About midway through my pediatric residency program at a well-known children’s hospital on the East Coast in the mid-1990s, I found out what was wrong with me.
I told the chief of the pediatric emergency department, a Jewish woman, that I had finally learned the name of a device after I had patients use it many times. I knew what it was for, but I hadn’t learned its name. It was a peak flow meter. The name finally stuck in my head.
“That’s because you are subhuman,” she told me firmly. She was not joking. She really believed that.
During my time there, this attending physician humiliated one of her pediatric emergency fellows because he had dared to support a family who had fired their incompetent pediatrician—an arrogant, short-tempered, vain man who brought a lot of business to the hospital. So, I suppose I should have expected a rude comment from her. But I admit to not expecting what she actually said.
Subhuman. As in what Adolf Hitler called Jews, the Roma, Slavic people, and anyone else not fitting his Aryan identity.
I have mild cerebral palsy, manifesting as a left-sided hemiplegia, and I had eight surgical procedures as a child and teenager to address them. These orthopedic procedures, the earliest of which were experimental back in the 1960s (I was a guinea pig for muscle transfers and tendon release techniques developed at the New York Hospital for Special Surgery in New York City), allowed me to discard heavy leg braces and achieve some use of my left hand.
Zakia Nouri et al. published a research letter in JAMA Open in 2021 that estimated 3.1 percent of practicing physicians had a disability, with 28.4 percent having mobility issues. (I would likely have been considered in that group.) The author acknowledged that physicians with disabilities are likely to face discrimination, just as physicians who are women or of racial or ethnic minorities do. Dr. Lisa Meeks, a researcher at the University of Michigan Medical School and an expert on disabilities and medical education, discussed harmful stereotypes applying to physicians with disabilities in a program published by the American Association of Medical Colleges.
As a physician with a physical disability, I know something about this.
Medical school
Prior to my admission to medical school, I had worked in banking and aerospace. Then I moved to the East Coast and started my medical education.
My physical handicap is obvious—there’s nothing to hide. I walk with a slight but noticeable limp. In medical school, I could suture slowly and had difficulty intubating because I could not fully use my left hand. I sometimes had difficulty drawing blood if the patient’s veins liked to collapse, but I could perform a spinal tap decently if someone else held the collection container. And I knew I was not going to be a surgeon.
My classmates took one look at my disability, and I became radioactive, even more so because I liked to ask questions in class, and they were convinced that my asking questions added material to the exams. That such childish nonsense seemed to prevail was disturbing to me, but the primary issue was my disability. The consequence was that any notion of “we are in medical school now, we are bonding through our shared struggle and will become physicians together” quickly went into the garbage—for me, that is.
If a classmate entered a room, it was empty unless someone besides me was in it. Actually, a good day was one when my classmates looked through me, and I was invisible. Many days, however, saw vulgar curses leveled at me—sexual vulgarities, wishes shouted that I would drop dead or drop out, “go to hell,” and constant and repeated “shut up,” “keep your mouth shut,” “no one wants your opinion,” over and over again. When my classmates went to work on the student yearbook while I stayed in the orthopedic clinic to learn how to treat a high ankle sprain, they cursed at me for answering the professor’s question, “What did you do this afternoon?” with “I learned how to treat a high ankle sprain,” because they feared it would expose their unauthorized absence from the clinic.
I had a lot of difficulty with gross anatomy and histology (microscopic anatomy). The Dean of Students was a psychiatrist; he ordered neuropsychologic testing for me, which determined that I had, allegedly, near-genius verbal IQ but very, very slightly (by five points) less than the average spatial IQ. My pathology professor pointed to a scar at my internal capsule as the source of a mild learning disability for 3-D shapes and topography. The stroke during early infancy, or perhaps in utero, that caused my cerebral palsy had also given me a mild learning disability, and medical school was challenging me to succeed despite it.
Male students ignored me or answered me rudely when I wanted help with studying, although one did help me one time. When I told a woman student, privately, that I knew she was failing physiology and that I would help her pass the course if she would help me with neuroanatomy, she gave me graphic instructions on what sex act I should perform on myself and clearly indicated I was not to approach her ever again. (She subsequently failed her courses and was suspended from medical school for two years; I barely passed the neuroanatomy course). Another woman student refused a similar offer from me because, she explained, she was concerned that our other classmates would think she was my girlfriend, and that was unacceptable. She also made it clear that I was to stay far away from her at all times.
