The Comfort We Had Is Not Here II of III: What My Job Was

after Anand Swaminathan, MD [ June 16, 2020 ]

The surge was really hard, but at least I knew 
what my job was. We were all struggling 
with the same problems, everyone in the medical field. 
Systemic racism is more difficult. It was always here, 
and it’s not like I’m working with colleagues 
through a difficult disease. I am learning, but 
I feel isolated in my ignorance.

During the surge I focused on reading and guiding 
others through, so they wouldn’t make the mistakes 
we made. I felt like I was doing something, although 
clinically it was hard to do anything. I have friends 
who are starting to hit their surges now, and I just 
provide the same information over and over. 
The pandemic moved quickly, our knowledge progresses
so slowly. Now, a new kind of helplessness. I’m married, 
I have three kids. How do we talk to our kids about this?

I grew up with an idyllic image of America 
with immigrant parents. The classic: my dad came 
with $10 in his pocket. The other part of that story –
and my dad would never lie about it – is that he had 
a medical degree. So yes, he only had $10, but 
he had a job and a place to live and somebody feeding him. 
We believed that we came from this place without 
privilege, but we had the privilege of education. 
Growing up, I dealt with racism because we lived in a white 
neighborhood. My school was private, very white, 
well to do. Racism was there, but I didn’t know so much.

My dad was a general surgeon. He made house calls 
to friends and neighbors. I didn’t want to a doctor 
who could only tell you about the lungs or the heart. 
I wanted to be able to provide information 
about anything when people asked. I like the undifferentiated,
not knowing what I’m going to see, talking with patients,
detective work. So I ended up in emergency medicine.
I’ve always worked with inner-city populations. 
I trained at Newark and Belleview, on the faculty 
there for 9 years. If you’re in New York City, Bellevue 
is the end of the road. On any shift, we were speaking 
six or seven languages with a translator phone. 
We saw lots of NYPD prisoners and all the male 
Rikers Island patients. So, the recognition 
of institutional and systematic racism 
came very quickly for me—all there in retrospect. 
But when you’re a resident training, it isn’t apparent. 
I saw hundreds of Riker’s inmates, I can count 
the number of white men I saw out of those hundreds. 
It was all African American and Latino. NYPD prisoners 
were a little more mixed, but not that much. 
Now, I see how the same person, based on skin color, 
was either arrested or just brought in 
and left in the Emergency Department to sober up.

Working at Bellevue, on a particularly busy night shift
the medical clearances came in from NYPD. 
We had to check and clear prisoners 
so they could go to jail. I remember 
a young Af Am man, probably mid-20s, 
obviously upset, which I get. But he was giving us 
a hard time, giving the nurses a hard time, giving 
the officers a hard time, giving me a hard time. 
I think I said, You’re wasting all of our time, 
we just want to get you out of here. And he said, 
I don’t want to be here. Then I said, Well, then 
you shouldn’t have gotten arrested tonight. 
He was pissed. Even if I was thinking it, 
I shouldn’t have said that. I now realize how much 
worse that was. Immediately, I knew it was wrong, 
I walked away from it, sent somebody else 
to care for him, which is nice, remove my bias 
from the situation, but I didn’t apologize. That will stick 
in my head forever. He doesn’t deserve to be treated like that. 
That’s not my job. I think about that every time 
I see a prisoner. My job is to take care of them. 
It doesn’t matter what they did.

Of course, now it does matter – not what the individual did, 
but the larger context. Working at St. Joe’s, we see a lot 
of arrested people come in as patients. I’ve taught myself 
over the last decade or so, with patients in handcuffs, 
I don’t want to know what they did. That’s not my role. 
I want to be as empathetic or sympathetic as I can. 
Now we’re realizing that’s not enough. What I thought 
was really good, was just the baseline. There’s much more 
that needs to be done for those patients.


JULIA SPICHER KASDORF