time was direct and to the point: “I’m not your nigger, Chancellor.” Got a few days off at work and decided to go to San Francisco, a return to the scene of the crime.
On the way south somewhere after leaving Oregon the train stopped in
the middle of nowhere and a voice came over the public address asking if anyone
with medical training was on board. My initial reaction was to let a doctor
handle it. God forbid that it was a woman in labor, or a cardiac event. No adult who has ever received CPR from me has survived, to be honest. That
doesn’t make me a bad nurse, just an unlucky one or more importantly one with unlucky patients.
A few minutes later the same appeal was broadcast again and, contrary to
my best instincts, my feet began a slow shuffle down the aisle. There
was a crowd of railroad uniforms in the restaurant car where a guy on the floor
was in status epilepticus, continuous seizures. That was bad for him, not that
bad in the hierarchy of health emergencies, and certainly better than the prospect of me having to do chest compressions or
deliver his baby. The conductor and stewards were standing around, not knowing
what to do, and identifying myself as a licensed healthcare professional—first,
set about an assessment, as always, that’s the first rule. After that there
wasn’t really much else to do. Back in the day the common intervention might
have been placing something between the victim’s teeth to stop him from biting
his tongue or whatever. No one does that shit anymore. The guy’s heart rate was steady,
although high, the space on the floor was uncluttered, he wouldn’t hurt himself
if he thrashed around a little, there weren’t many more interventions possible
short of hospitalization and some sort of anti-convulsive drip. An ambulance
had been called to meet the train but we were in the middle of nowhere and
there would be a delay. There was snow on the ground out in the middle of Bumfuck County, Oregon, that would be my weather report. The victim’s bag was beside him. Kids who are prone to seizures sometimes carry rectal syringes of Valium
for just these circumstances, maybe adults do too, that was my thinking. There was no medication inside. There was a phone though,
and unlocked, and pressing the most frequently-dialed number turned out to
be his wife who said he was supposed to carry emergency medication but often
forgot. Great.
At this point, maybe five minutes in, a big, round, tired-looking
middle-aged white woman appeared in the doorway. She wore wideload jeans, had arms
like a plumber and a face that had known great stress and great wonder. A labor and delivery nurse replying to the overhead. It took her awhile to get there, she hesitated just like me. She said there wasn’t
much she could do, given her clinical focus, but she asked—humbly—if she could
be of any help?
Another white chick came in the door a second later, mid-30s, kind of
hot, actually, not that that’s important here. She looked at me the black guy
on the ground next to the victim and she looked at the L&D lady who was
the very picture of ill health. The newcomer spread her arms wide like a scene
from Ghostbusters and said, “All
right, step back, I’m a nurse!” Turned out she worked on a med-surg unit in San
Luis Obispo. This is nursing. You can be in the hospital taking care of a patient,
everything is cool and the gang, until another R.N. walks by, automatically assumes she
knows what to do better than you do and starting to tell you how to do your job, especially in pediatrics where it is very often a young white chick with a ponytail doing the
telling. Not that there's anything wrong with that because some of them are pretty hot, actually. Still it's a kind of professional obtrusiveness you don’t see as much
among physicians, but in nursing everybody has an opinion on how to do whatever
task you face, whether you ask or not. It’s like a sexual drive
among nurses, to show yourself more competent than the next guy, especially if the
next guy is a guy. But we digress. The ambulance arrived, and the train eventually departed. In San Francisco, didn’t go anywhere on
campus. What would be the point?
Also, since the University of California police obviously had me on radar, for whatever reason—again, crazy is not the same as dumb. But that
Starbucks at the foot of Parnassus? That became my haunt for three long
days and innumerable sips of coffee, waiting for White Coat to show. The
afternoon of day three he did.
He said he was happy to see me. Did that mean we were friends?
Not really, it was more like sex which is my favorite analogy, actually, the history of White Coat and me, so far, featured brief intense interludes when each of
us had something the other needed. My need was information and to understand the beast, the University of California. His need was to be
heard. To share what he knew. A prior career had taught me about that, the urge
to talk, if you will—to lecture—it’s as strong as procreation of the species. To tell someone how to do something is one aspect, as on the train, or simply to tell a story. People need to tell what they know or think they know. And in the
hospital, nurses are keepers of the narrative, right? That’s kind of what it was
like between me and White Coat, he felt comfortable talking to me. Surprisingly he knew very little of Sue
Desmond-Hellmann or that’s what he said. He didn’t offer an opinion on her
choice of stocks either but it didn’t seem he much disapproved. That was cool,
that was his right, to be outraged or not as he chose. Didn’t tell him that it was me who ratted her out of course, because it wasn’t clear that White Coat would
have approved and he was too valuable now, in my shrinking circle of friends, to piss off. “The chancellor is a
different generation,” he said obliquely, speaking of Sue without explaining what he meant.
His attitude was completely different on the subjects of the medical
school Dean Sam Hawgood and Executive Vice-Chancellor Jeffrey Bluestone who were both potential adversaries of mine. He wanted to dish dirt on both guys, and okay by me. He said
he’d heard that Dean Hawgood and Dr. Thyne, whom he did not know personally, had a “close relationship.” As in fucking? That was my question actually,
without being crude. Like, how close? White Coat didn’t respond and his face
went impassive, completely unrevealing and perhaps disapproving, of them or of
me. But—speaking of Hawgood—he added suddenly, “You know he calls your people
‘abos?’”
“What’s that mean?”
“It’s Australian. Short for aborigines. I think Down Under it means, basically, nigger. I’m not sure about that. Did you know,” he leaned forward, “that they
used to hunt aborigines in Australia?” No and didn’t particularly care in this context. What difference did it make? And how would that knowledge help me climb back up Mount Parnassus? Obviously Sam Hawgood didn’t respect black
people or the staffing would have been different at General Hospital and he would have
defended my right to speak up instead of trying to bury me. How did that knowledge help me in a smackdown with UC? “I don’t think,”
White Coat continued, “that he’s a fan of your peeps.” That kind of made me
laugh. It was much the same phrase that someone had used for Sally Rankin, except
the slang, peeps, that she was not a fan of the black race. Was that the Bay
Area way of saying racist? Now he was
getting my attention.
White Coat warmed up like an old engine. It was really Bluestone he
wanted to talk about. “He’s Jewish,” he said, harping on his favorite theme of
who was Jewish on campus and why they wouldn’t help me. Which was getting old, even if true. Speaking of the
executive vice chancellor though White Coat seemed to have genuine animus. He said that in a relatively short time as number two, Bluestone had decided to route all grants on campus through his office, in
order to give him a “stranglehold on research,” White Coat’s phrase not mine.
Although perfectly willing to believe that Vice Chancellor Bluestone was a
shithead—that was my impression as well—it was hard to see how any of this
helped get me back in class. You feel me?
The financial disclosure forms for Jeffrey Bluestone and Sam Hawgood were in my possession at this point
too, by the way. Dean Hawgood reported nothing interesting—apparently his wife was a low-level
UCSF employee, nothing more than that. He had recently been named in the
local newspaper however as one of a roster of high-ranking UC administrators who were
trying to keep inordinately generous benefits packages at a time when the
university’s finances were in the toilet. That was not surprising. Dr. Bluestone, on the other hand, was
owner of stock in a company whose principal process he was also pursuing in his
UCSF lab, research paid for in part with public dollars. But that was
technically not illegal, not in California. Bluestone hadn’t filled out his
disclosure form until my request to see it, which meant he’d been in violation, but it seemed like small potatoes. By this point there were various documents
spread out over our little table, in the Starbucks on the N-Judah line. Mostly email, and just me and White Coat sitting there, me trying to point out this
or that and get his take on what he read. He didn't appear afraid that Sue
would walk in the door at any minute, either, for her afternoon latte or cup of blood or whatever. Mostly he
seemed bored. At first. Retaliation was just a fact of life at the University of California, he said. He was uninterested
and unimpressed with what he saw in the paperwork—until he reached for one
sheet and raised it to his myopic eyes. “This is what I’m trying to explain to
you,” he said.
It was a copy of the minutes from the prior year’s July 15 meeting of
the Regents, when they’d heard my appeal. He placed it flat
on the table and did the nail tapping thing just like the girls in the SON, this time pointing to the top of the page. Present for the meeting that day had been
twenty members of the Board of Regents, twenty-one with President Yudof who also had a vote. White Coat went
down the list. “Blum, Jewish. Gould, Jewish. Kieffer, Kozberg, Marcus, Nunn
Gorman and Reiss all Jewish.
“Also, Schilling, I think, and Stovitz, Varner, Wachter, Yudof and
Zettel.” He counted a straight-up Jewish majority and he said there was a better
chance of catching the Pope kissing a nun than that these folks would get
involved in my problems. “It’s not black people’s turn anymore,” he told me. He
added something he hadn’t said before.
Apparently President Yudof had made a statement condemning anti-Semitism
on campus. But he’d also made another proclamation, on the UCOP website. An edict you could call it. His
message, according to White Coat, was directed at faculty everywhere: “You
can’t fail a student just because he’s obnoxious,” Yudof's words were to that effect. Yudof actually said the word obnoxious.
White Coat looked over his glasses at me and smiled. “I think he’s
talking about you.”
Ten months after Mike Adams committed to keep me informed there was a
call and email message not from Ms. De Souza but from a Mr. Mark Paschal who identified himself as an Office of Affirmative Action, Equal Opportunity and Diversity investigator. Paschal was actually Mr. Adams' number two. He didn't tell me that. He did inform me that he had just opened the file. We talked for about 45 minutes.
That was it. His report was released two weeks later and concluded that nothing
alleged by me was true and, contrary to my protestations, the University of
California San Francisco was at the forefront of racial equity.
There were no issues on campus that were not being addressed as
regards race, he wrote. This case was without merit. And
in his report he quoted Nan Madden, Andrea’s supervisor, as saying that during
the now-infamous meeting at the clinic “[R.N.] made reference as not seeing
himself as a student but a provider and this was his ‘emancipation.’” Oh
really? Was my fist raised in the air?
The word “emancipation”
has not come out of my mouth since high school, during a discussion of the
Emancipation Proclamation, actually. Instead Nan Madden sounded more like a white woman trying to imitate a radical nigger. If she had claimed liberation instead of emancipation, maybe she could have gotten me to
sign on, even in retrospect and even if it wasn’t true which it wasn’t.
Liberation is something a black person is more likely to say because the word
implies what one does for oneself, technically, while emancipation is what someone does for
you, like what President Lincoln did for the slaves. In other words, Nan was
full of shit. And where we would most certainly have to disagree was her characterization
of a challenge, on my part, to my role as a student. You can trust me on that. No one who goes through clinicals for nursing school, or medical school,
or dentistry—and this includes me, on my fourth run through a nursing
education—suddenly would say he or she is “emancipated” and just as suddenly a script-writing healthcare provider. The system doesn’t work that way. She made that up too.
This was hardball on the university's part and also on my own, and for that reason her lies didn’t
really surprise me that much, it was just amazing
and—despite UC’s vaunted reputation—amazingly dumb. Mr. Paschal also latched on
to Andrea Crosby’s “doesn’t like women” comment and reported it as fact without
ever asking my opinion of women, just as Andrea had not. That was literally
part of his findings—"doesn’t like women,“ as a reported conclusion of Mr. Paschal's investigation. He
quoted the prior Office of Diversity finding as evidence for the present
finding. Yet in his report Paschal never addressed the principal issue of my
complaint: the SON removing me from the university rolls without my permission. He did take time however to describe me as mentally disturbed.
