My second day of work, I crutched into the Children’s Hospital of Philadelphia (CHOP). I was so excited to have gotten a research job in college that I didn’t want to miss any days of work, which meant showing up 4 days after having open knee surgery. I got off the elevator on the seventh floor and started hobbling down the hallway. A Black environmental services (i.e. sanitation) worker saw me and immediately called out “You ok? What happened?” I was taken aback by how nice, friendly and caring he was, even though I had never spoken to him before.
Over the next three months, as I got my giant knee brace off, as I used a single crutch, and as I started walking again, the environmental services worker would always check in with me to see how I was doing. This continued even when I was back to normal. Over the next three years, any time we saw each other in the hall, he would always get a big grin on his face and say “Hey! How you doing?”. As a half-Black individual, I took solace in our interactions as he was one of the few staff members of color I interacted with.
After graduating from college, I started working full-time at CHOP. Although I was still working in the same department, I was assigned an office in the A level. I found it odd—the A level is essentially the basement of the building; in my first three years the only time I ventured there was for my onboarding health appointment. I had no idea there were even offices down there.
To my surprise, I discovered a whole new world. Located in the basement were Environmental Services, Food Services, Facilities, Materials Distribution, and more. These are the people who keep CHOP running like a well-oiled machine: they cook and serve food to the patients, families, and staff; receive and deliver supplies throughout the hospital; and clean hallways and patient rooms. Unlike the employees in the rest of the hospital, the vast majority of the people working in or walking through A level were Black. The experience I had with the worker on the seventh floor had been a microcosm of this world, which was my new daily reality. From the elevator to my office, almost every person I would pass would smile and say, “good morning.” Depending on the time of day, people would be singing in the hallways. When the environmental services shift was over, people would gather at the elevators and just laugh with one another. Handshakes and hugs would be exchanged before saying bye for the day.
I soon came to learn that the A level culture was starkly different from the rest of the hospital. Riding the elevator up and away from the A level, the laughter and conversation would last until the elevator stopped. Like a switch was flipped, it would immediately become quiet, as “professionalism” was turned on. As a result, I certainly did not feel the same kind of happiness and joy walking through the other hospital hallways.
Once COVID-19 hit and I started working remotely, the first group of workers I worried about were my A level people. As non-clinical, essential health workers they were never included on any “heroes” lists or in any data analysis. But I knew deep down inside that this group of people I cared about was likely significantly impacted. It took 3 months before I saw something in the news related to my fears. In late June, a STAT News article about Brigham Health in Boston reported that 4.1% of environmental services workers were infected by mid-April, compared to 2.7% of doctors, 1.2% of nurses and 1% of all employees. The article detailed how hard it was to determine exposure due to large differences in where workers lived. 40% of environmental workers lived in coronavirus hotspots compared to 0.7% of doctors.1
This pandemic has brought to the forefront numerous crises, from public health, to housing, to economic downturn. Due to historical and present-day systemic racism, Black people are much more likely to be personally affected by all of these. These factors also contribute to why the A level is so different from other hospital floors. Yet despite all of this, when I went to the hospital on my last day of work to gather my things, the A level had not changed. Sure, there were masks, and people weren’t shaking hands, but the happiness was still there. Over the past few months, I had been longing for Black joy, and despite everything going on, my A level people gave it to me. As I begin my career towards becoming a physician, I will look to never forget their value – not just for their essential service, but also for the joy and empathy they bring every day. If I am able to give my patients and my team just a fraction of the happiness they gave me, I know that I will be doing something right.
1: https://www.statnews.com/2020/06/30/covid19-death-of-hospital-food-worker-a-microcosm-of-pandemic/
Sarah Rowley is an incoming first year student at the Perelman School of Medicine who is interested in Pediatrics and Health Equity.
