Early on in 2020, soon after the start of the pandemic, Columbia University’s Narrative Medicine program offered a free workshop online. Since I had attended a few in-person conferences before, I signed up. Out of that first session grew a small group of six or seven participants led by graduate students from Columbia’s Narrative Medicine program. When the term came to a close, one graduate student offered to continue the group and a suggestion was made that each participant take turns leading a session.

I knew what I wanted to do—and here was an opportunity to do it. I had come across an amazing film called “Thank You Charlie” made in Paris by Youri Fedida. Running barely 20 minutes long, in black and white and completely silent, it tells its story about oppression and control in a powerful way. I suggested a session about racism, and the group agreed to view the film beforehand. When we met, people expressed how deeply affected they had been by it. Some had felt physically affected; others had been emotionally distraught, and some had come away with an unshakeable feeling that nothing would ever be okay again.

The discussion was a critical coming-together of ideas with an obvious impact and brought forth issues of social justice at a moment when the world was having a reckoning about structural racism. It was at this point I remembered the poem “Chronic Black Excellence” by Michael Arnold (Fall 2019 Intima) and brought it to the group. In this poem, we were opened up to the layers of bias and prejudice that exist in our society. We were no longer being asked to consider Black and white as opposing sides but to consider Black people who had distinguished and separated themselves from other Black people by establishing themselves as “excellent.” But ‘excellent’ according to whom and for what purpose? As Arnold, who is a medical student at Ohio State University Heritage College of Osteopathic Medicine, asks in his poem:

Who is Black excellence for exactly?
What’s the message we are trying to send?
Who are we sending it to?

The poem compelled us to face the magnitude of ways in which our systems have been designed by white people for white people. It especially highlights the workings of a system that rewards Black people for separating themselves from their own communities; the classic effect of forced assimilation. The poem illustrated to us that structural racism demands so much of Black people—not only to work ten times harder than their white counterparts in order to be seen, but also to separate themselves to gain a moderate level of success and recognition. And yet, as our group considered, was the hard won success all it was alleged to be?

Other layers of meaning emerged: In occupying a space surrounded by white and other non-Black people (at medical school, in residency, as an attending doctor, or in any other medical role), Black individuals were likely to face a barrage of racist obstacles every day, from being ignored or micro-managed due to lack of trust; being constantly challenged or dismissed to being mistaken for holding a junior role; or having patients and families request another doctor. The list seems endless. And yet, as the poem points out, the right of Black people to enjoy success while being “average,” “regular,” or “normal,” like their white counterparts, is not even a “possibility.”Arnold’s poem asks us to contemplate the differentiations being made, the questioning that occurs:

Are we trying to claim that we are better
Than the Black people who lifted us up
High enough to access the white-dominated
Space called Western medicine?
Are we trying to signal that we
Are one of the “good ones”?

Our thoughts turned to those who were not deemed “excellent.” Were they the ones hiding inside the Trojan horse? It certainly seemed possible, because of the ways that our exclusive society was designed to prevent Black people from being able to join and advance in professional careers such as medicine.How does one make a successful career, and still maintain the right to be “average” and “normal,” in a society that is committed to ensuring your failure unless you are absolutely “excellent”?

In our hour-long Narrative Medicine workshop, we had barely scratched the surface of the issues raised in this poem. We took a minute, and then I offered a writing prompt for the group: “Write about a time when you sought validation or acknowledgement.” To be given a fair shot. To be seen and valued simply for existing and not because you have had to do anything extra. To be appreciated for who you are rather than what you do. Write about a time when you desperately sought to simply be enough.

Elizabeth Walmsley was awarded the Master of Social Service degree in May 2015 from Bryn Mawr Graduate School of Social Work and Social Research. She has spent 5 years in in-patient palliative care social work, mostly at Temple University Hospital in Philadelphia and briefly at St. Elizabeth Hospital in Edgewood, Kentucky. Prior to social work, Walmsley also worked as a high school English Literature teacher in Esperance, Western Australia after obtaining her first master's degree in European Literature and Education from the University of Western Australia. She has lived in Perth and Esperance in Australia; Kathmandu in Nepal; and Philadelphia, Cincinnati, and New York in the USA. A member of the Religious Society of Friends (Quakers), Walmsley writes poetry and watches Netflix in her free time.

Chronic Black Excellence by Michael Arnold

A hundred years ago, Abraham Flexner
Eulogized Black medicine.
The ink in his pen tattooed
A sleeve on the arm of systemic racism.
The idea that screamed off his report
And echoed the loudest throughout history
Was the notion that Black medicine
Was fundamentally inadequate.

For the last century, Black medicine
Has been self-medicating with Black excellence.
A treatment plan that may be just as bad
As the prevailing social illness.
Black excellence is a poisoned apple,
Being eaten by a Trojan Horse.
Side effects may include:
Elitist attitudes, reactionary logic
Burnout, brunch addiction
And respectability politics
The siren song of Black excellence
Has veered us completely off course.
It’s a self-appointed pedestal that
Makes us look down on the
People that we dreamed of healing.
It makes us want to walk away
From the neighborhoods that
Raised us and never look back.

Black excellence is a blade on
The tongue of Horatio Alger’s descendants;
White people who will cut and paste
Your story into anecdotal evidence
That absolves them of their privilege.
Black excellence is a weight that actively
Compresses our humanity,
Erasing the mere possibility
Of us being normal, regular or average.
It erases the relief of mediocrity
That many of our white colleagues
Comfortably enjoy during their careers.

Who is Black excellence for exactly?
What’s the message we are trying to send?
Who are we sending it to?
Are we trying to claim that we are better
Than the Black people who lifted us up
High enough to access the white-dominated
Space called Western medicine?
Are we trying to signal that we
Are one of the “good ones”?
Is it an attempt to exorcise the demons
Of ever-haunting stereotypes?
Or is it just our insecurities
Crying out, wanting desperately
For white people to finally believe
That we are adequate?

Michael Arnold is a medical student at Ohio State University Heritage College of Osteopathic Medicine. His poem “Chronic Black Excellence” appeared in the Fall 2019 Intima.