“Crosby’s statement that [R.N.] ‘perceives events through a paranoid
delusional lens’ is most compelling, and his subsequent behavior only
underscores her position—that she does not feel that [R.N.] is appropriate to
have as a UCSF student.” Oh, okay. At least that's settled.
Except Andrea’s degree was in nursing
not psychiatry and my continuing role as a student was not her call as
volunteer faculty to make. Except at UCSF where it was. To repeat, this was
coming from a woman who had known me for all of six hours. On the subject of
mental illness my own take would have been—this bitch is crazy. Not that there’s anything wrong
with that, actually, some of my best friends are crazy white women, but in this
profession inappropriate behavior by women is accepted as a norm while men have to watch their ass. It’s a risk
that men particularly run at the nurse's station where we’re surrounded by women whose worst instincts
may be reinforced, day after day, by other women, just as men’s bad judgment is accepted
and even cultivated in all-male surroundings. Mr. Paschal continued, “[R.N.] has a right
to return to UCSF; however, he should be treated no differently than other
similarly-situated students. In the letter of findings that will be issued, it
will contain specific instructions for [R.N.] to re-enter the SON.”
Which didn’t happen, actually.
Andrea’s comments were nonetheless pertinent, just not in the way she
expected. At one point she told Paschal, referring to me, “He felt clinic
difficult for him to work in as it is all Anglo Women. In fact the SFGH
Children’s Health Center is predominantly Asian, African-American and Latino
with numerous male doctors.” She made that up too: Her own supervisor, the
leader of the center, Dr. Thyne had admitted the clinic was lacking in both
minorities, except as patients, and men, no qualified black clinicians etc., and relying on
Spanish-speaking Chinese-American women because there were no native
Spanish-speakers. Andrea's Spanish was good but not that good. Two or three years later, as racial storms hit the
country’s major campuses, like at the University of Missouri, the University of California would not have fought the characterization as
non-diverse but this was new territory in liberal San Francisco where white people were accustomed to patting themselves on the back for thinking well of minorities, even though the reality might be quite different. The only hint of suspicion on Mr. Paschal’s part was noting in his report that all my errors seemed to have been
committed in a very short period after the academic quarter began, that six-hour
window. Everything else the SON alleged about me, he agreed to in its entirety.
He signed his title, “Senior Analyst.” The Regents and the Office of the President accepted this report as
factual and final. Diane Griffiths, Secretary to the Board of Regents, wrote to me to
say the Board considered the matter closed and told me “to work it out with”
the university. That wasn’t going to happen, either.
This wasn’t a search for the truth. UC wasn’t suddenly going to admit
the university had done something wrong and certainly not in the arena of race.
But the exercise had been useful nonetheless, giving the university the chance to make a
determination. The idea now was to look for errors. They seemed to have
made a big one.
In Paschal’s report there was one especially disconcerting note, an
illusion to “safety concerns if [R.N.] returned to clinic.” About the same time a friendly source in the university administration
provided me a memo written weeks earlier by Ms. De Souza, addressed to Michael Adams,
after the Governor’s Office inquired of President Yudof what was going on. “The
Clinic Director, Nan Madden said that she witnessed inappropriate and
unprofessional behavior by [R.N.] towards his preceptor,” Ms. De Souza wrote,
“and made the decision that [R.N.] was not to return to their clinic. She was
concerned about the wellbeing of the preceptor who felt threatened and
intimidated by his behavior.” The memo had the scrawl “approved,” and Michael Adams’
signature on it.
This was the first that anyone had told me of my threatening behavior.
No one had mentioned any safety concerns either, not to me or to the commission on nursing education. No one had asked me to respond, there was no opportunity
to defend myself—they simply made judgments based upon a false accusation
without telling me the accused. That was UC's way of doing business. This was an academic lynching whether White Coat would have approved of
the expression or not. And despite alleged threats on my part they were offering to
allow me now to continue my studies? That
was interesting. Would you send a student who had threatened violence against his
instructors back to work with children? There was something more going on here,
another narrative, a diseased and septic one that this black clinician would bring to light and help to cure.
CHAPTER NINETEEN
There’s long been a conflict among African-Americans ourselves just as
intense as the struggle with Caucasians. It relates to a difference in opinion or a
difference in interests you could
call it dating back to slavery. Its basis is a class distinction among slaves that is
still reflected in our beliefs today about freedom and how
hard to push whites for equality.
The difference is not based upon skin color, as Dean Dracup might have
believed, but instead upon occupation and rank in society. During slavery
the split was between house niggers and field niggers. Slaves who were employed
in the Big House as servants, cooking and cleaning for master for example,
taking care of the owner’s children—sleeping in the kitchen—were considered
fortunate compared to field hands who chopped cotton under a Southern sun
and lived in shacks. House slaves, first-among-niggers in the plantation hierarchy, were
not in such a hurry to overthrow the system. So too at UCSF.
So far, my experience on campus was entirely with house niggers like
Dean Martin-Holland and Michael Adams of the Office of Affirmative Action,
Equal Opportunity and Diversity. Adams you could call the “head nigger in charge” on Mount Parnassus, at the Big House, and was reminiscent of the H.N.I.C. on the plantation, a dubious title, head nigger in charge, from slavery and from Jim Crow. When White Coat was riffing about race on campus he called Adams
a “trained monkey,” which was not P.C. but accurate, yeah, pretty much dead on. White Coat's monkey metaphor was one of the few times someone described Mr. Adams to me using an animal
analogy: my own description would have been lap dog or
trained seal. Only the animals differed. White Coat said the same kind of
figures existed in the Jewish community in Europe, back in the day, who believed they could
escape a horrific fate by doing the Nazis’ bidding. In this instance, in San
Francisco, Mr. Adams believed he had a special relationship with Chancellor
Bishop, White Coat said, and Adams did his utmost to keep the lid on a racial
situation on Mount Parnassus that could get out of hand or become embarrassing to the Big Guy. Who won a Nobel Prize, by the way. If you
went to Michael Adams’ office expecting affirmative action, equal opportunity
or diversity—or in my case, justice—you were much more
likely to get the status quo, because that was in Mr. Adams’ personal interest, to maintain
his position as head-nigger-in-charge on campus. Not rocking the boat and making sure
no one else did, either. Complaints went to Mr. Adams’ office to die not to be
investigated, the doctor in the white coat said.
This was also my experience of Judy Holland-Martin although she was more
deliberate and dignified and did not dance for the white man, or white woman, so
to speak. The Caucasian females in the SON seemed to fear her, actually.
Still Dean Martin-Holland wanted what she wanted and was willing to sell me
down the river—an expression that also comes from slavery, by the way—and
presumably any other black person as well. At least she had style and
intellect. You could admire her moves on the court but you had to remain
mindful that she played for the other team. And she wasn’t above a foul or two when
no one was looking. The phrase White Coat did not use for Michael Adams was
Uncle Tom, which is the correct term actually, post-slavery. Blacks actually
don’t say house nigger or field nigger so much anymore. That’s my experience in Texas. For
women like Dean Martin-Holland the correct term would be “Aunt Jemima,” or the
unisex appelation, “handkerchief head,” although Uncle Tom is often used by the
uninitiated for both sexes. Being Old School myself my preference is to keep
my genders straight, making Michael Adams an Uncle Tom and Judy Martin-Holland an Aunt Jemima although there wasn't anything auntyish about her, at least not as she appeared at the School of Nursing.
“Oreo”—black on the outside and white on the inside—is also descriptive but the
drawback is that you have to be familiar with that particular brand of cookie.
According to this classification system, and continuing the food analogy, Michaael Adams’ assistant Ms. DeSouza was a
coconut—brown on the outside and white on the inside. It would soon be my pleasure to meet the university's principal banana, an Asian-Americans guy named Otsuki, yellow on the outside and—surprise—white on the inside. They were all white on the inside.
Mark Paschal who handled the second investigation for Mr. Adams was also an Uncle Tom, strictly speaking, willing to do what he was told to maintain his position as Senior Analyst, whatever that entailed. Charles Robinson, the University of California’s general
counsel and an alleged black man—also a Tom. Not that there's anything wrong with that. Now suddenly there was another black figure at Mount Parnassus whose desire to
accommodate white leadership’s interests was so ingrained that she made Dean Judy and Michael Adams look like black revolutionaries by comparison.
Her name was Renee Navarro and she was a physician who became, during the time
of my lynching, the first Vice-Chancellor for Diversity at the San Francisco campus. Dark-skinned (again, if you believed Dean Dracup, that meant Dr. Navarro
was radical which is the last word
to describe this woman) with a big shit-eating smile, not that there’s anything
wrong with that, either. She was appointed to her position not long after my appearance before the
Regents.
Chancellor Navarro: according to the Office of the President’s website,
in a “Women We Admire” series, the basic UC propaganda bullshit but interesting nonetheless, she had an uplifting bio. Born in Alabama, the first African-American woman to serve as a UCSF vice chancellor was one of six children of a sharecropper’s daughter. When the family moved to
California her mom got a master’s degree and teaching credential and proved a
tough act to follow, per President Yudof’s profile of the sister in question, on the UCOP website. Propaganda but an interesting narrative, she had led a fearless life but become, at UCSF, a ho for UC.
Renee’s mother
wanted her daughter to be a doctor even though Renee herself found the idea
daunting, that was what the website said. So, like, she started at University
of the Pacific’s pharmacology program, gaining enough confidence later to attend
medical school. Helped to pay her way through med school by working in a pharmacy, what’s not to like? Then impostor syndrome set in: “I was at UCSF at a time
when women were struggling,” Navarro recalled in the women-we-admire piece. “I felt isolated and challenged and didn’t know where
to get help and reassurance. There were few role models for me.’’ You can
imagine what she had gone through in the South as a child and at UC as a young
adult but these experiences apparently didn’t raise Renee Navarro’s
consciousness, instead they seemed to lower it. Which is another risk of racism, because some niggers do bow to the lash. One of the problems, White Coat said, when there are only a few
isolated people of color in achievement-oriented cultures like UC—White Coat theorized to me once—is that those blacks and browns who rise in the organization tend to view
themselves as exemplary rather than fortunate. White Coat boasted that there was a tradition of
education among Jews that led to their success at UC but admitted that Jews also network up the yin yang, more than anyone else except maybe the Chinese, and
once someone reaches a new position or enters a new endeavor, inevitably he
or she tries to bring in other Jews. “Your people don’t do that,” he
admonished, like it was my fault. My attitude was, like, hey, fuck you, buddy. Although it was kind of true.
White Coat did not know Dr. Navarro well and when he was asked to describe what he
knew, he declined. Or spoke in generalities only, what the Vice Dean needed to do on campus to improve inclusivity, etcetera. It was
a pattern: he would tell what he knew about anyone who was not a physician,
except Dean Hawgood whom he did not respect. Generally though if the
question was about a fellow doctor—some kind of professional courtesy kicked
in. That was cool, it was his call, odd nonetheless. Unwilling to accept White Coat’s non-evaluation evaluation, however, my plan was to probe
Dr. Navarro’s racial consciousness myself. Wasn’t pretty. White
Coat would not have even been close in describing the level of accommodation
this black physician exhibited. She made Uncle Tom look like Malcolm X.
