When the tumultuous history of 2020 is written, no one will argue that Joseph Gallien didn’t have a front-row seat. In March, Gallien was finishing his residency in emergency medicine in Manhattan just as the novel coronavirus was overwhelming New York City. At 31, he was making life-or-death decisions while confronting a disease for which there was no treatment, no cure, and little knowledge.
In April, Gallien came down with a cough and a fever, and knew instantly that he’d contracted the virus. When his temperature spiked a week later and he began having trouble breathing, he was admitted to one of the two hospitals where he worked, Columbia University’s NewYork-Presbyterian. He’d developed pneumonia; was showing signs of organ failure; and had lost 13 pounds. He was released five days later, only to learn that one of his attending physicians, apparently crushed by the weight of the pandemic, had taken her own life.
In early June, just as protests over racial injustice were roiling the country, he checked into his first shift as an emergency medicine physician at Lake Charles Memorial, a hospital in his Louisiana hometown, where half the residents are Black people, like him. Months later, Hurricane Laura ripped through, destroying homes and businesses and leaving hundreds of thousands without power, including most wings of the hospital.
As Gallien looks back on this year of death, destruction, and his own severe illness, what strikes him most are the stark racial inequalities of a health care system in which Black Americans are more likely to die at early ages of all causes, including Covid-19 — a system in which the number of Black physicians remains dismayingly small.
All summer, Gallien treated hundreds of Covid patients as the virus overtook his state, hyperaware of the enormous gap between where he works now and the state-of-the-art hospitals where he trained. In Lake Charles, he has far fewer resources, from PPE to the equipment he needs to help severely ill Covid patients breathe. In New York, he used small, portable laryngoscopes that were easy to maneuver. But they are too costly for his current hospitals, so Gallien uses an older, bulkier device.
Such inequalities are the main reason he became a doctor in the first place. “That persistent disparity is always on my mind,” Gallien told STAT. “It just surrounds you.”
Making his rounds in the hospital, he is constantly reminded of the obstacles he had to overcome to make it this far, an uphill climb reflected in somber statistics. While Black people make up 13% of the U.S. population, he is among the nation’s 5% of Black doctors — a number that has not budged since the late 1970s, according to a 2015 report. The number of Black male applicants to medical school has also remained largely stagnant: In 1978, 1,410 Black men applied to medical school; in 2019, that figure was 1,554.
Gallien, who goes by Jeaux, the Cajun-Creole spelling for “Joe,” has always shown up for work in fresh scrubs, diamond studs in each of his four ear piercings, and a pair of sneakers from his wide collection. “That whole white-coat thing just isn’t me,” he said.
By now, he knows to expect a range of strong reactions from the minute he introduces himself to patients. Occasionally, female patients might ask to see a woman doctor. Some demand to know his age.
But what always, always confounds people are the initials M.D. behind his name. African Americans are delightedly taken aback. “Almost every day I hear, ‘Wait — you’re young, you’re Black, and you’re my doctor?'”
By contrast, for many white patients, he said, his role as their physician is perplexing.
“I always say to everyone, ‘My name is Dr. Gallien, and I’ll be taking care of you today.’ But often with white people, I’ll be doing a physical exam, discussing their care and what needs to happen next, and they’ll say, ‘Are you taking me to get my CT scan now?’ Or turn to the white nurse in the room and address her as if she’s the physician. Sometimes, people will ask: ‘Can you get me a sandwich?'”
He always pauses patiently and says: “I’m your doctor. That’s why I’ve been examining you, and talking to you about your treatment plan. Is there a problem?”
Usually, they demur, he said — or make an embarrassed apology. Just this week, a white scribe had to correct a white patient when she addressed her, and not Gallien, as the physician. “Legit, I had been standing there talking to to her for five minutes,” he said. “When the scribe said, ‘He’s your doctor. I’m just your scribe,’ she just said got this look on her face and said, ‘I’m so sorry, I’m so sorry.'”
“Sometimes,” he said, “it weighs heavy.” Still, he tries not to take the confusion personally, or to let ill will “creep into my job.” He hopes that “maybe, when white people have an emotional reaction to how I dress, the color of my skin, they will have a different opinion the next time they have a minority physician.”
He has thought about whether his clothing choices play a role. “Am I wrong for not playing the part of what an older patient thinks a physician should look like? Is this why I’m being second-guessed? On the other hand, sometimes I treat children, or they’ll be with their parent in the room. They’ll look me up and down and see my shoes and then my ID, my stethoscope. And I think, ‘Maybe I’m giving this child an idea for what they can become.’ “Ultimately,” he said, “I choose to stay true to myself.”
The distrust of African Americans for the medical community has deep, well-documented historical roots, from the infamous Tuskegee experiments in which Black patients were told they would be treated for syphilis but weren’t, to the forced sterilizations of Black women. But experts say one reason for the continuing discomfort is the stunning lack of Black people who become doctors.
Cato Laurencin, an engineer, physician, and scientist at the University of Connecticut, who has researched the shortage of Black doctors extensively, said his studies confirm that the dearth of Black physicians hampers efforts to address disparities and improve access to care for all underserved populations.
“We know that Black physicians provide more culturally competent care, which translates to better care,” he said. One study found, for example, that African American men with Black doctors agreed to more “invasive” preventive services, such as diabetes and cholesterol screening and a flu shot, than those with non-Black doctors.