Cooperation during clinical rotations was non-existent. During one internal medicine rotation, the fourth-year student (subintern), who was a Black woman, and I were assigned to the same patients. As far as I could tell, she performed her work competently and conscientiously, but she refused to collaborate with me or even talk to me. She stayed silent if we were in a patient’s room together, ignoring me, and refused to discuss any cases with me. I was acutely aware of overt racism during certain rotations; in one, I witnessed a white second-year medical resident telling us it was our duty to throw poor Black patients out of the hospital as soon as possible to save taxpayers’ money. I treated this woman student with respect, and to her, apparently, I was an inanimate object.
Socially, things were no better. I had an assigned roommate in student housing. My roommate’s friends included the president of my student class. They would sit in our shared kitchen, and the president described in graphic detail his sexual conquests, including a woman who sat near me in class. They confronted me about my teetotaling and demanded I get drunk with them. They would light paper airplanes on fire and launch them out of our living room window, calling them Challenger missions, after the space shuttle disaster of 1986. What they didn’t know, though, was that I was a software engineer at Hughes Aircraft Company’s Space and Communications Group in El Segundo, CA, in 1986, and two of the Challenger’s mission specialists were my extended colleagues. I didn’t know them personally, but I created supply chain management software on a mainframe computer that helped them construct and test satellites, and they sat at the other end of the supply chain from where I sat. It would have done no good to tell my drunken, immature medical school classmates any of this, of course.
One time, a classmate suggested I tag along while a group “barhopped.” I was still trying to make overtures to classmates, so I agreed to go. Since I don’t drink alcohol, I nursed Cokes to stay awake while I watched my classmates become thoroughly inebriated and stumble from one bar to the next. On the way back to student housing, a woman student, who was confident I was a disgusting, horrible creature from the sewer, couldn’t walk without help, and I was the only sober person near her, so she leaned against me, and I held her up as we walked back to student housing. I made sure she got safely into the building and to her apartment. The next day in class, I was invisible to her again.
How did I get through? First, I had decided that no one could dictate to me whether I finished medical school except me. I didn’t know there was an imposter syndrome back then, but I applied a kind of backward logic to my ostracism: These students were trespassers in my medical school, and while I could not banish them, I would survive without them.
Second, the faculty made clear they supported me and wanted me to succeed. They offered tutoring when I needed it. There were times when I wasn’t sure I could pass all the courses, but I studied day and night, repeating a failed histology course during the summer. When I graduated, the Dean of Students personally congratulated me and said my achievement was remarkable.
I never saw or spoke to my classmates again after medical school, with one exception. When I returned to my alma mater to “hood” a woman graduate who was two years behind me, I ran into the woman who had so vulgarly condemned me for offering to help her with physiology. I shook her hand and heartily congratulated her on her graduation; she told me she was very excited to graduate and relieved to finish medical school. I asked her why she had said vile things to me when we were classmates. She said, very calmly, “I had no right to say those things to you, and I’m very sorry.”
But I didn’t yet know I was subhuman.
Pediatric residency training
When I matched to the pediatric residency program and began training there, I thought to myself that I was in for a much better experience.
I was wrong.
I was well-prepared to work hard, but I discovered I had a problem with organization. My being a “scattershot” affected my work, my preparation, and caused problems for myself and other residents. It reduced the time I had to study. The pace and volume of work were very high, and I had to learn to organize myself better. I accepted responsibility for this and knew it would take time for me to fix the problem.
My fellow pediatric residents were, on the whole, supportive, and they respected my work ethic and abilities. However, I slowly became aware the associate residency director was not. The previous year, he had used a relatively minor incident as an excuse to throw a resident with cerebral palsy out of his program, and, I was to learn, he was gunning for me next. As my work improved, the rewards did not come.
The associate residency director ridiculed me in front of my peers, nurses, and patients. He picked his favorite pet residents; if they made mistakes, his attitude was that they were outstanding young doctors who were learning; if I made a mistake, he elevated it to a crime. He encouraged other faculty to be cruel to me as well. Some resisted the invitation, but some did not.
He told me I was a “problem to be nipped in the bud.” The chief of the pediatric ICU and another intensivist told me I was mediocre and should switch to psychiatry.