Wrote to her a couple of times but Dr. Navarro did not respond even though it
was my speech before the Regents that led to her hiring. An explicit
test: The School of Nursing was faking its diversity numbers. The practice became clear after an open records request for my own file. The
released documents were few and far between—the university kept telling me they
had given me everything they had, which they had not, documents leaked out for years—but requests for more
generic documentation were sometimes agreed to by the Chancellor’s Office, which controlled release. The latest breakdown of diversity among SON students
had arrived in the mail and checking the numbers from Dean Martin-Holland’s
shop, since she had the diversity portfolio, something stuck out. The SON was double-counting minority men. It was unclear if this was
the work of Dean Martin-Holland or a man named David Vlahov, the new dean, from Johns
Hopkins, chosen by Vice-Chancellor Bluestone to replace Kathy Dracup. Regardless of who was responsible the definition used by the SON of “under-represented students” included men and minorities and they were being
counted twice. If for example the student was a black male, he was counted for
his race and for his gender in the hodgepodge of “under-represented.” There
were very few men of color in the SON, Hispanic or black, but the few there
were counted for their race and then again for their gender, doubling the handful. Wrote to new Dean Vlahov and to Dr. Navarro—the Vice-Chancellor
of Diversity, less we forget—to explain what was happening and how it might be
a problem. How can you find a solution to a problem if the very numbers you
rely upon are bad? Neither Vlahov nor Navarro replied. Oh well. Aunt
Jemimas they were—that was my call and felt pretty confident making it. Time to
move on.
This was now a couple of years out from the original injury or “insult,”
as we say in the hospital. Would hate for anyone to think of me as obsessive
because that’s so not me. My attention
span is, like, five minutes on a good day. But this was race in America, something more familiar to
me even than the nursing process—something we were taught from the time we were
kids, don’t let white people or their handmaidens the Toms get
away with anything. That’s what my
mother had instructed me and it was one of the few lessons that stuck, Chancellor Navarro’s journey through life had led to accommodation while mine
led to a fight. That’s the
kind of household we grew up in, not a sharecropper family in Alabama where the lessons may have been different or harsher still. Whatever the training, accommodation or confrontation,
it didn’t just go away, for me or for Dr. Navarro. So, in my case, conflict it was. Moved
back to Texas after Seattle and was working at a hospital in the Trans Pecos, near the Mexican border, but San Francisco stayed
on my mind. And UC. My new home was mostly populated by Border Patrol officers and their families. Plenty of time to pursue my quarry. Hunting an elephant you need to follow
signs of what’s been trampled underfoot. You can also look for the big animal's scat on the ground. That was the best way to track the University of California. You didn’t have to
be in the Bay Area to know what UC was up to, or to pursue an inquiry, because
everything was online. You could lose yourself clicking buttons on the UCSF webpage
and it was all there, more or less. You still had to watch your ass of course. As a prudent black man. As White Coat said, retaliation was the rule not the exception. It was
still not possible to take on UCSF head-on, because the university was not
going to fault itself, which would be the only way to declare victory, but on the margins, and in other areas, the
fight could be taken to Parnassus and to UCOP. Made three tactical moves
after long and careful thought and each was successful for what it
achieved.
First: an open records request not of the university but to San
Francisco General Hospital for all email related to my failing grade in the kids clinic.
The result was a goldmine, coming from a server that was not controlled by
Chancellor Desmond-Hellmann. Second was to renew my appeal to the Academic
Senate. This time the Senate president
was a sociologist from the School of Nursing, and the Senate attorney answered and
we exchanged a dozen or more email as she asked the details and unveiled the
procedure. After a few weeks the attorney began to encourage me to telephone
her. She
wanted to talk, she said, by phone, if you believed White Coat’s interpretation—he had
been right about everything else—in order to offer a deal. But that didn’t
interest the black man at that point in time. Not anymore. Have you ever seen the movie Pretty
Woman? It’s a chick flick, not necessarily my sort of
thing, but at the end what made the film outstanding was that Julia Roberts, who
portrays a call girl, demands legitimacy from Richard Gere’s character,
including a ring. That was my feeling too. The university needed to admit what it had done,
correct my grade, offer to re-institute my studies and pay for my financial loses,
including $30,000 in tuition poured down the toilet. There was
really no intention on my part to return to San Francisco but the
powers-that-be didn’t know that. The offer still needed to be made. My father
had a favorite saying: “In the end,” he told me, “everybody wants to be
respectable.” On some level that included me.
The email released by the hospital made it easy to reconstruct what had
happened that afternoon, two years before, at San Francisco General Hospital. The real action began the same night, after Dr. Thyne’s
butter-wouldn’t-melt-in-her-mouth reply about the difficulty of finding black
clinicians. Let’s call that Day 1. My response to her was that the lack of
diversity in clinic was still on my to-do list. We’re still Day 1—or,
technically, the evening of Day 1.
Thyne’s deputy in clinic was a Harvard-trained physician named Andrea
Marmor who that very night wrote an email to a SON pediatrics faculty about me—an
email that General Hospital did not provide, actually. We never met so it's hard to imagine what Marmor had to say about me but that's the UC system. In any case the reply was released, from a professor named Angel, of the School of Nursing, who
apologized for my behavior, unbeknownst to me. At this point Dr. Thyne was still
trying to keep a lid on, apparently realizing how damaging the whole discussion
of race in the hospital could be. To say nothing of at the university. The wider
context is important: the race protests in Ferguson and at the University of
Missouri had not yet taken place. The cell phone videos of white police
officers shooting black men had not yet been made, and Sandra Bland had not yet
hanged herself in a small town Texas jail. Liberal
whites on the West Coast still believed their own shit didn’t stink and that
they themselves were somehow above the racial fray. That meant Mount Parnassus. Then, at UCSF that night,
Mary Mac appeared on the scene—saying in an email that was cc’d to everyone
except me—that she was my faculty and she would decide what was to be done with
me. Mary asked Andrea Crosby to detail reasons for a failing grade, which Andrea
was more than willing to do. “I would not say that you are being banned from
continuing clinicals at SFGH or being punished,” Naomi told me in a message that same evening, still Night 1, a message that had skipped my mind until it reappeared in the document release from the hospital's server. Naomi said nothing about a failure at that point. She was lying or the wheels were
still turning or both. “I would say that your preceptors requested that you not return
this quarter. Sometimes students and preceptors are not a match . . . ” In the
morning Dr. Thyne was not only on board with failure but had taken an
extraordinary step. She asked the university to go to court to get a
restraining order to keep me off the General Hospital campus. An
evolution had taken place. Not just retaliation but a Big Lie in the making. This was all in the General Hospital correspondence dump.
The following message was written by Nan Madden to Angel Chen an hour or
two after my departure from clinic. This was Day 1, actually, shortly after the eye-rolling that so chapped my nuts. Keep in
mind that no further contact had taken place. After my meeting with Nan Madden
and Andrea Crosby that afternoon at San Francisco General Hospital we have never seen each other again or spoken/written to each other.
Never again did my feet cross the threshold of the children's clinic or the building that housed it. My only
contact thereafter with clinic faculty was the exchange of email with Dr. Thyne
later that night and again two year after that, after getting access to these emails in fact. “Hi, Angel,” Nan wrote, “as the clinical director of the
pediatric asthma clinic at SFGH I have decided that it would be best if [R.N.]
terminate his clinical with us today. Andrea Crosby and I met with him today,
at his request, and it was clear to me that he has problems with his role as a
student that are not appropriate for our clinical setting. He is not open to
constructive criticism and he insinuated that we were being racist and anti-male
by a few common courtesies.” That was her right as the clinic director if her actions were taken in good faith,
which they were not. She noted that it was my request for the meeting and at
that point no one had said anything about my clinical performance being
sub-par. And, fyi, it wasn’t an “insinuation” about racism and sexism in the
Children's Health Center. It was a direct charge and my call to make.
Madden went on in her email: “I told [R.N.] that I thought it would be
best if he took the afternoon off, but on further reflection I believe that we
can no longer work with him. I regret needing to give up our preceptorship with
a student so early in the quarter but I think our clinic is not a good match for
[R.N.]” She was calling me rude which is not true but let’s say, for sake of
discussion, it was true. She didn’t say anything about “emancipation” or a
Black Power stance although she hinted that my “role as a student” did not
allow me to criticize the clinic. Nothing else. Certainly nothing about threatening behavior. The email released by General
Hospital showed that Nan Madden and Andrea Crosby approached Karen before failing me, to ask her permission, as the lead SON
faulty in the clinic, and she gave it without even speaking to me or asking me
what had happened. Even though in Andrea’s subsequent evaluation Andrea accused me
of being rude to patient families and not working well with clinic staff, something, my rapport with families, which
Karen had praised me for in her written evaluation of me the quarter before. Five points out of five was my evaluation, if my memory serves. These ladies were at work on a different narrative. They had the rope,
so to speak, now they were testing the knot.
“Thanks for your multiple conversations with us yesterday,” Naomi
Schapiro wrote to Dean Martin-Holland two days later, as things firmed up.
Naomi also told Dean Judy about my refusal to meet with faculty—a decision made because no one had yet told me what led to my removal from clinic. An
administrative process was in place, SON faculty was reminded, by me, in writing. The chancellor had appointed Michael Adams to look into the matter but these ladies were unimpressed. My refusal to meet was mostly a bargaining position, really, they were right about that, on my part, to get Dr. Rankin to
release the evaluation. My conversation with
White Coat hadn’t yet taken place and his advice about how to proceed was still
in the offing. “This is how we do it,” Rankin wrote to me about her decision
that nothing would be shown to me until a meeting took place, when my response
was expected. There was something else going on here, a race-based and
gender-specific dynamic that at the time and for two years thereafter had been unknown
to me. Only the email from San Francisco General Hospital revealed it for what it was. Corruption, like an illness. My
message to Dean Sam Hawgood of the School of Medicine, who was Dr. Thyne’s supervisor, the very
night of my failure, caught a whale. Thyne had not been truthful with me but
she had been candid with the dean.
The next morning, Day 2, Dean Hawgood wrote to Dr. Thyne on his
BlackBerry, a single sentence questioning what happened the day before in clinic, after he received the message from me: “Any
background would be helpful,” he told Dr. Thyne. Hawgood, whose specialty was neonatal cardiology, or some shit like that, was just being careful, you could say. An hour later Dr. Thyne sent him a reply: “Oh dear,” she wrote.
“This relates to his recent dismissal from our clinic due to unprofessional
behavior. It has gotten to the level of the Dean in the SON and will likely
result in his dismissal. It is one of many issues related to his
professionalism and clinical performance. I can give you details if you want,
but the bottom line is that the conduct of our staff (NPs in Asthma Clinic) was
by all accounts completely appropriate. It has been a frightening experience
for the junior NP [Andrea Crosby] and she is concerned for her safety. Feel
free to page me any time if you would like more info.” Andrea was concerned for her safety? Weeks later, in conversations with the Office of
Diversity, Nan Madden was too: “concerned for her safety,” although she had
never mentioned that previously or in the email describing me as rude, written just
after my departure from clinic, the last time we saw each other. It wasn't on my evaluation either. That's because they made the shit up.
