Sriram Shamasunder, MD
Straddling Worlds
I grew up in the small desert town of Palmdale, 60 miles outside of Los Angeles, in a working-poor, largely white community. I was the youngest of three, a son of immigrants. As a child, I watched my mom’s interactions with the community. At an “all you can eat” salad bar, or at Sears, my mom would ask an extra question about the soup being cold or a shirt being rung up for a higher price than she expected. Sometimes the response would be a quick “go back to your country” retort by the clerk or waiter. I noticed if my mom raised her voice or pushed just a bit, thinly veiled racism would reveal itself. My father served as a counterpoint. He was quiet and soft spoken and rarely advocated for himself in a public setting. He was an oncologist, one of thousands drawn from their home country to work in rural and challenging settings where most US-trained doctors did not want to work. Every Christmas, a stream of gifts passed through our house from grateful patients. When we ate at the local Chinese restaurant, my father’s patients would often come up to our table and speak with immense gratitude about his kindness, expertise, and skill as a doctor. This captured my imagination and awakened me to the possibility of making a profound impact on other people’s lives.
Our family was like an island of five in the United States. A small collection of brown skin in a sea of white. We stuck together. My two older sisters and I attended an evangelical Christian elementary school. I accepted Jesus into my heart so many times during the Wednesday assembly. I wondered why he would not stay in my heart, so I accepted him again and again as many times as I was told. At the same time, we heard both overt and covert murmurings about throwing our home religion, Hinduism, under the bus. My parents were treated as if they needed saving—and as dangerous pagans at the same time. They were just a moment away from eternal life if they could just have a “come to Jesus” moment or eternally damned to Hell—depending on who was speaking to us. In high school, my oldest sister came home with questions about why my parents were going to hell, so they decided to pull us out of the Christian school. I started 5th grade in a San Fernando Valley private school, and my dad began a one-hour commute each way that would continue for the next 25 years until he died.
Like so many immigrants, I straddled two worlds. I kept my head down; I was quiet; I played sports. I was good at sports. They were an entryway into a United States that didn’t quite accept me. On the field or the tennis court, I could reign equal or superior to my white opponents.
Previously printed in Uncommon Ground: BIPOC Journeys to Creative Activism, Pease Press, 2022.
My dark skin, so much like my patients
In medical residency I trained at a Los Angeles county hospital. Black and brown patients lay on gurneys in the emergency room, and lined the halls of the wards. Our patients were mostly poor, often undocumented. The doctors were mostly white.
As residents, we worked and lived in the hospital so many nights. It felt like home.
On one of my days off, in street clothes, jeans and a t-shirt, I went into the hospital to finish dictating some patient notes. There was a metal detector at the entrance of the hospital. Later that morning, a police guard stopped me as I came out of the men’s room, suspicious I might have been shooting up in a bathroom stall. I presented my doctor’s ID out of my jeans pocket and immediately apologies flowed like water from an open faucet from the guard’s mouth.
My dark skin is so much like my patients. Until then, the hospital had felt like home. But that day I learned never to walk around the hospital without an ID. It was no longer a home where I could move freely without question. It was not my home.
A few months later, after a long call shift, I drove to the ocean. Making my way to the water feels like making my way home to where the water is fresh and clean and welcoming and opens the lungs after 30 continuous hours in the hospital.
Redondo Beach and Hermosa Beach are beautiful. It has many bars and the white folks flood them in the evening hours. Beachfront parking is full at 11 pm on a Thursday. I want to bypass the crowds and bars to go sit on the beach to clear my head.
As I circle for parking, I can see a cop car eye me as I come around the block again—my black, beat-up car and my nearly black skin in this dark night. My third time around the block, the cop starts to follow me, a slow dance around a three-block radius before he pulls me over.
The cop is rude. He flashes his light onto the back seat where he suspiciously eyes an ophthalmoscope and reflex hammer. He shines the light in my eyes and asks about the “paraphernalia” in the back.
He doesn’t give me a chance to answer. He asks for my driver’s license, registration, and proof of insurance, his voice finding its footing somewhere between irritated and angry.
I am nervous. I was living in NYC on 9/11, and immediately after, I saw fear in older white women’s eyes as they looked at me. It is a fear I recognize in my dying patients—but it always catches me off guard when I look in someone’s eyes and realize I am the thing they fear.
Back in the Jetta, my white coat hangs off my driver’s seat. My doctor’s ID hangs off my white coat close to the driver’s side window. The policeman’s flashlight catches the ID and he asks if I am a doctor. I say, yes, at LA County hospital a few miles away.
The wad of papers in his hand—driver’s license, registration, proof of insurance—become like a lotus flower as he opens his palms and they flow back to me.
He apologizes and apologizes. He says he didn’t realize that I worked at the hospital, the trauma center that takes care of cops when they get hurt or shot.
My doctor’s ID becomes a get out of jail free card. An ‘I exist’ card.
I exist. I exist. I have something to distinguish me from the black, the brown, the sick, the poor, the nameless, the undocumented—from my patients.
What if I had been one of my patients, black and brown and nameless?
What if I had been a plumber looking for the sea after a hard day’s work?
Or an undocumented Mexican man who worked and worked for four decades in the vineyards of Napa. I saw him in the hospital when his bone marrow finally failed, exhausted by decades of field work. His body was announcing its existence the only way it could.
