Reflections of a Naïve Trainee to Barnes Jewish Hospital/Washington University in 1970—My First 25 Years

“Aubrey, I didn’t know you were that smart,” said my colleague, a White faculty member who had known me for years, after I presented a research seminar in 1980. I brushed this off at the time, but in retrospect, it was one of many microaggressions I experienced in my early days at Washington University. I graduated from the Royal College of Surgeons in Ireland and arrived in St. Louis, Missouri in 1970 to start my postgraduate education at Barnes Hospital/Washington University as a rotating intern. This was just a 1-year position, but I hoped that with hard work and determination, I would be asked to stay. Starting my first rotation on the Washington University surgical service at City Hospital, I immediately recognized that all of the physicians were White. I stood out as the only Black physician. For many years, the hospital was kept strictly segregated, with Black patients kept in the rear part of the second and third floors. City Hospital had also denied professional training to Black physicians. By the time I started, the hospital had already been desegregated so that I took care of both White and Black patients in open wards. Through all my rotations for the first 6 months, I remained the sole Black house officer trainee. On my first day at Barnes Hospital in the surgical suites, I was asked on several occasions to bring a stretcher to the OR before the staff recognized that I was an intern, not a transporter. One observation that struck me was that Black patients were not often an integral part of their medical care decisions in the 1970s.

In October, I met with the assistant of the Chairman Dr. Carl Moore to request an appointment to inquire about a position on the medicine house staff. His earliest availability was in 2 weeks, so I made the appointment and turned to leave; simultaneously, the door to the inner office opened, and framed in the doorway was a gray-haired gentleman in a starched white coat puffing on a pipe. “Is there a problem,” he questioned. I blurted out that there was no problem; “I was just here to make an appointment to speak with you about joining the medicine house staff.” After a long pause, he invited me into his office. Stunned, I introduced myself and explained my desire to pursue internal medicine training here, including repeating intern year. Dr. Moore replied, “I have been 17 years here as Chair in Medicine and had only appointed three rotating interns to transition to residents in medicine and they were all MD, PhDs.” After digesting that information, I thanked him and got up to leave with my tail between my legs when he said, “Just to be complete however, I would like you to fill out a formal application.” I left the office disappointed, but I filled out the application, returned it, and began facing my likely return to Ireland or England to complete my training. Later that year, however, Dr. Moore accepted me as a resident in medicine, and I am forever grateful for that decision.

The ward service had 12 interns handpicked by Carl Moore every year, and we covered three floors of patients. At some point, I saw a photograph of Carl Moore making rounds on Black patients in the basement of Barnes Hospital. The walls were all tiled, and there were no windows. This image made an impression on me and raised the question of when the Black patients moved out of the basement. I learned that in the 1950s, Barnes Hospital, which had always accepted Blacks, had bed space for 435 and allocated 45–50 beds for Negroes; most of these patients were confined to a basement ward below street level. Barnes integrated its wards in 1963, and 1 year after that, Title VI of the Civil Rights Act of 1964 mandated that all facilities that accepted federal money could not discriminate by race.¹

As a senior resident in 1972, a White patient I was evaluating would not make eye contact with me. I indicated that I needed to examine her, and she absolutely refused. In my note under the physical examination section, I wrote, “patient refused.” The attending Dr. Edward Reinhard later called and asked for my assessment. I explained what happened. About an hour later, I was paged to indicate the patient was now willing to be examined by me, so I completed my evaluation. The following morning, I asked Dr. Reinhard what he told the patient that made her change her mind. With a little wry smile on his face, he said that he told her “Dr. A. R. Morrison is the senior resident on the floor, and if she refuses to be examined by him, she will need to find another doctor.” This act was very reassuring to me that the program was committed to supporting its house staff in confronting this and similar acts of racism on the service.

I started my renal fellowship in July 1973 and in 1975, became the first Black Chief Resident in Medicine. With tremendous support from David Kipnis (Chairperson of Medicine), I then completed postdoctoral training with Philip Needleman, then Chairperson in Pharmacology, from 1976 to 1978. This was one of the best decisions in my career as it set the foundations for a successful career as a faculty member at Washington University. My research progressed well and resulted in promotion to assistant professor in 1978. I secured RO1 funding and was awarded an Established Investigator of the AHA, followed by the Burroughs Wellcome award in Clinical Pharmacology and election to the American Society of Clinical Investigation in 1982 (the first Black physician to be elected). Although my personal advancement in academic rank progressed, I did feel that I was not encouraged to seek significant administrative responsibilities. Another observation was that although we had about one Black physician added to medicine house staff annually, none stayed on faculty after fellowship training in those first 25 years. Today, there are more URMs on the medicine house staff and faculty, but there is still a lot of work to be done.

In 1979 as a young renal attending, we were asked to see a patient with hypernatremia on the neurology service. It was clear that the patient had hypertonic dehydration produced by high osmotic tube feeds and needed free water to normalize his serum sodium. I calculated the free water deficit and left the renal recommendations. The neurology attending was clearly unhappy, came over to me, and said, “I do not trust your judgement and would like one of the more senior nephrologists to see my patient.” After muttering a few expletives under my breath, I asked Eduardo Slatopolsky to see the patient for me. Eduardo then looked at my note, copied the recommendations word for word, and signed it. Although I appreciated the support from Eduardo, this was a sobering reminder for me that who the messenger is does matter. Subsequent to that encounter, that neurologist always acknowledged me but never mentioned that incident, nor did he ever apologize.

In 1981, a new fellow started work in my laboratory. He would work nights and be absent from the laboratory for long hours during the day. After several months in the laboratory, he came to me and said he would like to submit an abstract to the American Society of Nephrology. I responded with some alarm; he had never shown me the data. This first-year fellow working in my laboratory responded to me that the data were so novel that he was not sure he could trust me. I believe this was because of my race. For me, he had not just crossed the line; he had pole-vaulted over it. I replied to him, “Please go tell the chief of the division [Saulo Klahr] that you will need to find a new laboratory.”

Years later, one of my peers in the Department of Medicine who I had known for at least 15 years underwent cardiac bypass surgery. Postoperative, he had an increase in his serum creatinine, and renal was consulted. The patient asked who the attending was. When he was told Morrison was the attending, he asked to be seen by another attending. Dave Windus, who of course was White, and one of our other renal attendings did the consult. The patient recovered, returned to work later, acknowledged me in his usual manner, and continued as if nothing had happened. This was eye-opening for me.

It is my hope the readership empathizes with some of the racial hurdles I had to navigate on my personal journey at BJC/Washington University. I suspect many Black physicians have similar stories to tell, but my use of the word “naive” in the title reflects the fact that I was not born in the United States and reflects my first experiences of society here. I hope by sharing them to contribute to the dialogue our country is having on racism. I would also like to point out that I had allies on the faculty who were very supportive and helped me navigate those troubled waters successfully.

Disclosures

A.R. Morrison reports consultancy agreements with the Robert Wood Johnson Foundation–Harold Amos Minority Faculty Development Program; honoraria from the Robert Wood Johnson Foundation; and being a scientific advisor or member on the National Advisory Committee of the Harold Amos Program.

Funding

None.