Dr. Thyne sent a second email to Dean Hawgood an hour after the first:
“I spoke with Kathy Dracup this morning and they are taking this very
seriously, particularly in light of the fact that there have now been 3 events
where the faculty/clinicians have felt threatened and concerned for their
safety.” Oh really? Which three were those? My last year had been spent out of
the country and just before that Kathy Dracup had sent me a thank you note written on
her personal stationary. Also there was an exchange of correspondence with the Nobel Prizewinning co-discoverer of protocols oncogenes Michael Bishop. When exactly did these threats take place? This was all being made up on the go by women whose
response when confronted with an intellectual threat was to claim it was physical. And it wasn’t their first response. The first response was to find me not a good fit at the SON, where it was my right to study, just like the white women. Now it was uglier still. Dr.
Thyne’s request for a restraining order was denied by the UCSF legal
department, on the grounds, she was informed the same day in an email, “no
threat was made.” Apparently, Legal was also unaware of any violence-prone behavior on my part. Yet the police would soon be following me on campus. It’s instructive to
examine what Dr. Thyne and Dean Hawgood did here: seeking a preemptive legal
order against a black student being failed after speaking out about
race. As a practical matter, how do you
defend yourself if you don’t know you’ve been accused? And how likely is it
that a student who threatened anyone at any time would be in clinical practice
at General Hospital’s children’s center? It was a lie then and is still, upon
retrospect—a horrendous lie that UC continues to tell today. Who knew about it at the time? Dean
Hawgood did, for one.
Still, you’re in school, right? And it was interesting from a sociological
aspect which in the past had only seemed like so much talk. In the
context of nursing theory, and all, which had seemed like hogwash to me before, for the longest time, C=RN and all. Years ago my girlfriend at the time gave me a book
by Italian journalist Oriana Fallaci who wrote a lot about relationships. In her work Fallaci said that lying is much more a woman’s tool
than a man’s—especially in any conflict with the other gender. Guys tell our fair share of whoppers too but working with women so
long it seems to me now that there is a fundamental difference
between the sexes in terms of deceit. Men try for some kind of verisimilitude—to
convince someone of something that is not true by making it sound true. But
many of the lies women tell, even very smart or accomplished women—nursing
professors, for example, or doctors—can be completely disassociated from fact. Claims
that are clearly untrue, night is day for example, perfectly
disprovable but that serving as part of a woman’s initial defenses, nonetheless. My
response was to bundle up the emails and send them to the Regents, too. Under
pressure, President Yudof sidestepped Michael Adams and ordered UCSF Audit, the campus professional investigative body, to look into what had happened in clinic.
The outcome was still assured—UC was still investigating UC—and even
though it was another whitewash, heads rolled. That was pretty satisfying,
actually.
CHAPTER TWENTY
Without a car there was only one way out of the Trans Pecos and only
two directions. The one way out was by train and the two directions were west to El
Paso, about four hours by rail, or east to Austin, a full day away via San Antonio.
Boarded the train one afternoon with a group of Mennonite women who lived on
ranches in northern Mexico and were sometimes maternity patients at our hospital. They always paid cash. Mama just broke her water and the father would pull a wad of large notes from the pocket of his overalls. In the train carriage the women were attired as always in floor-length dresses and long sleeves
even in the existential dryness of the High Chihuahuan Desert: talking among
themselves in Low German and looking like Heidi from a Swiss pastoral scene. A
couple of them were pretty hot, actually, not that that’s important. It was
funny to watch as these ladies lowered their heads, whispering among themselves
as if anyone sitting nearby could understand Plautdeutsch, and then burst into laughter. My guess was that they weren’t
talking about churning butter or darning socks.
In Austin across the street from the Capitol at a Starbucks with a
strong Wifi connection there was a long video conference with UCSF Audit in the
person of two men, the director, a white guy named Catalano with a shit-eating grin just like Dr. Navarro's. My assumption was that Catalano was the political appointee to make
sure that nothing ugly came out of Audit, and his investigator, a Nisei or Sansei named Otsuki who would do the actual legwork. This was much the same
as in the Office of Diversity, the lower level people did the actual digging, or not, while the primary responsibility of the manager Mr. Adams was to make sure that nothing got
out of hand politically. Did my homework before the link up and looked online
at a series of investigations performed by these two men, Messieurs Otsuki and Catalano, and each finding was
conspicuous the conclusion of no wrongdoing on the part of the University of California. Oh well.
There was a reason to go through with this but it wasn’t the audit per se.
The director, the guy with the big smile, was an accountant.
As he listened to my rap he was deciding what specifically he would look into
which—as in the case of the Regents’ meeting agenda—meant he was in absolute
control. Right away he refused my winner: my second request for
Academic Senate review, which was a slam-bang open and shut case—dozens of emails and the president of the Academic Senate going on semi-permanent leave the day
before he was due to rule. Catalano said, speaking of my request for Senate
review and of Dr. Newcomer’s written promise to make a decision, “Oh, that was
just talk.”
“No it wasn’t. I have the email.”
He was unmoved. For someone hearing the allegations for the first
time Mr. Catalano seemed to know a lot already, not a good sign. He may have been prepped by
the administration but it was his call nonetheless and he knew it. Nothing to do
but move on.
We went through the whole history of my time at the university. It was a little
odd to be talking about race and gender and generic patient outcomes for a faraway hospital at a
common table in Starbucks but that’s where
the good Internet connection was. Mr. Otsuki, the investigator, also wanted a
written statement and any evidence already collected by me, such as email. An
investigation is like any other human endeavor—if someone has already done the
work for you it’s easier. Otsuki contacted me a day or two later and told me that based upon
his preliminary review of the documents there was really no reason to
make an academic charge against Executive Vice Chancellor Bluestone, who was actually at the top of
my list of wrongdoing, like the Don, you feel me? The vice-chancellor was a certifiable thug, in my modest opinion, but Mr. Otsuki tried to pressure me not to include Bluestone in the formal complaint—probably someone was
pressuring Audit already. My no was adamant. There was a follow-up video
conference a few weeks later, in which the two men had the opportunity to ask
more questions but this time with me at a disadvantage. They could see me but
Mr. Catalano claimed that their camera was broken so there was only audio from the San Francisco end. It wasn’t possible to tell who was sitting with him and Otsuki, but my bet was this was artifice, there was nothing wrong with
their camera, someone was in on the meeting whose presence Audit didn’t want
known. The best guess was Professor Bluestone himself, whom
White Coat called “The Dick,” or Dr. Navarro, aka Aunt Jemima. Someone wanted to see the troublemaker up close without being seen.
It didn’t bother me, actually.
During the first
conference when the San Francisco end was visible one of my questions to Mr. Castelano was if he had heard of Chancellor’s Desmond-Hellmann’s tobacco stock
imbroglio, just as a test. He looked uncomfortable. “Vaguely,” he answered and made clear that he did not want to go there. He was under instructions to get in and out of this investigation with the least
damage to Sue as possible and any question that she had delayed or subverted the
General Hospital inquiry because of my call to the Times was not going to be on the agenda. Oh well. In the end Audit
chose nine issues to investigate regarding the university’s handling of my studies and the outcome was explained to me a few weeks later in a third
videoconference. That meeting, also online, started with Mr. Castelano going
down the list, “No finding of wrongdoing,” “No finding pf wrongdoing,” “No
finding of wrongdoing,” he was on the third or fourth bullet when my hand went
up to stop him.
“Hold it right there. In how many were there findings of wrongdoing?”
“Two and a half,” Cstalano said.
That was actually better than expected.
One of the findings in my favor was that not once but twice the Office
of Affirmative Action, Equal Opportunity and Diversity, which meant the
ubiquitous Mr. Adams, failed to inform me of the appeal process. When
Adams’ people made their findings against me it was my right in both instances to go
directly to the chancellor to overturn the decision—it was an administrative rule. The first time the appeal would have been to Michael
Bishop and the second time to Sue. But in his finding Mr. Paschal had written
specifically, when he presented his conclusions, that my only option was to go
outside the university, to court, or to try my luck again at the Office of
Civil Rights. Not true. In the first finding Ms. DeSouza had not mentioned any appeal at all. Michael Adams’ shop saved the chancellors from a potentially tight
spot—having to confirm the failure of a black student on false academic charges.
Mr. Otsuki said that despite the email falsely describing me as having threatened violence against my instructors, “That was just an
impression,” on the instructors’ parts and was their right, as their “opinion”
of me, physically-threatening. The request for a restraining order was also
completely acceptable on Dr. Thyne’s part, as “her opinion” of me, as well, Mr. Otsuki said.
Oh really? In a followup telephone conversation Mr. Otsuki said that black men have
“an unfortunate history of violence,” and that it was understandable for white
female faculty to fear us. Oh, okay. Well, that explains that—no
harm no foul. The point of UCSF Audit’s investigation was not findings
like these. As soon as they were in and reported—my next open records
request was going out, for the notes of the investigation itself. It was funny how—not funny haha, funny weird—when speaking with the auditors, everyone’s memory suddenly failed, the notes from Mr. Otsuki's interviews showed. Dr. Rankin was one of the primary pushers of the violent-Negro
narrative but she told Otsuki in her interview that all of the claims of threatening
behavior arose in the clinic, not in the School of Nursing, even
though that was not what the email showed.
Former Dean Dracup—now Professor Dracup—could not remember saying
anything to Dr. Thyne about me or meeting me at all. She suggested that the
investigators try Dean Mirsky instead whose memory might be better. The best
part was the interview with Judy Martin-Holland. According to the Audit notes
of the conversation, Dean Judy did not remember ever meeting me and said we had
communicated mostly through email. Nor did she remember my request for Academic
Senate review—a request that was addressed to her and that she had not answered. “Ms. Martin-Holland did not
specifically remember the email that was sent to her by [R.N.],” Mr. Otsuki wrote, “that he questions his ability to appeal to the Academic
Senate. When shown the email, she did remember receiving some emails from him .
. . she does not recall if she specifically responded to this email or not.”
The answer was not. She also said she was unaware of the Academic Senate review
process. Please. Her title was
Associate Dean of Academic Affairs. This woman could probably recite the rules
backwards. It was hard to be sure where Judy Martin-Holland fit into the
two and a half findings of wrongdoing but it was a great feeling later, looking at the School of Nursing’s website, her title was suddenly,
post-audit, “Associate Dean of Academic Programs
and Diversity,” some shit like that, while another professor suddenly had the
Academic Affairs portfolio.
There was nothing in the Audit
documentation about Jeffrey “The Dick” Bluestone, our Chief Education
Officer who sat on my case. In the release of documents, also, two pages were titled “Karen Duderstadt” but were blank. Everything had been redacted. There was another interview with Andrea, in
which she continued the Emancipation claim, my alleged Black Power protest in
clinic. Actually, that was one lie that began to sit a little better with
me—burnishing my street credibility, so to speak. Not that my street credibility needs burnishing. Just wished she had said liberation instead of
emancipation, you feel me? Life had not been easy for Andrea in the interim. And then it was. She’d been transferred to General Hospital’s Women’s Clinic, where there was
even less chance she would meet guys, someone told me much later she married a doctor, not that there's anything wrong with that, suddenly she was no longer
at General Hospital at all. As White Coat said, UC makes changes but admits
nothing. At the time of the telephone interview with Audit, Andrea was working in San Diego County and described herself as no longer affiliated in
any way with the university. Andrea was a bigot—a dumb Asian-American chick, not that there's anything wrong with that, who thought she knew
black people because she’d worked in a clinic frequented by African-Americans. She was a cracker, to use the civil
rights vernacular, as were Karen, Mary Mac, Dr. Rankin, Dr. Thyne and Nan, white women all, who struck out at what they neither understood nor sympathized
with, a black male nurse. In her interview with the auditors Dr. Thyne was back
to butter in her mouth. Unfortunate misunderstandings and all. But she did say
that she felt my communication with her had been impertinent. Really? Released with the other Audit docs there was a second email, written by me, to Dr.
