 |
| Carlos Roberts, M.D. |
On a cold day in mid-February, the expected winter storm stayed to the south of York and Dr. Carlos Roberts stopped by as promised to tell me his winding story. Carlos is from Trinidad and Tobago, a warm Caribbean two-island nation just off the coast of Venezuela, part of the West Indies. He traces his lineage to the East Indies, to India, along with about forty percent of the population of Trinidad.
How was that? The island, claimed by the Spanish, was sparsely populated into the late 18th century. In 1777 Spain lured French planters from nearby islands to immigrate to Trinidad, and to bring their African slaves (mostly men) with them. In 1797 Spain surrendered to the British (without a fight) and Trinidad became a British crown colony. The population then consisted of about 2,000 white individuals, 4,500 free people of color, 1,000 Amerindians, and 10,000 African slaves.
 |
| Map of the West Indies, with Trinidad the southernmost and considered part of South America (from nationsonline.org) |
Carlos said that his paternal great-great-grandparents were persuaded to be shipped to Trinidad from India under the indentured servant program. After their years of required service were completed they chose the offer of land, and they raised a very large family.
While Carlos knew that his father’s background was fully East Indian, his mother’s story was “a little bit unknown.” That is, until recently. By testing his own DNA, he found that his mother’s line is British, Irish, Scottish from her white mother, and Nigerian plus other African countries, from her not-white father. So Dr. Roberts is half-East Indian and half-other. He is, as he said, “mixed.” .
His father’s mother was traditional and did not approve of her son marrying a non-Indian. His father’s father, on the other hand, was welcoming. Carlos told me that his Indian paternal grandmother “never once in her entire life,” never once, called him by his name; she always called him “Boy.“ You see, unlike his two sisters and his brother, he looked “different.” There was awareness of "other."
But there was an unusual twist to the racial hierarchy in Trinidad. Because the (white) British (on top) feared an uprising of the much more numerous (black) African slaves (on the bottom) after their emancipation, the (brown) Indian indentured workers (placed in the middle) were automatically installed as officers of the law to help maintain the order, to prevent an uprising by those below. A defined order was set by color: white, brown, black. There a racial ordering.
 |
| Ethnic Makeup of Trinidad and Tobago (from Encyclopedia Britanica) |
Once he decided that he wanted to be a doctor, the next question was: “How do I do that?”
Besides being a good student with a true photographic memory, he was a talented sportsman. In fact, he represented Trinidad and Tobago in field hockey at the Central American and Caribbean Games. The strong team won a silver medal at the 1993 games in Ponce, losing to powerhouse Cuba in the finals. Maybe, he thought, maybe he could parlay his athletic skills (he excelled in soccer, too) into a ticket to college in the States, and then on to medical school.
 |
| 1993 CAC Games men's field hockey results (from Tudor Krastev) |
While here on the visa in 1995 he stayed with his uncle in Brooklyn, home to many immigrants from T and T. So Carlos called around to the schools that had offered him scholarships before. He took winding bus rides to Bloomsburg (the bus caught on fire on the return trip to New York) and West Chester, both in Pennsylvania. And he looked at St. Francis and St. John's in New York. He was accepted to St. John’s on a soccer scholarship after a trial as a walk-on, but he could go only if he could pay his own way for the first year. Of course, he could not. Another disheartening setback.
 |
| Friendly Nostrand Avenue restaurant in Trinidadian Brooklyn (from Museum of Food and Drink) |
He needed to stay in the States. His uncle’s wife was “a wonderful lady” who taught at Hunter College. Her mother had advanced ovarian carcinoma and Carlos helped take care of her. As an essential caregiver, he was allowed to extend his visa. He did odd jobs and worked as a laborer for a few years swinging a heavy sledgehammer and knocking stuff down. And he waited.
Things began to look up after he started working as an assistant to the owner of a small New York real estate company. And as he made enough money for college he could enroll at St. Francis in Brooklyn Heights. His boss recognized his potential and offered to pay his tuition if he worked full-time. So Carlos got up early, took classes until noon, studied on the train, and did real estate until nine or ten at night.
He was on track and sailing along when he got a surprise call from the soccer coach at historically-black Lincoln University in Missouri. A team member had recommended him to the coach. On this sole recommendation, Carlos was offered a scholarship; no try-out needed. But he was now comfortable in New York; what should he do?
He told his Trinidadian girlfriend, Kesha Baptiste (now his wife), of his dilemma and she felt that he needed to get out of New York.
 |
| Kesha |
The visitors stood at the door a while, then left, at which point the smitten one simply told his pal that the girl in the doorway was going to be his wife. His unbelieving friend said, ”You don’t have a chance in hell.” But Dr. Roberts knew better. He had already seen the image of her face in his mind’s eye one day when he was sensing that it was time to get married.
 |
| Kenny Sattuar |
What did Mr. Sattaur do then? He decided to celebrate! He took Carlos and Kesha to Ruth Chris’s on Long Island, where Dr. Roberts had his first-ever steak. And then (wait for this...), Kenny then said he would continue to pay Carlos his weekly wage for the next year as he went to Lincoln to finish his college degree.