When a pediatric nurse, who also had cerebral palsy, and I left the hospital in an ambulance to pick up a transfer at an outlying hospital, we heard, “there goes the Special Olympics” as we walked to the ambulance. We tended to a mortally stricken toddler with meningococcemia who had been left alone by the emergency room attending at that hospital. He was going into shock, and I needed to hydrate him, but his one IV line was inadequate. Neither staff there nor I could get another IV started due to collapsing veins, so I used a spinal needle to start an intraosseous line and successfully started another drip. I began antibiotic therapy, and the thoroughly competent, dedicated, and inspiring nurse and I worked to keep the patient stable during the ambulance ride back to the children’s hospital. Upon our return, we transferred a stable patient to the ICU. He would not remain stable for long; he crashed soon thereafter. We understood he was dying, but we felt very sad that we could not do more.
The intensivist started additional IV lines, and when he pulled my needle out of the child’s leg bone, he clearly indicated by the look on his face that he was disgusted with me and repelled by me, even though I had actually done exactly what I was supposed to do in those circumstances. He also insisted on recording that the child had crashed in the ambulance, which was false, just so he could document that this was somehow my fault. Later, he admitted that the child would have died even if I had had access to a Star Trek “beam me up Scotty” science-fiction transporter that would have put the child in the PICU in ten seconds.
My previous experience in banking, aerospace, and consulting had helped me build “customer service” skills that were very transferable to medicine, and I generally had an excellent rapport with nurses and patients (and parents). I was able to help de-escalate conflicts that threatened to interfere with patient care. When a politically favored resident won praise from a family, she was recognized for it. I was ignored. On the other hand, an intensivist screamed at me that I had ruined a family’s experience because I had brought pastries into the pediatric ICU for staff just as he was counseling a family whose child had died (suitably exaggerating the incident from molehill to mountain status).
The associate residency director denied me opportunities for leadership and to supervise other residents. He put me in an enforced parking spot. There were other punishments for me. I was punished for not finishing work because I washed my hands between patients in the Neonatal ICU, where my fellow residents did not (though we all used gloves).
I continued working as hard as I could to better myself. My research was selected for presentation at a county pediatric society meeting. I guest-edited an edition of an in-house pediatric journal, consistently sought tougher and more complex cases to challenge myself, and, thanks to years of retail banking experience, was far more diplomatic and effective with difficult parents than even some attendings were. When a mother threatened to sue the hospital because a woman pediatric ICU attending had abused her verbally and ignored her during the former’s daughter’s hospitalization (the doctor particularly enjoyed abusing me too), I intervened privately and persuaded her not to take any action. I told the mother that I would not defend the ICU attending’s inexcusable behavior, but her technical handling of her child was correct, and demanding that her child be transferred to another hospital at that point was dangerous. This mother calmed down, and I promised to keep her informed. I later told her that once the child was sufficiently stable, she could find excellent care at a different hospital, likely without the arrogance she encountered at ours.
I’ve always felt that if you find someone in need in front of you, you find a way to handle it. You don’t do it to impress anyone; you do it because it’s your obligation to the world, and you’ll feel good going home that night.
When an adolescent patient pined for his father (who was abroad) and shrimp scampi for his birthday, I couldn’t bring his father to him, but I could bring the shrimp scampi. The opportunity arose to leave the hospital for 30 minutes to collect a large portion of this dish from a take-out restaurant. Because the cook had not sealed the container properly, I wound up wearing some of the sauce, but my patient didn’t care. He dove into his favorite dinner with gusto.
On a night off, I intervened on the local public transportation system to get a pregnant woman who had fallen to an emergency room before she gave birth, resulting in well-deserved commendations for the police officers who worked hand-in-glove with me and a very nice thank-you letter from their commander. On another night, I forced a mentally ill man out of an intersection where he was playing chicken with cars and called 911 several times, fruitlessly; when he ran across a street that divided one city from another, I called a sergeant directly and persuaded him to send officers across the boundary to help me. They drove him home to his concerned family.
That counted for nothing at the children’s hospital. I would have done it ten times over because it was the right thing to do.
While on duty as the on-site subhuman in the pediatric emergency room, I sprinted out to the parking lot to intercept a woman who had taken her convulsing child to her car against medical advice. I ordered her back into the ER and took her keys as she tried to start her car; she punched me in the mouth. I had to physically restrain her until police arrived. No ER attending physician or nurse helped me. They came out only after the officers and I had the situation completely under control. I helped persuade the woman to cooperate and stop fighting by telling the very sympathetic and supportive police sergeant that I would not press charges if she agreed to allow emergency treatment to resume. He handled her with grace and diplomacy, and I was proud to work with him. He made my day.