Thyne, in response to her explanation of how the clinic operated. My response was direct but, it's my belief, not at all rude:
“Dear Dr. Thyne, thank you for responding so promptly. To correct the
record, or perhaps I did not explain myself well originally, what I meant to
say was not that she demeaned my race or gender, but that she rolled her eyes
when I tried to explain to her that my race or gender might be an issue in
relations between preceptor and student. And she did not ‘rolled her eyes’ in
quotes, she did it in fact, on more than one occasion as this end of the
discussion progressed. It’s not an issue of over-sensitivity on my part, it’s a
question of lack of sensitivity on her part, regardless of where she may have
been employed in the past. I can only assume she meant to demean my concerns,
and in that effort she succeeded. I was sitting a few feet from Andrea and her
comments throughout this part of the discussion were to the effect, as Nan will
tell you, that she was not accepting my view of my experience in the clinic. I
appreciate Andrea’s skills but she seems totally clueless that I might not be
the same as she is or that my comportment might be different from hers or that
my approach to my practice might be different from hers.” It’s difficult
sometimes re-reading or replaying after the fact what one has said or done, but even the second time around this message was all still cool
with me. Fuck her if she didn’t like it, not to be unprofessional or anything,
not to be un-collegial, but the health of minority children was more important than Shannon Thyne's feelings of superiority. And Nan simply lied, which she continued to do after
the fact. Fuck her, too. The only one of these perps who summoned my
sympathy, throughout this search for justice, you may ask?
Kathy Dracup.
She was Old School, like me. We were both UCLA alums (“Go,
Bruins!”) and you never want to underestimate old college ties. She had fucked
up, certainly, accusing a nigger of something she knew not to be
true, but that’s nursing. She was hardly alone, as she wrote to the nursing education commission. This is nursing, non-diverse and unrepentent.
Time had passed her by. In Dracup’s favor
was our meeting in her office when she did not react well to the mention of
Professor Duderstadt. My feeling, long after the fact—this may just be my
imagination—Kathy was trying to warn me not to trust Karen. Apparently, overall, there wasn't enough listening on either side. Oh well, again.
Throughout this ordeal, giving as well as taking, the black man refusing to be a victim, it was particularly interesting watching everyone’s bureaucratic moves. At the University of California most players have high, tight games, although subtlety and honesty do not seem to be any more prized on campus than in the outside world. The point seems to be to show how much smarter you are than the next person. There's also the corruption. During the period leading up to the disappearance of the
Academic Senate president, while he was still considering my case, Sue
appointed him to a prestigious committee looking at the future of the
university. The news was all over the UCSF website. Also during the period of
the audit, Sue made a big financial grant to a woman named Boyd—a
psychologist and researcher who was, coincidentally, the chief ethics officer on
campus and supervisor of Mssrs. Catalano and Otsuki. That also got played up
big on the university website. The chancellor was trying to influence outcomes but such is the power of the position, she got to influence outcomes on campus. As chancellor you get to make prestigious appointments and
dole out money. That was cool, it was what it was—still, it didn’t do
much to endear her to me. So, like, started sniffing around for another way to bring the
struggle to this white woman—or to President Yudof—or to Medical School Dean Sam
Hawgood. Preferably my target of targets would have been Dr. Bluestone, aka
The Dick, who might benefit from what
White Coat called a lesson in probity, or “remediation,” as Dr. Rankin
might’ve said. It was just hard to get traction. At that point President Yudof looked like the remotest possibility.
The University of California was still deep in the red and the solution
that Yudof and Sue and the Regents had decided upon was more direct ties with
industry, Big Pharma specifically. This had gotten Yudof in trouble in Austin
when the University of Texas’s MD Anderson Hospital transferred patents on a new cancer-fighting
drug, with Chancellor Yudof’s permission, to a private company with ties to the governor.
It seemed like, well, this could be an issue again because Yudof was up to the
same thing in Oakland. Another idea was to
pursue Yudof’s right-hand man, Executive Vice-President for Medical Affairs Dr.
John Stobo who President Yudof brought with him from Texas.
Before arriving in Oakland, Dr. Stobo was in charge of University of Texas Medical
Branch on Galveston Island, my alma mater, in fact. Both Stobo’s and Yudof’s signatures are on my Highest Honors degree in nursing from Medical Branch, actually, but
that was one old college tie that meant nothing. Wouldn’t cause me the
least hesitation if the opportunity arose to screw either of these guys because
they both knew what really happened at San Francisco General Hospital and didn't care. Dr. Stobo had been informed, by
me, in dozens of emails, to which he never replied. This wasn’t going to be revenge, it
would be justice. Called an acquaintance in Texas named Tom Curtis who had been
a reporter for Texas Monthly and later
worked in the Medical Branch public affairs office, under Stobo. Tommy was retired now and said
he could speak freely.
He described Dr. Stobo as a medicine-is-business type of physician who, for example, had been on the board
of an insurance provider that was Galveston’s main private employer and was a
yes-man to the island’s business community and to the university administration,
which meant Mark Yudof, at the time. Tommy said that there'd been a scandal that was hushed up during
Stobo’s stay at Medical Branch involving a contract between
the university and a company that employed Stobo’s son. Tommy suggested looking
for the son in Northern California. A good reporter, Tommy always was. A quick web search found one of Stobo’s
kids—John Jr.—working at a healthcare-related venture capital
firm in San Francisco, just across the bay from Dad. What a coincidence! Small
world, yet again. This looked like a promising area of research, then a different
course of action came to mind: to go deeper instead of going wider. Look
again, in other words, at what was already in hand instead of looking for
something new. It was the kind of idea my thesis advisor might have suggested.
Bureaucrats have
their own language, their own terminology, their own way of saying things—as in
healthcare—that the ordinary public might not know or understand. UC leadership is a
beehive of lawyers and scientists, and doctors—the head of System ethics was
for example, during most of my struggles, a nurse. They’re all very very smart
people, one presumes. Many were professors before they joined the administration but many have not lost the jargon or it’s gotten worse.
When the Audit report
was completed, Dr. Boyd, the psychologist who supervised Castelano and Otsuki, sent
me a single-paragraph email saying there was “insufficient evidence” to substantiate
allegations of bias or unethical behavior. But the typical practice, according
to those who know UC System, is that in a sensitive case UC auditors produce two reports—one sanitized version that
goes to the complainant and fails to substantiate the allegations and one that
gives the real lowdown and goes to the Office of the President and the Regents. My version from Dr. Boyd was the cleaned-up one, thank you very much,
or toned down, especially when you consider the claim by Dr. Boyd that there
were “no IGAs” (improper governmental actions, shorthand for official
wrongdoing.) Oh really? The university did nothing wrong describing me as
violent and having the police follow me on campus? Dean Dracup admitted she fabricated the claim of me threatening faculty, after all. Nonetheless, despite the denial of any IGAs, another wave of
retirements followed, including the president of the Academic Senate.
Looking at the Audit
report something told me that there was more in those pages, even the
whitewashed ones—code, you might call it, that only needed to be deciphered by
someone who knew the secret language. But by whom? Not me—my bureaucratese is
poor, not ever having spoken it professionally, at least not UC’s dialect. This
task would require someone who understood the language the report was written in
because he or she had written something similar in the past, as an
administrator. Someone who knew “the enterprise” that UC calls itself, knew
the personalities involved or their positions, their functions, their offices
and how people in those offices communicated. For me there was only one
possibility.
White Coat.
Hooking up with him
was going to be difficult. We weren’t going to run into
each other getting a cup of coffee.
Calling his office
or lab was a bad idea too, if only for his sake. Email was not an option. UC
has since admitted to monitoring messages coming and going to and from
university servers—there is no privacy even for tenured academics. Even then,
not knowing the explicit details of any surveillance, it was still a good bet
they were doing something. Internet research eventually yielded White
Coat’s C.V. attached to a research paper he helped to write, with his email
address and cell phone number at the top of the page. “Oh. You,” he said when his memory kicked in, on the phone.
He sounded busy. At
UC everybody is always busy, it’s kind of a status thing. The busier you are the
more important you must be.
“Of course,” he
remembered me, he said. He liked me, he had said too. Or kind of said. The problem
was names. We hadn’t used our own names during our chats. To me he was “Doc,”
my title of preference for all MDs, male and female, young or old. He called me “Son” even though we were
probably close to the same age. The only reason his name was known to me at all was
that it was embroidered on his white coat. The difficulty for him, explaining
his momentary confusion, was that my call was coming out of the blue. But this
guy was fast on his feet and he soon recovered. “So,” he said, only half in
humor, “I hear you’re still trying to tear down the university’s reputation.”
“Only the
chancellor’s.”
“You know,” White
Coat assured me, or words to this effect—he always talked fast, it was hard to keep up with him, he was living
on the West Coast but there was a New Yorker somewhere in his past—“these
racial issues at UC, they come and go. Nawbody can say a complete sentence on
campus right now without mentioning dah-versity.”
This was coming from a physician who probably had an IQ of 200. He sounded ike a cracker. “Things will get a little
better and then black people will decide they have bigger fish to fry than the
University of California and move on.” He mumbled something about anti-Semitism
on campus that he considered more important. “The African-American position at
UC is based upon education, not race. Your people will see that eventually.” What he was saying
was a recycled version of Dr. Thyne’s paucity of African-American practitioners
speech. Having heard it a couple of times already it didn’t make me angry anymore. “I wouldn’t bet on it, Doc. I don’t think race is going away as an issue.”
“You have to admit,”
he said, “that the Holocaust was worse than anything blacks have experienced.”
This was a common argument among my Jewish friends, kind of like who would win
in a fight—Superman or Batman? Except it was who had suffered more, blacks or
Jews? Please.
“I’ll tell you
something, Doc. Slavery took place on these shores not in Europe.” That was that. We were
through sparring, it was just something to do before getting down to business.
Long ago we had agreed to disagree, not on the facts themselves but how to
interpret them. We could do that without rancor which is what made ours a good
relationship. People talk a lot in this country about differences between
blacks and Jews and certainly that was at work in what happened to me at Mount Parnassus but
for me and White Coat the dynamic was healthy. He had that older world-weary-but-wise thing going on, with a wry sense of humor. My role was to play firebrand
black radical, which is in my bag of tricks too. In neither case
was the description completely accurate, we were both playing stereotypes but
we were both professionals, so to
speak, and we met each other’s expectations and the performances were credible.
He agreed to look at the investigative finding, “Off the record.” He said that,
“off the record,” like five times. Yes, Doc, off the record.
The difficulty was
how to get a copy to him. Definitely not by using his office fax machine or an attachment even to a private email account. He was paranoid which is
something else we had in common. The University of
California does not have the CIA’s mission but it does have the CIA’s scope of mission and some of the same
methods, Los Alamos and all that. White Coat himself had told me that. We finally settled on his wife’s home fax machine for transmitting the report but he said he couldn’t remember the number off the top of his head. He said he’d get back to
me, which seemed to me at the time to be his way of blowing me off, but he actually
took my number and texted me that afternoon and a few minutes later Dr. Boyd’s finding
of no wrongdoing went off into the ether.
My guess was that
White Coat would call me in a couple of weeks. He woke me up the next morning.
