The Burden of Proof

There is a question I have spent most of my life answering.

The strange thing is that nobody has ever asked it outright. Instead, it arrives in smaller forms. Can he keep up? Does he really understand? Where did he train? Can I speak to your consultant? Different words, always circling the same thing. Are you good enough?

I have never doubted the answer. Other people, it seemed, needed convincing.

I was nine when I first noticed it, newly arrived from Ghana. The teachers, understandably, wanted to know how I would settle. Would my English hold up? Would I manage the curriculum? Reasonable questions, on their own. Nobody thought to ask the ones that would have answered them faster. Was Ghana an English-speaking country. Where had I actually been born. What my parents did for work. How many languages I spoke before I ever set foot in a classroom in England.

I was born in Wimbledon. Both my parents were doctors. English was my third language, and somehow the one I spoke best.

But a first impression, once formed, is difficult to dislodge. Once someone decides your English might not be good enough, they start listening differently. Your accent becomes evidence rather than simply an accent. You are asked to repeat yourself, not because your English has changed, but because their expectations have. And then, slowly, something else happens. Your English "improves." Nothing has actually changed except how carefully you've begun shaping your own voice to make other people comfortable — softening a rhythm here, adjusting a word there — until they relax. Until you're accepted. Until the next assumption arrives to replace the last one.

This might be intellectually challenging for him.

I found that one almost funny. I had been doing algebra in Ghana. I arrived in England and found myself discussing Strawberry Fields Forever. It wasn't that one curriculum outpaced the other — they were simply different, and what I needed was time to adjust to a new culture, not a diminished intellect. But the pattern didn't stop at the school gates. In secondary school science I was placed in one of the lower sets. My teacher was kind about it, and offered extra help if I began to fall behind. I appreciated the kindness. I recognise, now, the assumption sitting underneath it. By the end of the year I had finished top of the set, with marks higher than several students above me. They moved me, because there wasn't really a choice.

That happened often enough that I started to notice the look that came with it. A slight narrowing of the eyes. A pause. A quiet recalculation, as they worked out what to make of me. Every time I was underestimated, I became a little more determined — and determination, I would learn, is not free. It costs something to keep producing excellence simply to be regarded as average.

Medical school made the pattern impossible to ignore. I arrived already different from a lot of my classmates — following a three years first degree, two summers spent selling books door to door across America, failing, adjusting, succeeding, learning how to talk to strangers who had every reason to shut the door on me. I knew who I was by the time I got there. What I hadn't accounted for was how many people would assume their experience of the world was mine too. Some of my classmates had grown up somewhere they'd barely met a Black person, and without quite realising it, they thought they already understood me. They were surprised I was articulate. I always found that funny. I was born in Wimbledon. My family invested everything in my education. I went to private school from the age of ten. If anyone in that room should have sounded the part, it was me.

The assumptions didn't end with qualification. If anything, they lost what little subtlety they'd had. Patients asking where I was really from. Where I'd trained. Which university. Whether I was actually the doctor, and whether they could speak to my boss instead. Sometimes the questions came from genuine curiosity. Sometimes they didn't. You learn, eventually, to tell the difference without needing to be told.

Higher surgical training carried the pattern further still. People looked for weaknesses before they'd seen any evidence of one. Some trainees were quietly expected to need longer, or not quite make it at all — and when conversations turned to additional support, extra time, further review, I noticed how often the faces under discussion looked like mine. I can't prove why. I can only describe what I watched happen, more than once, in more than one place.

I finished training. Passed the exams. Finished the fellowships. Became a consultant, and thought, finally — no more proving myself.