So, Carlos moved on. He studied hard and played soccer in Jefferson County, Missouri. It was “a very interesting place,” he said, with some irony. During the last game of his first season, he tore his ACL and needed surgery. He did quite well in his studies and qualified for an academic scholarship. He took this and gave up his athletic ride so the coach could build the program by recruiting another good player; someone else could be given a chance.
Carlos recovered from surgery and continued with the team. One day they played against Missouri University in Rolla. To say it kindly, the small (and 87%-white) town between Springfield and St. Louis was not very progressive. The home team was all white, as were their vocal supporters. During a throw-in, he heard a spectator shout, “Why don’t you go back to the cotton fields and pick cotton?”
He did not get upset with the players on the field or the crowd, but it suddenly occurred to him that his mother had been making a derogatory comment as she would say to him: “You need to shut your cotton-pickin’ mouth.”
Carlos had never experienced overt racism before; connecting it in his mind with what his mother said hurt terribly.
He felt overt racism again in a match in Kentucky. The Lincoln goal-keeper, Dustin Carney, was upended by an opposing player. No red or yellow card was thrown. Carlos, as the captain of the team, approached the official and asked why this obvious infraction wasn’t carded. The official looked away and spat on the ground. A melee of sorts ensued and the game was called. The naked complicity of those charged with ensuring fairness on the pitch, keeping a level playing field, was too much for Carlos to bear. Institutional racism.
 |
| Mara Aruguete, PhD |
The acceptance to medical school, the hoped-for letter, the letter saying, “We are pleased…” is anxiously awaited by all eager applicants, and Carlos Anthony Roberts was no exception. His dream was to go to historically-black Howard University, the alma mater of the previously-mentioned Eric Williams. Yes, going to Howard would be nice.
So he applied to several schools and waited. He was happy enough when he received the acceptance from Lake Erie Osteopathic Medical School. But he heard nothing from Howard, his first choice. As he was waiting he had to send LECOM fifteen hundred dollars to hold his spot in the class. Carlos didn’t have fifteen hundred dollars. He went to Dr. Aruguete; he needed advice from his advisor.
Her immediate answer: “I’ll write you a check now. You don’t have to pay me back.” With gratitude, Carlos immediately went to the bank, deposited the gifted check, wrote his own and mailed it to Erie, and headed home. When went through his mail (you guessed it) the acceptance from Howard was sitting there. He put a stop to the mailed-in check and returned the money to Dr. Aruguete.
Unbeknownst to our protagonist, Kesha, who, like Carlos, was in the States on a temporary student visa, had quietly entered the Green Card lottery. She received notice that she was one of the winners the day after Carlos got his news from Howard. Timing. (Of those who apply each year, less than 1% receive a card.)
 |
| Borat's Permanent Resident Green Card |
So, in 1998 they had a small wedding on campus. They bought a cake and boxed wine from Walmart, her mother’s friend made Kesha’s dress, Kesha’s mother cooked the food, Carlos rented a Tuxedo for a day, and his roommate and co-captain of the soccer team made the VHS video (complete with unwitting commentary). In attendance were his older sister’s son and a cousin from Trinidad whom he had bumped into while at St. Francis.“It was an amazing day,” said Dr. Roberts.
After Lincoln University in Missouri, he went to Howard in D.C. where he “met a lot of great people,” including the steady midwife who helped him with his first delivery at Prince George’s Hospital. As he considered a specific course in medicine, he thought about going into orthopedics because of his sports background. But after he nodded off, actually fell asleep, during one of the operations with hammers and saws, a hip replacement, he let that idea go. Dr. Roberts said he preferred more intricate and complex surgery, and his experience during his first rotation guided him to obstetrics and gynecology.
 |
| Founders Library at Howard University in the spring (from Howard University) |
While 800 miles apart, they wanted to start having kids. So when Kesha called him one Thursday night during his internship to announce that she was ovulating, Carlos went into action.
 |
| The National Pike in 1850: From Baltimore to St. Louis (by 1838) The first national road and the most heavily traveled road in America at the time (from heraldstandard.com) |
(There is good evidence that women are most fertile the five days before ovulation since it takes a while for the sperm to find the egg. Maybe some men have more athletic spermatozoa, more determined swimmers. Who knows?)
Anyway, when his wife was then offered a post-doc fellowship at Hopkins she wanted to take the opportunity, but not with her husband back in St Louis; he would gladly make the effort to move closer to her program.
A friend from Howard, Tommy Kimble, was doing his OB/GYN residency at York and told Carlos that he was in luck: there was an unexpected open slot for a second-year OB/GYN resident for the upcoming year.
Speaking of “luck,” of which Dr. Roberts seems by now to have had an unusual abundance, he feels that this is mostly “opportunity and preparedness meeting in the same space.” It is what you do with what has been given, with what has been presented.