Since California is two hours earlier that meant it was just after dawn in Sin
City. “What have you done?” he asked. He didn’t sound as if he really wanted an
answer. It was more of a statement.
“Beg your pardon?”
White Coat was
livid. In our first talk in Starbucks he had started to get florid with anger about Palestine and probably the same thing was happening now, long distance, there was just no way to watch him change color. My first concern was his health—getting excited
wouldn’t help his blood pressure or whatever, men our age have to keep our cool. His agitation seemed to rise at first to a kind of
cruising altitude, and then level off, leaving my cell phone shaking not because
he was shouting or cursing but because he was growling in my ear. He said the
report would end the one career that had never occurred to me was really at risk:
Mark Yudof’s.
As White Coat
explained it, there are “rules of deception,” my phrase not his, for a
university president. You can lie to the students—in fact that’s considered
good practice. Keep them in the dark until they graduate—about tuition,
university investments, presidential perks, whatever. In its University of
California incarnation this rule especially applied to the Berkeley campus
where students start demonstrations at the drop of a hat. You can lie to the
public too, to the degree the press will let you get away with it. Which in the
Bay Area was not hard because for the longest time the press was tame, at the Chronicle and the Times. Lying
to faculty is also okay but harder to do because faculty members are by
definition smart people and that kind of deception can be risky in an
environment filled with folks who do research for a living. Lying to the
Regents though is never permitted. If it’s a big deal, like race, and you get
caught misleading the Board you’re toast. The third report on my dismissal,
completed as Dr. Boyd’s UCSF Audit, full of lies and half-truths as it was,
was factual on one point. At the time Mark Yudof wrote to me in a letter that
an investigation was taking place, an assertion he made to the Regents as well,
there was actually no investigation on-going. Audit had reviewed nine
allegations and confirmed two and a half and this was one of the those two and a half. Yudof
lied to me which was not a big deal but he also lied to the Regents which was. He resigned a few weeks later. The black man does not gloat but he did feel a certain warm glow upon hearing the news.
The chairwoman of
the University of California Regents during much of my struggle was a Hollywood mogul named Sherry Lansing, who is married to William
Friedkin by the way, who directed The
French Connection not that that’s important, one of my favorite movies, and The Exorcist, which is not, not
that that’s important either. She was quoted in a Bay Area newspaper emphasizing
that the only reason Yudof was stepping down was his health, which meant that
the real reason was something entirely different. At that point President Yudof had already
been publicly reprimanded by the board for extravagant public spending on his private
life. UC was, it seemed, a two-strike environment and he'd had both chances. This time he didn’t say he wanted “to return to the lab,” like so many others who
get fired from administration at the university but he wasn’t a scientist either. He
didn’t say that he wanted to “return to my first love, teaching,” although he did retire to a professorship at Berkeley’s law school. The
narrative of his departure gradually developed along those lines though, a
return to the classroom. Interesting that Sherry Lansing, who also produced Fatal Attraction and Indecent Proposal and was president of
production at 20th Century Fox and had not just survived but
prospered as a female executive in what is said to be the most cutthroat business
in America, moviemaking, was a poor liar. Not because she didn’t get enough
practice.
Saw some photos of
her, btw, from her earlier acting career, and she was kind of hot, actually.
Riffing on that: if a movie is ever made of the black man’s struggle on campus, on Mount Parnassus and in Oakland at UCOP, a couple of ideas come to mind for a possible title—just
brainstorming here. How about Fatal
Evaluation or, my personal favorite, Indecent
Investigation? My preference for the actor to portray me is Denzel Washington.
The principal heavy,
depending on casting, might be the Regents chairwoman herself, not Sue or Jeff Bluestone. The reason is
that she was as responsible as President Yudof or Dr.
Desmond-Hellmann. Sherry Lansing was Board chair for most of the time the university was
manipulating the facts of what happened that afternoon in the Children's Health Center at San Francisco General Hospital. Every School of Nursing email that became evidence—every
fact or figure regarding the lack of blacks and Hispanics at UC sent by me to President Yudof went to her, also. She did fuck all. And then the Regents were forced to do
something and that was firing Mark Yudof. Is that karma or what? The Regents—and President Yudof—were concerned about anti-Semitism, not the fact that there were no blacks on campus, or that care of
African-American children was poorer than for whites. It was
like that with the Office of Civil Rights, too. There was a hierarchy of equality concern, you might call it, and blacks had been replaced at the top.
Oh well.
CHAPTER TWENTY-ONE
The original title of my memoir was A
Nigger in Nursing: Race, Gender and Corruption at the World’s Premier Health
Sciences University. Only later it was clear that a subtitle wouldn’t be not
necessary. Racism, sexism and
corruption are different faces of the same beasts, inefficiency and unfairness.
Chancellor Desmond-Hellmann committed all three sins, racism, sexism and
corruption, as did her predecessor Dr. Bishop, despite the Nobel Prize and
proto-oncogenes and all. Their successor Dr. Hawgood is doing the same thing
now. Medicine is not synonymous with morality, hello? What the School of
Nursing attempted to do to me was what the University of California has been
doing to blacks and Latinos for a long time. There’s a lot of money at stake in
UC’s “medical enterprise,” as the university calls it, revenue-producing
patents and costly procedures that must continue to be billed for. For that
income stream—to the doctors, nurses and researchers—to continue, and grow, the
poor and minorities have been targeted. It’s not about skin color. It’s about
perceived vulnerability and what UC wants and believes is there for the taking.
It was like that when the university used me for surgical
practice back in the day and when Dr. Duderstadt tried to get my free labor
four decades later. For me personally it was about not being a victim. Wasn’t
that hard a decision, really. It’s not our way—not my family nor my race. And
as an African American you’re always looking for an opportunity to kick a
little white ass, you feel me? It’s hard to accept even now—despite a long
history of racial prejudice in this country—that white people really believe
they are superior due to less-pigmented skin. Color is an excuse to justify economic
crime. It’s like that at UC too, actually. Although whites have used an iron
hand to protect their privileges on Mount Parnassus the actual number of these
super-educated academics who really believe that being Caucasian conveys some
kind of superiority is probably quite small—especially among people who look
through a microscope for a living. This isn’t about melanin, it’s about money,
it’s about jobs and about restricting the labor market—it’s about protecting
one’s own chances and improving the chances of one’s own ethnic group or
culture, or one’s kids.
For example: at the height of my struggle with the School of
Nursing my plan was to write to the Dean of Graduate Studies, a Jewish woman
named Watkins, to get her to force the university to respect my right of appeal
to the Academic Senate. This was another of White Coat’s ideas actually and not
a good one. Dean
Watkins was someone who he said would respond. He called her a decent person.
The rules were clear and they were being broken to prevent a black student from
finishing his education—the sort of thing that even in the South would be hard
to get away with. But the UCSF website happened to mention one day that Dean
Watkin’s daughter was a student in the UCSF School of Medicine. Small world,
yet again. Chances were, it suddenly seemed clear, that the dean wasn’t going
to be much interested in rocking a boat carrying her own child. Which turned
out to be the case. She never answered. The point is that white women like Sue
and Dean Watkins are just as guilty as the white guys were before, but women
are always victims, not oppressors, you feel me, and nurses are there for the
patients not for themselves—that’s also what we’re told. Healthcare is living a
lie but, hey, don’t let it spoil your shift.
Nowhere more than in this archetypical
women’s profession has this hypocrisy been so true. Almost a century ago the
Rockefeller Foundation paid for a study on the barriers to black women entering
nursing, on the theory that jobs in healthcare were one way to cut the rate of
poverty among African-Americans, and especially African-American women. The
results of the research were so bad they were buried for the rest of the
century.
You can only imagine what it was like for
Sue at Genentech, back in the day, one of the few women in the all-boys
environment where medicine met venture capital. The treatment in South San
Francisco was probably worse than before fat Bristol Myers Squibb, but not as
good as it would be working for Bill Gates, later. Sue had to develop some very
high-level defense skills. Because there’s often a lag between what we
experience and how we respond to it. At UCSF she didn’t realize that the environment
had already evolved, the students now mostly women. So, like, the faculty around me in the School
of Nursing was like that too. They
didn’t get it, the old boys club had merely been replaced by old girls. These
were some evil ass bitches but they were some well-educated evil ass white
bitches, that was the big difference for me between San Francisco and
Crackerville, Texas, where my skill at bedside had previously been tested. What
upset Dean Dracup, during our meeting, was my comment that the SON is like an
exclusive white women’s club, telling the Dean of Deans that precisely because
it was run like an exclusive white women's club. There’s a much better argument
to be made that we’re in a post-feminist age than a post-racial one, actually,
which is what everyone was talking about when Obama got elected, America’s
post-racial age, you know?
When Susan Desmond-Hellmann said, as she often did, that women
wanted the same things that successful men have had, she neglected to take
account that ill-gotten success of white men was not due solely to denying
women but also denying black men and Asians and Mexicans. It’s never going to
be like that again, a field cleared of all competition—and especially not for
white chicks, because no brother or sister is going to accept discrimination as
the order of the day, even for purposes of fulfilling white female empowerment. That
would be a feminist mistake. Unless, for me, speaking as one guy, the
pussy was really really really good. Like everything else in human sciences,
UCSF’s version of racism has actually been studied previously, actually, and
being African-American on Mount Parnassus was described in a learned paper, no
shit, prior to my arrival thank you very much. As involving quite literally the
payment of a “black tax” to study there, that’s what the research showed. That
was a few years before my time at the SON, when this involuntary contribution
was discovered, and it was named like a disease-causing microbe. The
paper—written by a UCSF sociologist—said that blacks could fight the system or not but, day by day,
we still have to pay. My bill just turned out to be at the high end.
At one point the industrious Mary Mac sent an email to her
colleagues, which was released to me some years after the fact—in which she
fished among white female instructors who met me, if anyone felt physically
threatened by my presence in the School of Nursing. You couldn’t make it up. She'd
apparently gotten the idea from Dean Dracup, or from the ladies in clinic—or
she’d given them the idea, it was hard to tell. It’s a white female’s standard
fallback in an argument with a Negro male, by the way, similar to a white cop’s
explanation, “I saw him reaching for something,” before he opens fire. Anyway,
let’s see, continuing with the losers on the staff of the Office of Diversity,
including the ubiquitous Mr. Adams, his assistant Ms. De Souza was also gone. That’s
the UC way, btw, the chancellor may not take the blame but will take action
after the fact. Mark Paschal who wrote the second finding, no different from
the first, also got the axe. Actually we exchanged a couple of texts later,
catching up on our post-UC careers. Mostly, it’s the clinic that still sticks
in my mind, years later, the scene first quarter at General Hospital with all
those earnest young white women running here and there, speaking third-year
Spanish, and holding black babies in their arms. Was it wrong to object? You
wouldn’t think so but they did. If you say something like that,
their demeanor told me, you must not like women because everyone knows that
women should be taking care of children except when they’re not because they
have a right to pursue their own careers. This was all too complicated for Mr.
Paschal, by the way, unnecessary detail to my case, he texted me. “You were
complex,” Paschal wrote, long after the fact, “but your case was not.” That’s
code for “You should have taken the deal.”
