About a year ago, a patient called me a “nigger” for the first time.

I was working an extra weekend shift as the only doctor on-call. It was a sunny day in New England, and seemingly calm. Until it wasn’t.

“Code gray. Code gray,” announced the neutral voice through the hospital speakers. “Code gray” signified a behavioral emergency. A patient was at imminent risk of harming themselves or others. Or already had. My work phone rang. “Dr. Calhoun, we need you in the adolescent unit,” a nurse said. I was already on my way.

The patient was a red-headed teenager. For several weeks he’d exhibited severe behavioral problems during his hospitalization. He’d just broken a window with his fist because playground time was over and he did not want to come back inside. A crowd of mental health staff, including psychiatric nurses and mental health techs, gathered around him. They took turns attempting to de-escalate the patient as he hurled out insults and curse words in return.

I approached him, smiling: “Hello, I’m Dr. Calhoun—”

“Get away from me, you nigger,” he hissed, nursing his bloody wrist.

The all-White staff, who moments before had been firm about setting behavioral limits with the patient, were silent. I held my ground, and my deep brown eyes met his bright green ones. “I will not tolerate racism in this unit, and I expect an apology,” I said, resolutely. I continued to care for the patient, but I felt demeaned in a way that curse words and rude language — both common in hospitals — had never accomplished.

“Nigger” has been used throughout history as a term to liken Black people to property, as less than human. It has not just been used as a derogatory slur, it has also been used as a political tool, to sway racist people to vote for or against certain platforms. “Nigger” is so much more than a word; it is psychological violence, sometimes coupled with physical violence, even murder.

Today, Black Americans are still the target of most racist hate crimes. When I hear that word with the hard “R” on the end, I don’t feel safe. It reminds me that White supremacist ideology is alive and well today in hospitals, supposed places of healing and nurturing.

Clearly, others disagree.

After my patient said that to me, I told a White supervisor what happened. “Oh, wow,” she replied, immediately turning back to her computer.

When I told a Black supervisor, however, he responded with urgency. After asking me how I was coping and providing emotional support, he immediately went to the patient to inform him that his racist behavior was unacceptable.

Later, the patient apologized to me, his cheeks red. “I’m sorry I was racist,” he said, hanging his head. This was the first time I’d dealt with White patients spitting “nigger” in my direction as I tend to their health. It wouldn’t be the last. This is just the tip of the iceberg; American medicine, since its inception, has always been injected with anti-Black racism.

As one of my History of Medicine professors at Yale tells us, it has only been a little over 50 years since Black people have been allowed to be cared for in the same medical spaces as White people. And the experiment isn’t going well.

As a physician, I work in many different hospitals across New England. Before that, I was a medical student in the Midwest. Sadly, I have witnessed racist behavior too many times to count. White staff describing hospitalized Black children as “animals” or “nightmares.” White nurses pushing me to overmedicate or physically restrain Black children, telling me that the child doesn’t feel pain, both emotionally and physically, because they are “so violent and dysregulated.” When I push back and refuse to follow these orders, sometimes they report me to my bosses. Fortunately, my supervisors have backed my decision as the physician. These same nurses and staff, when confronted with an aggressive White patient, somehow find patience and empathy — even for patients engaging in violent racist behavior, like using slurs.

Suddenly then, patients are struggling and need support and comfort and not punishment. Suddenly then, patients should not be held accountable for racist behavior, because they are struggling with mental illness.

These scenarios aren’t unique. Many Black physicians I have spoken with all over the country have similar experiences. This racist behavior, as well as these problematic differential dynamics within the medical team, are not hospital problems or even regional problems. It’s a national one.

As a psychiatrist, I know that mental illness is not a scapegoat for racism. One could argue that mental health disorders can cause patients to lose their filter. But racist behavior does not just happen out of the blue, it originates from mindsets and beliefs.

When I confronted one of my hospitalized patients after she hurled that word at a Black nursing supervisor, she told me resolutely: “‘Nigger’ is in my vocabulary, Dr. Calhoun. My family speaks this way at home. That nurse made me angry, so I called her what she is.”

“Well, in this hospital, you need to keep your racism to yourself,” I told her. She stopped using that word, at least on my watch.

We don’t absolve psychiatric patients from responsibility and boundaries. We wouldn’t allow a patient to engage in violent behaviors unchecked. So we can’t tolerate racism, either.

Because racism is violence. It does psychological and physical harm.

However, the best kept secret of American medicine is not the widespread prevalence of slurs one might hear while on the job. It is how often my fellow doctors excuse or even defend that behavior. These are people who, like me, have taken an oath to do no harm. Failing to defend Black colleagues targeted by racism is doing just that.

When a Black staff member told me a belligerent White patient called her “nigger,” I asked if she was okay. My White male supervisor answered for her, in front of a room full of medical professionals and staff, “She’s fine. We are desensitized to the n-word here”.

“You are,” I replied. “I will never be.”

Later, I pulled that Black staff member aside. She was not okay. “The people here don’t care about us,” she whispered to me. “Sometimes I can barely make myself come to work.”

A multitude of studies have shown that Black people suffer from weathering, the cumulative stress of experiencing racism. Racism shortens our telomeres, ages our brains, increases our cognitive load, and makes us sick.

Psychiatry should be leading the charge when it comes to the mental wellbeing of doctors experiencing anti-Black racism. Yet, even in the mental health field, there are no support systems in place to psychologically prepare Black doctors for the heavy burden of blatant anti-Blackness they likely will experience on the job. Also, racist slurs and behaviors are like a punch to the gut; they aren’t just painful, they’re distracting. Yet, it is expected that Black doctors should just take the hit, and continue functioning at high capacity without delay.

Neither schools nor hospitals prepare doctors for the racist treatment that their Black patients will face, either. They are not well-equipped to shoulder the burden of witnessing patients, and sometimes colleagues, harm Black people who are already sick. But they should be.

Medical schools and training programs should have initiatives in place to help Black doctors prepare for and process the racism they experience. They also need mechanisms to hold patients accountable for racism, as well as the staff who defend them.

I often hear people say they would take a stand against racism, were it not so difficult to identify. Indeed, the everyday cuts and slights that Black Americans face are invisible to some. We’ve all been taught, at least in this country, that being called a “nigger” is as conspicuous an act of racism as it gets. Yet in my experience, most healthcare providers remain silent when that happens. There is simply no excuse.

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