Getting back to the meandering story: Dr. Mary McClennan, one of the faculty in St. Louis, was friends with Dr. Marian Damewood, the head of the program in York, and they spoke. Carlos had already interviewed at York and he was readily accepted as a second-year resident.
After a night on call, he drove to Southcentral Pennsylvania the next day to start the year. He and his wife bought a house in downtown York and they lived there through his residency.
When Kesha’s water broke early one morning and she went into labor she turned to awaken her husband. He was scheduled to be on call that day; he had hoped to do the delivery, but he had to work. Yet, he might still be able to help bring his daughter into the world. But as his wife’s labor progressed there were signs of trouble. The baby’s heart rate slowed. The father’s heart rate quickened. And the more experienced Dr. Kathryn Hassinger did the complicated vacuum and forceps delivery. Their second daughter, born in 2008, had an easier time of it; she was an elective C-section baby.
 |
| Leonardo da Vinci's 1511 "first in history" accurate depiction of the fetus in the womb |
After his residency Carlos wanted to do a fellowship in gynecologic oncology, a decision influenced by having cared for his aunt’s mother with ovarian cancer. So he spent an intense month at Memorial Sloan Kettering (MSK) on the Gyn service. He never got more than four hours of sleep, but it was, he said, “the most exhilarating experience.”
Though he “didn’t enjoy end-of-life care,” he applied to MSK and Hopkins for three or four years of oncology training. These top programs were extremely competitive and Carlos was not offered a position. He was disappointed, but his residency prepared him to be a generalist, and that was “okay.”
 |
| Dr. Vincent Lucente |
When Dr. Roberts returned to York, he took over the urogynecology practice of Dr. Leslie Robinson. He said that he “loves” being in the operating room (like all good surgeons) and helping women “get their lives back” as they are no longer hampered by embarrassing incontinence and related problems.
One of the most disabling of these conditions is that of a fistula, a connection, a tract, an opening, between the bladder and the vagina resulting in continuous leakage of urine. In the past, it was caused by so-called obstructed labor due to pressure of the baby’s too-big head against the bladder. It is now most often an accidental complication of surgery.
A bit of gynecologic surgical history is needed: In 1852, American surgeon James Marion Sims (1813-1883), of Montgomery, Alabama, reported on his surgery for transvaginal fistula repair in three blacks slaves, Anarcha, Betsy, and Lucy. The slave owners lent (yes, lent) him the three young women for the period of treatment. They were kept in a shack behind his house and he subjected them to a total of 42 painful surgical procedures, all without the benefit of anesthesia, over the next four years. Only Anarcha's surgery was successful (and after 30 tries). Sims is known as the founder of urinary fistula surgery and the father of modern American gynecology. A 14-foot statue of him stood in Central Park from the 1890s until it was removed in 2018.
 |
| Painting by Robert Thom for the Parke-Davis "Great Moments in Medicine" series (Anarcha is kneeling on the table) |
Dr. Roberts said that the care for a woman with incontinence, and, in fact, of a woman through her reproductive life, and as her daughters have children, is no longer provided by a single person. He said that this now is “compartmentalized” and that there are “many more people touching that individual than in the past.”
There are positive aspects to specialization, sure, but he is concerned that as care is fragmented we “may lose some of the doctor-patient relationship.”
He sees this relationship as a tricky one in our consumer-driven health care system. Old-fashioned paternalism is frowned upon, of course. But true shared decision-making, he thought, the collaboration between the doctor and the patient, could be likened to, perhaps, “paternalism with more information.”
And Carlos hopes to be able to be good enough to adequately train the physicians who will someday care for his wife and two daughters. And to pass that goal on to the following generation of doctors, and so on. He said that “when you’ve been helped so much in your life you have to pay it forward.” He fears that if this doesn’t happen, medicine as we know it “will die on the vine, and that will be a miserable death.”
This sentiment led Dr. Roberts to read me something he wrote about his personal journey. He titled it “I am I Because You are You” and sent it to several of his mentors. Standing in front of a mirror looking at himself he saw his evolution as a physician. He saw himself at different ages. But as he felt the passage of time and stared at his reflection in “the mirror of life” for a while he no longer saw his ancestral biological lineage. Instead, he saw “the tapestry that has been carefully woven by those that have taken the time to inculcate the best parts of themselves” in him. He thanked them for their “munificence,” for their generosity.
These thoughts echo the South African social philosophy of Ubuntu: "I am because you are." Or as formulated in the Zulu saying: "A person is a person through other people." In our relationships with others, through intimate I-Thou dialogues, we create each other.
 |
| Dr. Detlef Gerlach |
Dr. Roberts encourages his daughters, like every good father does, to think critically, to read widely, and to “seek out and validate information” for themselves. (I am certain their professor-mother encourages nothing less.)
So, looking ahead, I imagine a recurring scene: Dr. Carlos Roberts quietly standing off to the side of an expectant mother in labor as he coaches a nervous student on the first day of her OB rotation: “It’s okay, I’m right here. You are going to be doing this delivery.”