True or not, his line is pretty good, it
seems, now that my sense of humor has returned. Not accurate but a good
one-liner. Paschal himself landed on his feet, btw. Based in the city, he goes
out to school districts and businesses that are having race or gender disputes
and he troubleshoots or does “investigations,” presumably as he did at UCSF,
first digging to find out from management what outcome is most desirable and
then writing his report. It saves time, one supposes. “But,” was my reply, in
our exchange of messages, “you were fired,” a none too subtle reminder that
selling your integrity can have a cost after the fact. Paschal who is black or
that’s my presumption based upon his voice and manner—perceived on the phone—he
seemed to have a less naive view of the dynamics of diversity in this country
than most of us. It’s a business.
Taking advantage of certain classes of
people in America is a kind of economic activity and always has been. It
accounts for part of the gross national product and, in an evolving
economy, investigating that exploitation is generating jobs and
income too. In the best tradition of the small entrepreneur Mr. Paschal just
wants a piece of the action and he considers his time in the Office of
Diversity a step along the way. “I was never,” he texted me, referring to his
own dismissal, “a big fan of UC.” He is a survivor but not everybody was.
Among the higher ranks, Dr. Thyne was at first promoted and then
demoted. She became General Hospital’s chief of medical staff about the time of
the second investigation but after the third, with the appearance of
inconvenient email, she was suddenly no longer chief. Then she was no longer in
San Francisco at all. She moved to L.A. as chief of staff for a UCLA hospital
in the Valley, presumably still due to her “close relationship” with Dr.
Hawgood who is said to have been a mentor. She landed but not softly. Her new
gig does not have the status of General Hospital which got, by the way, all
that money from Facebook where Sue is on the board, also by the way, not to
gossip or anything.
Anyway, in my unseemly
haste to recount who did wrong and my undue satisfaction over their misery—this
isn’t revenge, it’s justice. At least that’s my claim here. It’s also important
to note who did well, who did the right thing, who stood up and was counted. And
who showed tolerance which is kind of what this is all about.
At UCSF it was a long list and my sister students made up most of it. Despite
outward calm, my nerves were on edge much of those last ten weeks, especially
after the UC pigs began to take an interest. The other students were mostly
cool. No one who’s ever been through nursing school fails to recognize the
danger—the knowledge that at any time the instructors can focus on you as
the person they don’t want to see graduate. It was the first time it had
happened to me and luckily it was later rather than earlier in my education.
Outside the university community the two people who earned my
respect were both elected officials: Governor Schwarzenegger and the San
Francisco Board of Supervisors member for the ‘hood, Malia Cohen, who has a big
heart. It’s
the fashion today to say that Arnold Schwarzenegger was a poor governor but he certainly
fit my definition of an attentive steward of the public trust. Out of all the
tens of thousands of letters Schwarzenegger received in office, many of them
from the disaffected and crazy—in California, after all—his
office plucked mine from the pile and inquired of the Regents what was up with
that? After he was informed of my removal from the university some months
after that—UC emails released long, long after the fact showed his staff again
asking what was going on. That’s my definition of good service by an elected
official, Republican or Democrat. The usual liberals did not respond including
Jerry Brown, who was attorney general, and San Francisco’s state senator Leland
Yee, the flamboyant critic of UC who was just convicted of gunrunning, no shit
again, or Kamala Harris who was D.A. and is now the junior U.S. Senator from
California. San Francisco! It’s a tough town. Just like at Ocean Beach,
you can drown. Oh well. Ooooh well. On the local level of the
potential good guys and good girls there was only Malia Cohen. As she noted in
an email the Board of Supervisors does not have oversight of General Hospital
but my sense was that she didn’t like what she heard went on there. Wasn’t much
really she could do. We’ve all seen video of a public official listening
gravely as some unfortunate citizen pours out his or her problems. It’s true. Sometimes,
just listening is the most important thing an officeholder can do. Back to
the ethically-challenged: Executive Vice-Chancellor Jeffrey A. Bluestone
resigned, “to return to the lab,” where he was soon reported to be working on a
new diabetes drug for Genentech. In the same vein Dr. Daniel Lowenstein who
replaced Bluestone as executive vice chancellor is said to have once described
blacks on campus as troublemakers. That would include me, presumably.
There’s nothing wrong with provocation,
that’s my mantra. As long as it works. The
key to fighting a juggernaut like the University of California, it seems to me
now, in retrospect, was embracing the struggle, not praying for it to end. It
was like swimming at Ocean Beach, you just had to wade in and fight to keep
your head above water. Hope for a good wave, you feel me? To me, Executive Vice
Chancellor Lowenstein was merely the latest face of UC dishonesty, more
disconcerting than hearing about him was hearing the change in White Coat
himself who was telling me about Dan Lowenstein. Suddenly, in our last
conversation, White Coat was out for blood. Mine. He asked: “A lot of this has
been provocation, hasn’t it? Tell the truth, you could have worked it out with
the chancellor. What you saw as ‘burying your case’ was really them waiting for
you to make a reasonable offer. "That’s how the system works, I told you
that the first time we met.”
He added: “You’ve destroyed the careers of people who have
never set foot in General Hospital.” There was a long pause. When you’re
right you’re right, right? There was a provocation component at work here,
sure, but it would have been hard to find an institution more deserving of
provocation than the University of California. This may sound corny—but
whatever ever happened to doing the right thing? Or was right and wrong at UC
merely an issue of negotiation—of where, by mutual agreement, you drew the
line? “Besides,
with Lowenstein the resistance to the criticism is personal.”
“Yeah?”
“His son committed suicide at Berkeley,”
White Coat said, ”and he’s still in denial. Dan seems to see any attack on UC
as an attack on the boy’s memory. He’s old guard in that way. He has a point,
if you ask me.”
“Lowenstein needs to do his fucking
job.”
White Coat went into his long-suffering wiseman routine, which
was okay because my firebrand revolutionary persona was also in play. In all
modesty my rap was a lot better. “What your people don’t understand,” White
Coat said, carefully, slowly, like when we talked for the first time and he
didn’t know what to expect from me, “is that when you tear something down,
something worse may replace it.”
Oh well.
My sympathy for lost careers was exactly
equivalent to their concern for my lost education. To quote an earlier and more
thoughtful White Coat, UC is a big important institution and like any such
organization the people in authority make the mistake of thinking their own
role is more lasting than it really is. Whether it’s thenArmy or the Girl
Scouts—IBM or Apple—no one
is indispensable. There’s always somebody waiting to take your
place—especially the higher you go. An institution doesn’t feel any particular loyalty,
your colleagues may or may not, but what if they’re gone too? Still, there was
one departure that amazed me. So, like, scanning the
news online one day back in Texas, minding my own black business the way the
Constitution says we have a right to do, looking for connections, especially anything
involving Genentech, actually—when a last bombshell landed. In a story about
Genentech’s pricing for an costly med the Washington Post highlighted
once again Dr. Desmond-Hellmann’s confusion about the difference between right
and wrong.
A brilliant woman, capable and forward-thinking, and through and
through a thug. Not that there’s anything wrong with that. The story was about two
Genentech drugs—Avastin and Lucentis—one that costs $50 and the other $2,000 a
dose and both of which do the same job in preventing blindness from macular
degeneration. So, like, the story was about Sue’s time as Genentech's head of
product development, the five years right before she came to UCSF as
chancellor, and basically, as the Post reported, the extreme
efforts she took to push the more expensive drug by misrepresenting the cheaper
one. Not that there’s anything wrong with that, either. “When Lucentis did
go on sale,” the Post piece read, “Genentech’s blockbuster
drug already had a competitor [Genentech’s already existing and cheaper cancer
drug, Avastin, which works just as well for macular degeneration]. How could
the company convince doctors and hospitals that Lucentis had any major
advantage over Avastin? Over and over again [The Company] sought to discourage
use of Avastin by raising concerns about its safety. They told doctors that
Avastin was not approved by the FDA for use in the eye—Lucentis was. They
reminded doctors that if the repackaging firms cutting Avastin into smaller
doses were careless, infection could be introduced. And despite the lack of
conclusive evidence on the point, they said that Avastin patients might suffer
more side effects than Lucentis patients. Sometimes, senior FDA officials said,
these warnings stretched the truth.” This was what the newspaper reported word
for word.
The named culprit in the misrepresentation
in which patients, facing blindness, were forced to pay $2000 a dose for a
medication rather than $50—one Susan Desmond-Hellmann—incumbent chancellor of
the University of California San Francisco, although the authors of the Post story
apparently did not know that. Genentech had stopped selling Avastin to
repackaging companies that cut the med into smaller doses, the Post said,
in order to force sales of the 4000% more expensive Lucentis. This was all on
Sue's watch. “In October 2007,” the Post reported,
“the company’s president of product development at that time, Susan
Desmond-Hellmann, explained in a letter that Lucentis was already available.
Moreover, she said that in a routine FDA inspection of the company’s Avastin
manufacturing facility, ‘concerns were raised by inspectors relating to the
ongoing ocular use of Avastin because it is not designed, manufactured or
approved for this use. An FDA official, Wiley A. Chambers, said that that
company had misconstrued the agency’s position. The routine FDA inspection at a
Genentech plant, Wiley told his colleagues,” per the newspaper, “was unrelated
to the intrinsic safety of Avastin in ophthalmology. Instead, it showed that
Avastin had been contaminated by glass particles, a danger that could have
harmed cancer patients or eye patients. ‘Genentech has found a way to blame FDA
for their decision to limit distribution of Avastin,’ Wiley wrote to
colleagues.” The result was that Genentech under Sue’s leadership pushed a med
that was 40 times more expensive and no more effective because that math was
better for her company.
Genentech was a major university vendor too,
btw. A last, final, going-away open records request to UC asked if the medical
center on Mount Parnassus was charging for the more expensive Lucentis, instead
of the cheaper Avastin, but the request was never answered at UCOP by the new
president, Janet Napolitano. Anyway, Sue resigned shortly thereafter. The Post did
the heavy lifting but in all modesty my efforts must have been helpful. This
wasn’t emancipation by the way, as Nan and Andrea claimed. It was liberation and
my fist was raised in the air. Sue landed on her feet of course, she
wasn’t in the breadline by any means. She was hired by Bill and Melinda Gates
to lead their foundation. In some respects it’s a better match for SDH. She’s
very smart and very competent, she got UCSF’s finances back in order for
example, if only through industry ties, but the ethical incidents—she just
couldn’t stay up on Mount Parnassus any longer. She's a gangster of course,
probably a bigger one than Mark Yudof or Sam Hawgood, not that there’s anything
wrong with that. At the Gates Foundation she can use her talents to deal with
her former colleagues in Big Pharma. Women in leadership ? Great—but the
idea that somehow they are more ethical than guys? Dream on. They just haven’t
had the opportunity to do wrong that white men have had. White women seem to
have hit the ground running, one must say, though, bad-acting in power, so to
speak. Working in an environment of practically all women, lo these many years,
my feeling is that women are the same, only different. They’re no better,
certainly. That’s what diversity means, by the way, black people included. We're
no better than whites but we are equal. Hello ? We’re all different but
all the same. No one is better than anyone else. An exemplary example of
bad-acting, once again involving Sue, not to beat that drum again.
Back, after the Times reporter
flew to San Francisco to talk to her about her choice of investments, my
question to him was of course, never having met the Golden Girl myself: “What’s she like?”
“Very genuine,” he said.