“This is not simply a Black male crisis,” Laurencin said. “It is an American crisis.”
The scarcity is so striking, former New York City mayor Mike Bloomberg announced last month that he is donating $100 million to four historically Black medical schools to support some 800 medical students.
While that news is welcome, Black children should be encouraged to pursue science from the moment they enter school, said Hilda Hutcherson, senior associate dean at the office of diversity and multicultural affairs at Columbia University College of Physicians and Surgeons, where she is also a professor of obstetrics and gynecology.
“We’re not preparing young African American students to apply to medical school, and that kind of tracking starts in elementary school,” Hutcherson told STAT. “From an early age, African American boys and girls are more likely to be reprimanded, to be sent to the principal’s office, to have the police called for behavioral issues and to not be encouraged to perform well. There is a tendency for teachers to make assumptions about the ability of African American kids, especially African American boys.”
Gallien said he experienced this discrimination firsthand. “It just happens,” he said. “A lot of individuals don’t want to see you grow, to realize your potential. They make judgments based on how you look.”
As a young single parent, his mother, Jennifer Deruso, tried to instill him with confidence. She considers him a “miracle baby,” she said, since she did not know she was pregnant with him until she gave birth at 18.
Jeaux was a gifted student who also excelled at basketball, baseball, and football. But Deruso, a physical therapy assistant in Lake Charles, which is home to several large petrochemical plants and casinos, did not allow him to play sports unless he kept his grades up. As a promising high school student, he took part in an enrichment program offered by a local university, which helped foster his love of science.
But his most powerful influence was his beloved grandfather, who had been blinded at his job at a chemical plant. When Deruso was at work, Gallien and his younger brother went to his house, and the two generations looked out for each other. The boys often accompanied him to doctor appointments.
“I was my grandfather’s eyes, in a sense,” Gallien recalled.
The experience of helping the his grandfather navigate the medical care system made a lasting impression. “He started talking about becoming a doctor even before he was in school,” Deruso said. “We’d be eating dinner and Jeaux would say, ‘When I grow up, I’m going to find a way to fix Grandpa’s eyes.'”
Diagnosed with cancer when Gallien was in high school, his grandfather left him a lasting wish. “Before he died, he told me, ‘Jeaux, don’t become a bum. Study, make something of yourself. Be a role model for those coming up after you. Touch somebody.'”
Still, when he was a teenager, teachers and advisers discouraged his larger aspiration of being the first person in his family to finish college. “A lot of times, I’d get the whole spiel: ‘You’re smart and all, but you should just think about going to trade school so you could just work at the plant.'”
Those remarks just made him more determined. “I used their comments to add fuel to the fire,” Gallien said. “I’d listen and smile and say, ‘Thank you, I’ve got bigger plans in mind.’ I didn’t grow up seeing Black doctors, and I didn’t grow up seeing college-educated individuals. But I knew I wanted to jump, hoping that when I did, I’d jump to bigger things rather than face-planting.”
In 2007, he received full-ride scholarships from universities across the country, including the University of Texas at Austin, and Rice. But the costs for extras — as well as homesickness for his family, friends, and his favorite Louisiana foods — seemed prohibitive. As a devout Roman Catholic, he chose to attend New Orleans’s Xavier University, the nation’s only historically Black college that is Catholic.
But there were challenges. In medical school at Louisiana State University Health Sciences Center in New Orleans, he was the only Black male student in his class.
In part because he knew he might be the first Black doctor many of his patients saw (and in part due to its flexibility, and range of conditions he might be treating), Gallien decided to go into emergency medicine.
“He knew what he wanted, and he was relentless in pursuing me as a mentor,” said Lisa Moreno-Walton, a professor of clinical emergency medicine at LSU. Each year, Moreno-Walton gets 150 requests from students who would like her to be their adviser. “I have to choose wisely,” she told STAT. “I have two criteria: identifying people who are willing to work hard, and who will give back to the community. I could see Jeaux would do that.” Indeed, he became the national conference chairman of the Student National Medical Association, and was co-president of its local chapter.
Yet as he applied for elite residencies in the Northeast, he heard again: “‘Your resume isn’t good enough for the Ivy League.'” It was hard, he said, not to think people were not judging him by his skin color. During his daily prayers, he asked for strength. “You’re going to do this,” he told himself.
On Match Day in 2016, he learned he was accepted to Columbia University Irving Medical Center and Weill Cornell Medical Center.
While Gallien loved his time in New York, there was never any doubt that he would return to the South to be closer to family and friends (as well as étouffée and jambalaya). “Here, I also feel that I have the opportunity to be more influential for those around me, and to be available to them. There are not a lot of people in the ER who look like me,” he said. “I can provide my community with someone they can relate to.”
Still, back home in Louisiana, the past few months have been trying. Many of his colleagues lost their homes in the hurricane but still came to work, sleeping at the hospital, where only the ER was functioning.
“It was very depressing, but at the hospital, our job is to stabilize patients, and to stay strong,” he said. “You’ve got to stay focused.”
In between shifts, Gallien spends time with his family. He’s raising money for hurricane relief, helping college students with their applications to medical school, and mentoring 10 medical students. Seven of them are Black.
“Other people before me did so much more with less,” Gallien said. “I’ve got to keep paying it forward.”