On April 7, I received an alert from the Tulane University Police Department describing a confrontation involving two of my fellow Tulane affiliates. Someone had interrogated them about their race as they walked near the hospital, then issued a death threat while revealing a handgun. “If you are Chinese or Japanese, I’m going to kill you.” That menacing declaration haunted me as I prepared to see my next patient.
A sign on the door of the examination room read in large letters, “Special Isolation Precautions,” indicating that the patient had tested positive for SARS-CoV-2, the virus that causes COVID-19. I donned my personal protective equipment — plastic gown, gloves, N95 mask, face shield. My mind was elsewhere, and I was relieved to have committed this ritual to muscle memory.
I knew with each patient encounter that I was vulnerable to becoming infected. I had heard the stories of dying healthcare workers in New York, Wuhan, and other parts of the world. I took the risk seriously, but I knew what I was getting into when I chose infectious diseases as a specialty. I understood that we combat contagious pathogens such as tuberculosis, measles, and Ebola, sometimes becoming infected ourselves in the process. What I did not know was that the job called for combating a different kind of epidemic as well.
“If you are Chinese or Japanese, I’m going to kill you.”
I am used to racism. I was born in Virginia to Chinese immigrant parents. My native language is English. I have lived all over the U.S. and chose to come to New Orleans to care for a vibrant community with great medical needs. Still, no matter my cultural identity or professional achievements, I am always shadowed by jokes about my eyes and questions like, “But where are you from from?”
In my first week as a medical intern, my supervising physician, also Asian American, overheard a patient refuse my care while calling me a racial slur. With a knowing hint of shared experience, he whispered, “You have to have thick skin to go into medicine.”
I now consider discrimination an occupational hazard for physicians-of-color. As a minority in this country, I quickly learned that ignoring racist microaggressions is an essential survival skill.
COVID-19 has intensified my racialized experience as an Asian American. I have received taunts of “Coronavirus!” and been questioned about my infection status by Uber drivers. With President Trump fanning the flames of xenophobia by using the term, “the Chinese virus,” verbal and physical abuse towards Asian Americans have dramatically increased. Nationwide, nearly 1,500 cases of discrimination towards Asian Americans have been reported in one month alone. Asian Americans have been abused on sidewalks, grocery stores, and subways. We have been denied services, yelled at, spat on, beaten, and stabbed. We have been discriminated against by our neighbors, our classmates, and even our COVID-19 patients. Like all healthcare workers on the frontlines, Asian American physicians and nurses worry about the risk of infection to ourselves and our families. Meanwhile, we simultaneously have to worry about a second and arguably more pernicious fear.
I maintain an emotional distance to protect myself from moral injury, just as I keep a physical distance from others to prevent infection.
The impact of racism during this outbreak is not limited to Asian Americans. African Americans are both more likely to become infected and more likely to die from COVID-19. In Louisiana, African Americans account for 56 percent of deaths, though they make up just 33 percent of the population. Higher rates of co-existing medical diseases are a contributing factor, but we must not ignore that these differences stem from structural racism, in place long before COVID-19. African Americans in Louisiana are more likely to live in poverty, less likely to finish high school, and less likely to have employer-sponsored health insurance. During an epidemic, these chronic inequalities are amplified. Differences in the ability to self-isolate, housing density, incarceration, and other social determinants facilitate contagion and worsen the impact on African Americans.
New Orleans is a gumbo of cultures; we celebrate this. But in order to fully respond to this pandemic, we as a community must recognize and confront the racial tensions and disparities it has unveiled.
The April 7 incident, which I can only call a hate crime, occurred at the intersection of Tulane Ave. and Claiborne Ave., halfway between Tulane Medical Center and University Medical Center. I walk this path several times a week to reach the multiple hospitals where I work. I will not walk there again.
I have developed a thick skin to defend against racism during this outbreak, as my supervising physician advised. I maintain an emotional distance to protect myself from moral injury, just as I keep a physical distance from others to prevent infection. Both coronavirus and racism are invisible, but when faced with racial threats and discrimination my N95 mask is useless.
Under the highway overpass, with the assailant’s gun visibly signaling peril, my Tulane colleagues defused the situation by assuring that they worked at the hospital and were “here to help.” I, too, must remind myself that the joys of celebrating patient triumphs overcome other fears.
Outside the patient’s door, I double-checked that my personal protective equipment was secure — plastic gown, gloves, N95 mask, face shield and, underneath, my thick skin. I opened the door and said, as much to myself as to the patient, “Hi, I’m Dr. Zheng, I’m here to help.”
Crystal Zheng, MD, is an infectious diseases physician at the Tulane University School of Medicine. Follow her on Twitter @CrystalZhengMD.
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