In their talk up on Mount Parnassus, the
reporter told me, Sue described the Marlboro cigarette holdings as only an
oversight. Her financial disclosure form was hand-printed, by her, in clear
neat penmanship with one mistake in spelling crossed out by a single line and
initialed SDH to verify the correction, just like a doctor correcting an entry
on a patient’s chart. The official explanation was that she merely copied what
her financial advisor gave her and never really paid any attention to the name
“Altria”—maker of Marlboro—or the description, “Tobacco,” which is a
carcinogen, also hand-printed by her. Fair enough. Believe what you will,
certainly stranger things have happened.
The next year howeve, looking at her new financial
disclosure form, she had no stocks at all. The previous year’s form with page
after page of wealth and wealth management, devoted to the $30 million she
received for selling her Genentech holdings, was gone. Probably her husband
took ownership of her portfolio in order to avoid embarrassing questions in the
future. That’s cool, too. It’s the way the system works. It’s perfectly legal. One
of her few assets listed, that second year, was a $50,000 annual payment by
Genentech, for a position she held during much of her tenure at UCSF, on the
company’s science advisory board. A request for her email to and from Genentech
brought the response from the university that she did not communicate by email
with anyone at the company where she was formerly president of product
development and then on the science advisory board. Oh, really? Well, that’s possible too—not likely but
possible, because anything is possible in the Bay Area where America’s best and
brightest live, work and play. About the same time Sue gave a talk on
medical entrepreneurship as part of a colloquium at Stanford University and the
first question from a student in attendance was about her tobacco holdings. That
question gave me a warm feeling all over. It was one of the few times this very
self-possessed physician appeared to lose her cool in public. She danced around
the question and finally assumed the role of victim, describing her invaded
privacy as a public servant in the State of California. “They can ask for my
email!” she told the audience. Yes, they can ask. But you can
say you don’t have any.
CHAPTER TWENTY-TWO
Women always want to know how you feel, it’s
not just a cliche. Working in this job, especially with all these chicks,
any kind of personal interaction ends with being asked some version of, “How
do you feel about that?” Whereas with guys you can go weeks if not months
without being asked that particular question. Years, in fact. My answer is
pretty good, actually. Even though some shit doesn’t change.
There was a streaming of UCSF’s diversity
conference last year, led by Dr. Navarro, who is the designated
Negro in the administration. She was talking about a climate survey that had
just been taken on campus and its results were, according to her, that the
climate for minorities on campus was improving. There was just a tick or a
hesitation when she said it—something that made me suspicious. For good
reason. If you looked on the university website, where the numbers were
actually broken down by race, whites on campus felt the
atmosphere for minorities had improved but minorities did not. Because there
are so many more Caucasians on campus. Dr. Navarro was able to report the
majority opinion—to lie in other words or misrepresent the truth. That’s UC. Very
smart people who know how to mislead. If you're dishonest you can learn a lot there.
The U.S. Department of Education’s Office
of Civil Rights finally busted the university however. As the diversity
conference was taking place, Dr. Navarro herself had just signed a consent
degree with the Office of Civil Rights pledging not to violate
anti-discrimination laws in the future. After a Muslim dentistry student got
failed—again in clinicals, where there was no objective standard of
performance—she just happened to be an Egyptian female, who was dinged by her
preceptors for speaking Arabic in the clinic. You couldn't make this up. So, like,
one way to look at it—that behavior contract Mary talked about finally got signed, right? Not
by me but by the university. And a few months later yet another sentinel
event. This time in District Court. Michael Adams sued UC, Dr. Desmond-Hellmann and the whole
administrative crew who fucked me, actually, not that there’s anything wrong
with that. He said in his lawsuit that he was fired for trying his utmost to
bring diversity to UCSF, while Sue and Jeff wanted him to downplay race on
campus. The truth will be revealed, one supposes—he has demanded a jury
trial. There’s the very real possibility of course that Mr.
Adams sees this as a way to make a few bucks, especially from Sue who’s got a
lot of bread courtesy of Genentech. My guess is she and the university will
settle for a mil or two. She’s working for Bill and Melinda Gates now, and
still on the board of Facebook, which is having its own image problems, and she
needs to be sitting in a federal courtroom describing her role maintaining an
all-white campus like Mark Zuckerberg needs a hole in the head. So, too,
President Yudof’s successor Janet Napolitano—what are the chances she’s going
to want to explore race in higher education in an open courtroom? You know?
One interesting sidelight of Adams’ suit, this is incredible karma actually,
he says in the pleadings that among the reasons he was fired was for calling
Dr. Navarro an Uncle Tom. The woman is not an Uncle Tom of course,
she's an Aunt Jemima, and that raises a pertinent question. If
Michael Adams is an Uncle Tom and he calls Renee Navarro an Uncle Tom, what
does that make her, an Uncle Tom squared? Something like that? An über-Aunt
Jemima? Stay tuned. It may get sorted out before a jury.
In another race-related lawsuit, a
Japanese-American female researcher recently accused Mr. Otsuki of UC Audit, my
inquisitor, who is also Japanese-American, of faking his investigation
into her discrimination case. Mr. Otsuki is no longer with
UCSF, retired after valiant service or he may have gotten a
shove during housecleaning. Figuring out what happens at UC is like
Kremlin-watching, or reading tea leaves, or reading an editorial in People’s
Daily. Mostly for me it was seeing Mark Yudof take a fall that was the high
point of my civic involvement as an African-American in America. Yudof was a thug back in
Texas too, and probably at the University of Minnesota after that, so the ending his career at UC didn’t lose me any sleep. That’s what it means to say racism
and corruption are different faces of the same coin. It’s just that if you’d
asked me before the fact, my bet would have been that someone like President
Yudof would get in trouble for race in Texas, in the Old South, and corruption
in San Francisco, not the reverse, shady business relationships and backroom
deals in Texas, and skin color in the liberal Bay Area, not bias, not race and certainly nothing
involving moi, thank you very much. Wrong again. My joy over President
Yudof’s dismissal had its limits, however. Eventually you have to leave the
race wars behind and earn a living and in my present gig that involves bodily
fluids—Churchill’s trinity of blood, sweat and tears—and the nursing trinity of
pee, poop and buggers. There’s probably a Code Brown being called somewhere down
the hall at this very minute. My bargaining position in the endless
exchange of emails, with administrators and investigators, was a wish to return
to my studies. Actually there was bad faith on both sides because that was
never really the plan, not after my last few weeks on campus and especially not
after UCPD got interested. Well, why didn’t you just sue? That’s what people
ask. That’s what we do in this country, we file a lawsuit. It’s lawyers,
actually—having an allergy to the profession, actually. In my family we’ve gone from slaves to criminals to lawyers in just three
generations. The speed of those transitions has left me a little dizzy. So,
like, who said you can never go home again? That’s not necessarily true.
You can go back to places you’ve been, you just can’t go back
to being who you were when you were there before. UC was for me—graduate school
was for me—a great education. And it continued to be a learning experience
throughout my unsuccessful struggle with the Board of Regents. But you know,
once you graduate, finally, it’s time to move on. Sure that’s a
rationalization. And the setting did have a role in my decision. Baghdad
by the Bay: Never again, thank you very much. Been there, done that.
That town! Like my Jewish brothers and sisters say, never
again.
Not because any of those General Hospital bitches
beat me down or succeeded in turning me into a victim. What you read here
is about how not to be a victim. How not to be somebody’s bitch or running dog
for the white master, you feel me? As Mao or Malcolm X might have said. That’s
the secret of whatever success black people have had in this country. We fight.
It’s just San Francisco, it’s hard to explain—never again. You
feel me ? If the East Coast is
the beginning of the continent, New York, Boston, Philly and environs, where
people arrive as immigrants, San Francisco is the end, where you either make it
or you take a dive off Golden Gate Bridge. Or you move to L.A., like Dr. Thyne,
which is worse. Having barely escaped both those fates, it’s my
intention not to try my luck again.
Not all my memories of the School of Nursing are bad. There was
the way Tara’s nose flared when she was nervous. That is my most memorable
recollection probably—she was making a presentation on a kid’s case, sitting in
front of all the pediatric nursing students, and the instructors, Karen
and Naomi and Angel, all the usual suspects, really. Tara got married a while
ago, someone showed me a picture online, looks like he’s a good guy, may she be
forever happy. The memory of swimming at Ocean Beach stays with me too, even
today. However far out you went, half a yard or a quarter mile, was too far.
Getting in the water above your knees meant taking your life in your hands. But
that was cool, you want to be a risk-taker as a black man, you have to put all that testosterone to use.
There was also the fog that is a real presence in the city, with
a personality of its own—worse in summer. You could watch it coming up Mount
Parnassus, creeping up the hill from the ocean, literally, holy shit. It was
easy at times like those to imagine the city in a prior day, the famous row
houses being built, the turn of the previous century, ’01 for example—when Grandfather mustered out at
the Presidio. To him the 9th Cavalry was a job that got him
out of Texas and as far away from the South as he could go. His job
description? Killing for the white man. So, like, when he left San Francisco,
a civilian once again, he merged into what was still the frontier. Bowler hats
and floor-length skirts, the Chinese settling in, they’d come to build the
railroads, that’s what the history books told us, and a scattering of blacks
like Grandfather himself who had escaped Jim Crow—he was riding back south and
it seemed like the best direction for him to go, back to Texas. For him San Francisco was probably a
more dangerous environment than anything he saw in Southeast Asia. My family has never been particularly God-fearing but my belief is
that Grandfather never approved of Baghdad by the Bay. God knows that my mother
didn’t. The look in her eyes when she came home from work, after spending her
day with the Symbionese Liberation Army and the Panthers, it was like she was
in shock. Good thing that Mother never had to deal with the Office of Civil
Rights or the University of California Board of Regents, that’s my feeling now,
it could have been worse. Separated by generations we have that much in common. For Grandfather, the first generation of my family born free, the white institution that changed him was the U.S. Army.
Because something happened when he was in the Far East, back, back in the day. ‘00 or thereabouts, that altered his perception and my own—hearing of it—and is
pertinent here and now, talking about UC or even the CIA. In the Phillipines
two Buffalo Soldiers went over to the enemy.
At the time the Army was fighting an
insurgency, many of the guerrillas were Muslims who didn’t want to substitute
American domination for what they had already experienced under the Spanish. Anyway,
these two soldiers apparently felt they had more in common with the rebels than
with the white men who were their officers. So far, so good. These two brothers
spent a time in the jungle with the guerrillas, who were called Moros, btw, before accepting blandishments by officers to return to the Army.
The two Negroes took the deal, as White Coat would have said, and they lived just
long enough to regret the decision. The Army took them back—and hanged them.
That’s what it means to say you can never go home again, you can never go back
once you’ve passed a certain threshold, crossed a certain line. That’s what it
felt like for me suddenly in Baghdad by the Bay. Going over to the other side
is not something to regret particularly, or not at all, but it’s not a step to
take lightly either. If your advocacy reaches a certain point you can’t just
shake hands with old adversaries and make friends. And never never never trust what white people
tell you—there’s almost always a noose waiting. Especially in San
Francisco. That would be my point actually, that would be my premise. It‘s a tough town, believe me. In Baghdad by the Bay never never
never take the deal. Do what you think is best but be careful how you do
it. If you’re going to fight you have to be prepared not to
take any prisoners or not become one yourself in San Francisco. You can give up but you
can’t come back, you feel me?
Anyway, that was the big lesson of my
graduate studies, in life and in the Science of Nursing. It was an expensive
education but complete and detailed and in the best tradition of one of
the world’s great institutions of higher education, the University of
California.
Fiat lux!