If the soul is ignored long enough, the body rebels. A mass in the throat rises to the surface of the skin. A cavity of a lung, riddled with tuberculosis, starts to bleed. The body announces its existence.
Sometimes when I fill out death certificates, I wish I could write the cause of death as poverty. Or American racism.
As a doctor, I am looking to make common cause with the Navajo Nation, where uranium was mined from the earth and left exposed to make Navajo folks fall ill.
As a doctor, I am looking to make common cause with black boys stopped by the police, shot by police without a doctor’s ID to protect them.
I am looking to make common cause with the 11,310 black bodies who died from Ebola in Liberia! They came into our awareness only in sickness and in death.
Before blood flows from every orifice, can we note their existence?
May we learn their names in life. They exist.
As a doctor, I aim to stand with them before the beautiful fire of their lives becomes ash.
In this country, the only way I know home is through them. I want to reclaim a space for home for the black, the brown, the nameless, my patients, myself. I try to find my home through them.
Excerpted from a piece previously printed in Endangered Species, Enduring Values: An Anthology of San Francisco Area Writers and Artists of Color, Pease Press, 2018.
To Walk in Beauty Once Again
Fragility sticks to everything alive like the quiet wetness of morning dew
In this global pandemic
as a doctor
I see this fragility
threatening to swallow so much of what we love
like a large red blanket covering a small bed
And I can’t unsee it
In the spring
I spent five weeks in Navajo Nation
an indigenous community in the southwest of the United States
taking care of covid patients
Covid as common as desert cactus in Arizona
blooming like dandelions in an open field
That evening like every other evening
I stood outside a patient room
an emergency room converted into several pods of plastic
cocoons that separate one patient from the next and them from us
all in the hopes of keeping the virus at bay
Blue plastic reflects emergency room light
light like a parking lot at night or a mall
perpetual and yellow glow fluorescent
I methodically don my PPE
Velcro gown clasp
secure the back
face shield
N 95 on
cloth mask over
double glove blue glove pulled over brown skin
no brown skin between gloves and gown
Double-check
Zip up tent step in / zip closed
behind me
He lies left side down
a young Navajo man
Black hair braided down long past his lower back
right down the middle of his back
like a beautiful outer spine
stark against
bleached white sheets
each thick hair knot
dense and strong as rope
like ancestors clasping hands one over the other
Each knot
a closed knuckle
gathering like a prayer at the base of his skull
He has an oxygen mask on.
I watch his eyes closely for signs of fear
And I watch his hands for signs of trembling or what they might reveal
about a life before and up to this moment
He breathes fast
We make small and short talk
a few words between catching his breath
he says real soft between quick breaths
I don’t wanna die
I say we will get through this
and then again louder
the first time for him
the second time for me
We will get through this
I leave the hospital at midnight
The next morning
short coffee run in my rental car
my colleague calls to say that overnight
my patient emptied his lungs like a gas tank
and puttered into the early morning in fumes
exhaustion
He was just intubated
He will be flown to Albuquerque or Phoenix
off indigenous land
My wife calls at that moment FaceTime with my five-year-old daughter behind her shoulder
I submit to the fact I likely will never see him again
I submit to the fact that he may not survive
I submit to tears that slip down my cheek
And I watch my own hands as they wipe them away
Everything submits to something, I tell myself.
The bears rummage through rotted wood and suck up and slurp up ants.
The ants submit to the bear
The bear submits to winters
Trees submit to fire
the rocks submit to water as it etches grooves across grey
the river water submits to the seasons
thinning out come late summer
and our bodies to time.
And so many black and brown bodies this time.
This is the year of submission
Or surrender
Or survival
I can’t decide which
When a patient is about to be discharged from the covid unit a call goes overhead
from all over the hospital
like a bird migration we descend on the covid unit from anywhere we might find ourselves in the hospital
All the health providers gather in a line on either side of the hallway
like a sports team
waiting to high five their star player to come out of the tunnel onto the field
It is this moment a covid survivor gets wheeled out the big doors into the sunlight
like exiting a dark tunnel
into
their families arms
In those sweet moments, i think
This is the year of resilience
the year of I won’t let you go
My Navajo friend tells me with confidence
The Navajo people will walk in beauty once again
And she repeats it again
We will walk in beauty once again
The first time for me
The second time I think she says it to convince herself
Previously printed in Essential Truths: The Bay Area in Color, Pease Press, 2021.
Reflection Questions:
In what ways do you "straddle two —or more— worlds"?
How does that experience show up differently due to percieved identity?
How does skin color or clothing impact the ways people are treated in hospitals, and by police?
What systemic injustices were intensified by the pandemic?
Sriram Shamasunder graduated from University of California, Berkeley and completed his residency in Internal Medicine at Harbor-UCLA Medical Center. He obtained his Diploma in Tropical Medicine & Hygiene in 2013. Throughout his career he has spent several months out of every year in underserved settings around the world including South Los Angeles, rural Liberia, Haiti, Burundi, and rural India.
Sri is an Associate Professor of Medicine at UCSF, and co-founder and faculty director of the HEAL Initiative, a health workforce strengthening fellowship working in Navajo Nation and seven countries around the world. HEAL currently has over 100 fellows over the last three years, half of whom are Native American and from low and middle income countries (LMIC).