I received silence from the ER attending physicians. After all, I was subhuman.
Late in my third year, the associate residency director told me definitively that I was not going to graduate from the residency program because my performance was unacceptable. I would need to be on probation for several extra months. Given his past behavior, I understood that he was preparing to cancel my career. It was quite ironic, therefore, that a physical confrontation with the chief of the pediatric intensive care unit during that last year of residency started a cascade of events that guaranteed my graduation. One day, the pediatric ICU chief recklessly endangered the safety of a first-year resident who had lost consciousness and fallen. He refused to examine him or to refer him to the emergency room. I witnessed this and became enraged. With the help of other residents, I put the unconscious intern on a gurney and announced I was taking him to the ER. The PICU chief stood in my way and said he was the senior doctor there and would make the decision.
I charged at him with the gurney; startled, he quickly got out of the way, and I got the resident checked into the adult emergency room. When I returned to the PICU, I found two other first-year residents crying. I asked them what was wrong. They had overheard the PICU chief insulting and denigrating the unconscious resident, laughing in conversation with another PICU attending.
I reported the incident to a senior physician executive and to the chief residents, who corroborated the incident’s details. With one stroke, the PICU physicians’ opinion of me didn’t count anymore. When the associate residency director informed me again that I was not going to graduate, I told him firmly but calmly that I would be forced to defend my interests if he continued unlawfully harassing me. He raised his voice to me and asked, “Oh, you’re going to sue me?” I replied that I would use whatever means I deemed necessary to protect my interests and my career, and I was not obligated to discuss that with him. I would act as I saw fit.
He threatened me that if I challenged his authority, I would regret the day I ever became a resident. But he had finally overstepped his bounds, and I did not have to sue. A dozen attending physicians told him to stop, and when, during a residency promotions committee meeting, he again proposed to put me on probation or fire me, not a single person supported him. The war was over; I had won.
But he had one last parting gift. At the risk of sounding a little arrogant myself, I believe I earned an invitation to serve as chief resident. But he didn’t have the integrity required to acknowledge anything I accomplished. His letter to me read to anyone with a modicum of intelligence, “Dr. Aryel, you are still a hopeless idiot, and your graduation is an act of charity on our part.”
Then he did something much worse. Frustrated that he couldn’t make an example of me, he turned instead to a woman intern with a hearing impairment. He and the exceptionally cruel chief of the pediatric ER tortured her and destroyed her career. I know they enjoyed doing that.
After residency
My wife, a pediatric neurologist, rescued the first resident with cerebral palsy and persuaded a different residency program to accept him; he graduated and became a pediatrician. Regretfully, the woman intern, coincidentally a victim of domestic violence, could not respond to my wife’s efforts on her behalf.
Notwithstanding my subhuman status, I resolved to do the best I could for my profession and my community. I made, and later was recognized for, notable contributions to the expansion of public transportation. I joined the National Disaster Medical System (the medical equivalent of the National Guard) and over a little more than three years, was cited twice for outstanding service. I was later offered a command in the western U.S. but declined because my wife and I were headed for a different city.
I was a key subcontractor to Real-Time Disease Surveillance (RODS), the first automated bioterrorism and epidemic surveillance system in the United States, and co-edited and coauthored the first textbook to describe the principles and practices of this new branch of data science. It was required reading during the first few years of graduate programs at the University of Pittsburgh, Carnegie Mellon, and Johns Hopkins. President George W. Bush personally visited the RODS laboratory.
In 2000, I earned an MBA and was elected to the Phi Kappa Phi Honor Society. In 2006, I was the lead quality consultant on a project to help New York City improve patient outcomes from an $825 million mental health budget.
In Reno, I ran a practice that was, essentially, an outpatient pediatric ICU and handled many chronic and rare diseases as well as child abuse and neglect. The practice was recognized as a top performer and won awards for quality of medical care, vaccinations, and community service. In 2019, the practice was recognized for achieving the highest HPV vaccination rate in Nevada and the second highest in the United States.
Not bad for a subhuman.
Ron M. Aryel is a pediatrician.
