Let’s not forget invisible workers in our hospitals
While I was completing my clinical fellowship at the University of Pennsylvania in 1990, I usually was one of the first people to arrive in the office, giving me the chance to interact with the custodial staff who arrived even earlier to finish a final cleaning of the clinic before the first patients arrived.
One day, I remember wearing a newly laundered and starched old-fashioned long white coat with cloth knots instead of buttons, a sash across the lower back, and my name sewn in red over my left breast pocket. One of the older custodial staff saw me and spontaneously smiled, stopped his work, and said that I was looking sharp that day. I am sure I smiled and thanked him.
That type of quick greeting was not a rare event. Simple acts of kindness and recognition and words of encouragement from support staff often were high points of my days in those years.
I recalled that moment when I read about three behind-the-scenes employees of New York hospitals at the center of the pandemic who died after potentially being exposed to coronavirus. Hospital support staff distributed personal protective equipment (PPE) but were not often given enough for themselves. As I read, I remembered people like those described in the article, who were kind to me in the early years of my medical career.
For many African American physicians of my generation who trained and worked in overwhelmingly white academic hospitals, the men and women who held the vital jobs that allowed those institutions to run were a rarely acknowledged but deeply valued source of encouragement. Even though I was the son of a physician and comfortable in medical settings, the mostly African American support staff were a lifeline to me in those institutions.
In countless ways, they helped me to get through bad days. Sometimes it was just a smile or a heartfelt “good morning.” During my internship in Chicago, one older African American woman who worked in the cafeteria would always discretely pile my plate up with extra large servings of food and nod to let me know that she was using the only power she had to make me feel special.
Often, those who knew my name made it a point to address me as “Dr. Kington” to remind everyone within hearing range that I was a doctor; some would simply call me “Doc.” They took pride in seeing those of us who had entered those worlds, and they let us know they were proud.
Previous generations had similar, if sometimes more troubling, memories of the kindness of support staff. My Uncle Charles told a story about one of the rare quasi-integrated clinical rotations he and my father had taken at a Southern hospital in the early 1950s. He recalled how the white medical students and the black medical students would round on patients together with the white doctors, but when the rounding ended, the white students went with the white doctors on the elevator and rode to the doctors’ dining room, while the black medical students walked down the stairs to the basement where they ate with the janitors.
What the white students didn’t know was the food was much better in the janitors’ cafeteria! It went without saying that the janitors were all black. And I know that those janitors went out of their way to make the black students feel special somehow.
That connection so many of us had and continue to have with these staff makes it especially disturbing to know that in many institutions, these workers were not a priority for being provided with PPE. Even more disturbing: I can see myself having made the same decision thinking that the nurses and doctors were at greatest risk. But perhaps we should have been better prepared and known more about the risks for all staff — just one aspect of our appalling response to the pandemic.
This epidemic has changed our world in so many ways. It has reminded us of the important roles filled by the “essential” workers who do the hard behind-the-scenes grunt work in society: the delivery people, those who run the registers in our groceries, janitorial staff, and especially support staff in our hospitals and medical centers — those who hand out masks and clean rooms and fill cabinets and transport patients.