A Black Trauma Surgeon on 'Racism, Violence, and How We Heal'

— Brian H. Williams, MD, talks about his new book, structural racism, and gun violence in the U.S.

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In this video, Jeremy Faust, MD, editor-in-chief of MedPage Today, and Brian H. Williams, MD, surgeon and former congressional health policy advisor, discuss Williams' new book, The Bodies Keep Coming: Dispatches from a Black Trauma Surgeon on Racism, Violence, and How We Heal.

The following is a transcript of their remarks:

Faust: Hello, it's Jeremy Faust, editor-in-chief of MedPage Today.

Today, we are going to be joined by Dr. Brian H. Williams. Dr. Williams is a trauma surgeon. He was the team leader at Parkland Hospital the night of July 7, 2016, which received the mass casualty incident in which the most U.S. law enforcement officers were killed since 9/11.

He is also now an author. His book, The Bodies Keep Coming, is coming out soon. He is now running for Congress from Texas after being a healthcare policy advisor and fellow in D.C.

Dr. Brian H. Williams, thank you so much for joining us.

Williams: Thank you for having me. It's a pleasure to be here.

Faust: So the book is called The Bodies Keep Coming: Dispatches from a Black Trauma Surgeon on Racism, Violence, and How We Heal. I read this book over the past week or so and it's very, very powerful.

As a trauma surgeon, you see what I see as an ER doctor, which is the end result of these problems that you characterize in the book and so many [others] have as well. It reminds me of a quotation from a well-known physician in New York, Lewis Goldfrank, who worked at Bellevue. Dr. Goldfrank would always say, "What's the lesion?" And what he meant, not what's the lesion of the brain that caused this stroke, but he meant what's the lesion in the healthcare system that led this patient to come here today for this problem?

In your view, what's the lesion that's behind that steady stream of bodies?

Williams: There's a systemic issue with, in my mind, structural racism. It's something that we are beginning to wrestle with more in academic medicine. You see a lot more research coming out about this. We talk about it more freely and openly in our academic centers. It's beginning to become more discussed in mainstream media.

But it's a confusing term, right? What does that mean? We're addressing these structures that put certain populations at risk, and they overlap in medicine because these are also structural or social determinants of health, right, our lived environment -- education, housing, economic inequality. If we can address these structural issues that will lead to racial disparities in healthcare, we can do a lot to uplift individuals and communities.

So I see that as the central lesion that we need to address, not just in healthcare, but as a society.

Faust: Absolutely. And in medicine itself -- you write about this -- we were taught, I was taught, that a risk factor for this disease or that disease might be "race." But in reality, I think that we now know that's almost never the case, right? It's always racism. It's a problem of the society.

Do you experience that there's been a change in the house of medicine about this in terms of people like me, white physicians who didn't necessarily have the whole spectrum of understanding during medical school and training, and also people who refuse to accept that? What's your experience been over the past 5, 10 years where I think we've seen a lot of shift?

Williams: I think this is really the beauty of being in academic medicine, right? We're continually challenging our old way of thinking and trying to improve. I remember when I was a medical student, I was taught all the time that race is a risk factor for X, Y, or Z. Now, we recognize that it's racism that contributes to a lot of these disparities.

I do feel that there's a shift and a movement within medicine to address this and discuss it head-on. But, as you mentioned, there is still resistance. People don't want to accept that, or it's hard to understand because you can't point to a specific person or a specific issue. A lot of this is just the structures that exist around us that lead to these disparities.

I'm really inspired by the newer generation of medical students and residents that are coming out now. I think they're much more socially aware and courageous to address these issues to improve the well-being of our patients and our communities.

Faust: Yeah, I agree with that. I also think about demography. We know that anyone can treat anyone, but we also know that there are better outcomes when, for example, a Black physician is treating a Black patient. We've seen all kinds of studies across different demographics that tell these stories that we didn't always want to acknowledge.

In terms of recruiting the next generation in, do you think that we're doing an OK job here? You write about the really devastating impact of the Flexner Report, how few Black colleges and Black medical schools there are, but also every other medical school has a role to play here. How's the pipeline from your perspective as someone who people now look up to and say, "Hey, I want to be that guy."

Williams: This is something I still really struggle with, Jeremy. How do we get more -- for me, Black men in medicine, we represent 3% of physicians -- but just more marginalized, underrepresented communities in medicine, racial and ethnic minorities?

The pipeline is just not enough, right? Because we need to help people get interested in these sciences earlier, help them be able to succeed during elementary school, high school, college.

But also when they get into these environments, as they move up, we become a smaller proportion of who's represented. We go to these institutions and, you know, I was the only Black trauma surgeon where I was working. You have to be representing for the trainees and be there for them, but also be there for your patients and do your job and do all these other things that come with being the minoritized individual in a group.

There's a lot of extra work that comes with it that we accept, right? That's good weight to carry. We do that. But we need collaboration and to work with allies who recognize that this impacts all of us. It's not just the role of Black people to address lower representation for Black students in medicine, or Hispanics, LGBT -- choose whomever -- it is the role for all of us, because it's not a zero-sum game. When we uplift all these different groups, we all benefit from that, and our patients benefit from that as well.

