RFC Essay Contest 2020: 2nd Place, Medical Student Category
Quality Improvement
by Jason Mascoe, MS-4
During one of my earliest encounters in medical school, we participated in a poverty simulation. This seemed like an odd endeavor. Why? I am the son of Jamaican immigrants, a former missionary in domestically underserved urban and impoverished countries and had post-baccalaureate internships medically serving marginalized groups: refugees, unsheltered homeless and immigrants without insurance. I did not understand what there was to simulate. Poverty is closer than we admit to seeing. I vocalized my apprehension to my academic leadership. It was deemed educationally valuable. Skeptically, I participated.
There was an elaborate setup with all the establishments and resources the picturesque, marginalized, urban community would have. I received my packet of the character I was to embody. He was a 27-year-old African American male with a felony, living below the poverty line, supporting his girlfriend and her infant son from a different father, and lived check -to-check. Inside the packet were supplemental wages and ancillary obligations. For the next few hours students were engrossed in this alternate universe, personifying what it should feel like to live either on or below the poverty line.
It was challenging to embrace my character. I did my best to stay open to the experience — hoping that this was a coincidence, being 1 of 2 “black” men in our cohort. Four hours felt like hell. Inner turmoil brewed while attempting to justify this experience and appease the majority’s ignorance. It was difficult to look around the room and try not seeing caricatures of family members, students I mentored, patients I previously cared for or the young men I worked to get out gang activity and back into high school — being the first in their families to graduate and go to college.
Soon, facilitators eagerly introduced emblems, symbolizing paraphernalia, for unlawful distribution. I became physically sick, stomaching my disdain in silence. For the first time in my life, I felt like the minority people tell me that I am; invisible. That day, I was ordered to be the person my family sacrificed for me not to become — a stereotypical statistic of the modern-day man of color.
Within two weeks of donning my white coat, this experience taught me that cultural sensitivity and competency is seldom proportional with level of education. I needed to safely grow over the next few years. Therefore, important conversations needed to be held to promote a healthy learning environment for myself and for other students underrepresented in medicine.
I quickly fostered safe, professional relationships with some of the core leadership to debrief the shared traumatic experience for members of my cohort. In a special encounter, blame bowed down to grace and we were able to move beyond a conversation of deep hurt and disappointment, shifting to growth as a community. We knew, that for our success, and the success of the program, we would have to work together to do, and be, better. Because of accountability, we were able to provide safe, alternative, and meaningful experiences for students and respective community members to be edified in the process.
As I progressed through training of my first year of medical school, a mentor of mine pointed out my heavy burden for social justice. He called it a “righteous anger stemming from a graciously gentle, yet intentionally poignant soul”. He was right.
I am a pioneer. I see a need or wrong and push for it to be corrected or better supported. If it meant creating a program, committee, or a curriculum to educate others for people to have a chance as being viewed equally worthy of resources, then it needed to be done. Considering my successors, I fought to preserve ongoing, difficult, conversations with faculty and a few colleagues of how to keep the unspoken, unknown, unheard experiences and perspectives of those considered minorities when plans are being made for us, by people without our perspective. I respectfully declined the response of “I do not know,” to remain the default for those who are marginalized. Swiftly, I became a wanted voice during difficult times and when seeking honest feedback amongst my institution’s leadership and peers.
Good intentions may still hold detrimental consequences. Too often, upholding the prestige of the white coat hinders us from wholeness. There is a void in healing that medical education, alone, cannot teach. True restoration requires actively developing a state of being comfortably uncomfortable. Its fullness is experienced by humbly earning the right to get your hands dirty, skin-deep, in others’ hardships and suffering to palpate their pain.
Jason Mascoe is an MS-4 at Penn State College of Medicine.