Faust: I couldn't agree more. There was an editorial recently in the New England Journal and Clyde Yancy wrote about how the affirmative action decision of the Supreme Court really is going to hurt everybody. This is not about one group having an advantage. It's really about everyone being benefited by having a workforce that reflects the patient population.

Williams: Right. I wrote about this. The example I talked about is the EMS services that began, I think, in Philadelphia. This was a group of Black men working with a local medical school to start local EMS services, which we take for granted now. We all benefited from that. We all can contribute to the health of our communities and our nation.

Faust: Let's talk a little bit about "that fateful night" -- July 7, 2016. You were the trauma team leader at Parkland Hospital in Dallas.

For people, just to have some context, Parkland is a very storied place in American medical history. The entire burn formula for how much fluids we give is called the Parkland formula. JFK was received there when he was assassinated. This is a place where a lot of important things have happened. And then you were in charge the night of this mass shooting in which we had a bigger loss to U.S. law enforcement than any other event since 9/11.

Something struck me in your description of this night -- well, two things. One thing was as an ER doctor, just how much resonance I felt reading your description of that. Everything rang true; yep, that is the feeling of it. That triggers a lot for people in our field.

The second piece though is that you cried that night. Which you say, and I believe you, you had never cried before in the medical setting, even though you had seen so many gunshot wounds on young people. Why do you think that night was the one that tipped you over?

Williams: I think that at that point, I was at my emotional bursting point for a lot of reasons. I had this pent-up anger about injustices within the system. I had spent so much time treating gun violence victims that were mostly young Black men, and that wasn't changing.

At that time, it was a unique time in our country's history, right? That was the election between Clinton and Trump. If you think about that period, what was happening the summer before the election, and the days prior we had the shooting of Philando Castile who was shot in his car and died. His girlfriend livestreamed his death, which is kind of a morbid thought, but that happened. The next day, Alton Sterling was shot and killed at close range in Baton Rouge.

So there was this groundswell of protests for racial justice that were occurring around the country. I'm thinking about like, what is my role in all this? I'm sitting here in the hospital taking care of patients, but is that enough?

When [the shooting] happened, the police officers came in that were injured and three died. And I learned that it happened at this rally downtown, that there was a Black shooter. I talked to the family and I told them what had happened, which is something we do frequently in our line of work, right? Give them bad news.

Normally, we go right back to work, because we have to get back to work. I took a moment, went down this back hallway where I'd never been before and was by myself, and I just dropped to the floor and started crying. I mean, I was convulsive crying. The cork had just popped.

It's a night I still think about today. I still think about that evening everyday up to this point. It was clearly a personal transition point for me for the emotional being I was. Then what followed was the professional evolution as well.

Faust: You quote your wife, Kathianne, saying, "You're the only person in the world with this experience -- a Black trauma surgeon who tried to save the white police officers shot by a Black man because of racist policing." When you heard those words and when you processed all that, that was a change in not just your emotional life, but also in your professional life and what you were going to do with your time. Is that fair?

Williams: Absolutely. There was going to be a press conference 4 days after the shooting. I was asked to be there; I declined. I told my wife about it, and she said, "You have to be there." What you just quoted is what she said to me.

My initial reaction was, I don't want to be that guy. I don't want to be the Black person that's just there for the optics, right? I don't want to attend. But she kind of nudged me and said, "Look, this is bigger than you. This is not about you right now. This is something much larger and you have to be there."

So I went, reluctantly, just intending to sit there and not say anything. But as the press conference progressed, it just didn't sit right with me what was being said -- mostly what was not being said. We weren't talking about racism. We weren't talking about gun violence. And that was all wrapped up into this incident. So at some point I did speak, I made some unprepared remarks.

From that point on, I mean, things just changed from that point. That became a viral moment at that time. And my life of anonymity was pretty much over.

Faust: Yeah. I'll share one other quotation, which is that at the microphone I believe you said that you wanted to say to the police officers in the room and around the country, "I support you. I defend you. I'll care for you. That does not mean I do not fear you."

I actually think that's so profound in terms of how we need to approach the lesion and where the healing has to happen. That we can say to each other, "Hey, look, we want to work on everything, but that doesn't mean that we're going to delude ourselves into something like you're not afraid." Because you yourself have been pulled over for no good reason, right? There's fear there, and it's for good reason.

What was the response to that particular line of reasoning to put out there in public?

Williams: Well, the response was varied. There were many that were supportive of that response, and I was criticized a lot for that response. That was another world I'd entered into, having my words parsed and critiqued. Despite what I meant to say, people heard what they wanted to hear in that.

But I think in the end, it did start the conversation about these issues in a way that had not happened before. Afterwards, many police officers said to me, "I never thought about it that way until I heard you say it." People would stop me in the hall and say, "You know, this began conversations with my family members about race and gun violence and policing." And then there were others that said, "You know what? You should never be allowed to take care of police officers. You should never be allowed to take care of white people." So it was an interesting dichotomous world to enter into at that time.

For a long time, I was really wandering back and forth, like, what does this mean now? I just went to medical school to take care of people. I wanted to be a good surgeon, a good doctor, and a good teacher. That was it. And now I have all this layered on top of that. So what does that mean?

Now, I've just started to realize I have to integrate that into my life and how I'm going to move forward to do the work that I've been trained to do.