Student Stephen Nurse-Findlay Photo by Peter Howard “It’s ingrained since day one, when you have parents who’ve been grooming you to be successful,” Bisola Ojikutu explains, “not to let certain things [that might reinforce stereotypes] slip in front of certain people.” “I did look at top schools,” says Raegan Durant, “but I also looked for a place that would offer strong support. At Hopkins’ people were constantly asking me, ‘How are you doing? Is everything going okay?’” “We try to give under- graduate students the kind of guidance we wish we’d had when we were applying to medical school,” says SNMA president Nia Banks, leading the group’s monthly meeting. Number of Black M.D. graduates of The JHU School of Medicine during the last 30 years.	In a Sea of White Faces By Kate Ledger For black medical students, getting into Hopkins is only the first step. Amid the rigors of training, they find themselves navigating the subtleties of life as a racial minority.   tephen Nurse-Findlay remembers the precise moment he knew where he wanted to go to medical school. Sixteen years old in 1987, living in Trinidad, he had flicked on the TV just in time to catch the news from America about an unprecedented operation separating Siamese twins joined at the head. A black man stood at the podium. "I was waiting for him to introduce the surgeon," Nurse-Findlay recalls. Then, as the man began describing details of the daring, 22-hour procedure, the Jamaican-born teenager realized he was looking at the operation's artist: the pensive pediatric neurosurgeon Ben Carson, M.D., of Johns Hopkins. "I thought, Wow," says Nurse-Findlay, "here's a place that lets someone who is brilliant be brilliant. And I thought, I've got to go there. I've got to get with that program." The road to Hopkins, Nurse-Findlay attests, was no cakewalk. After finishing high school in California, he earned a scholarship to historically black Tuskeegee University in Alabama. With his sights fixed on Baltimore, he says with a laugh, "I worked my tail off," and graduated magna cum laude with a dual major and numerous distinctions, including leading the school twice to victory in the national black college bowl. When he matriculated in 1995, he became the first graduate of Tuskeegee ever to become a Hopkins medical student. Today, a third-year student immersed in long-houred clinical rotations, Stephen Nurse-Findlay is one of 45 black students among the School of Medicine's student body of nearly 500. Hopkins, he says without hesitation, has lived up to the impression it first made on him. That's a long stride for a school with a history blotched with years of segregation, where the first black students, a British-trained Nigerian, James Nabwangu, and an African-American, Robert Gamble, graduated as recently as 1967. Yet, even though Hopkins is committed today to creating a culturally diverse student body and eagerly invites applicants from ethnic groups under-represented in medicine (these also include Mexican-Americans, Native Americans and Puerto Ricans), the experience of being a black medical student at Hopkins is still the experience of being a minority. The second-year class of 117 has a mere six African-Americans; two men, four women. The first-year class has a total of 13. Black students continue to grapple with the pressures of feeling that culture and skin color set them apart, of being, as one African-American fourth-year student put it, "the only minority face in a sea of white faces." Tempered Ebulliance here's a certain ebulliance to my nature that had to be tempered here," acknow-ledges Nurse-Findlay, as he reflects on making the transition from an historically black college to a predominantly white school. "Making the right first impression is much more important than it was at Tuskeegee." He learned that lesson at the beginning of preclinical classes when he showed up with his sandwich in a bright red, "Aladdin" lunchbox and found his classmates light-heartedly characterizing him by it. "People will take me for what I project," he says. "I wanted to be seen first off as the hard-working student that I am, not as a class clown or a Will Smith or a comedian." Now, as he observes a colon resection on his anesthesia rotation, Nurse-Findlay asks the resident a dozen questions and jots careful diagrams in a pocket-sized notebook. He's meticulous, he admits. Only later, wearing jangling, silver bangles on his right wrist and tiny, trendy glasses, does Nurse-Findley seem relaxed, waving jovially to passing friends. Part of his seriousness on the job, he points out, is generic to being a medical student, but more than other students, he tends to prepare for his rotations, finding out a week ahead where to go, what time to be there, who the residents will be. Others check with him when they're not sure about those details. He also makes a point to dress well and conduct himself professionally and with polish. "My classmates may roll in a little more casually," he says, "but I'm not complaining. I don't mind holding myself to a personally higher standard. That's me." "It's harder for black men than for black women," asserts Bisola Ojikutu, a third-year student from Chicago, wearing slender braids swept grandly into a pony tail. "Women are less threatening. There are fewer hindrances to success." She objects, however, to Nurse-Findlay's idea of working harder than his classmates to prove himself. "What sets apart our experiences as black students is that we tend to work hard to create an image that will break stereotypes. It's a key deficiency within the black community. We're always trying to blend. Ultimately, that puts undue pressure on us as medical students. "Sometimes it's like wearing a mask," Ojikutu acknowledges, though she adds that Hopkins is no different from other predominantly white and inherently hierarchical institutions in American society. On the clinical units, where team etiquette is vital and where grades depend on a higher-up's opinion, blending in becomes particularly important. "It's ingrained since day one, when you have parents who've been grooming you to be successful," she explains, "not to let certain things [that might reinforce stereotypes] slip in front of certain people." Plummeting Applications uch insights could become moot. Whether or not the nation's black students will continue to find their way into America's medical schools recently has become a serious issue. After climbing steadily for the last decade, the number of minority applicants plummeted 11 percent this year, a decline that the Association of American Medical Colleges linked directly to legislation in California, Texas, Louisiana and Mississippi that barred affirmative action in higher education admissions. Although educators had braced themselves for a drop in minority acceptances, they were stunned to find so few blacks even applying to medical schools. Controversy over affirmative action, they speculated, has been disillusioning for prospective students. And now it's raised public health concerns, says AAMC President Jordan J. Cohen, M.D., who called the downturn "an ominous sign for the medical community and our nation, which badly needs a physician work force that is both diverse and reflective of our society as a whole." With its highly competitive admissions standards, Hopkins has not yet felt the sting of the national crisis. "We're very lucky, we tend to get the strongest applicants across the board," says David Trabilsy, associate dean of admissions. The School is  well aware, however, that it's not enough just to receive minority applications. A demonstratively supportive environment is crucial for these young people to succeed. "When Hopkins first started taking black students, admissions officers went around to the historically black colleges and took the best of the senior classes," says Roland Smoot, M.D., assistant dean of student affairs, who, in 1965, became the first African-American physician granted admitting privileges here. "Then the students got into this environment, and socially they felt like outcasts. They didn't perform. I could pick up the class list and tell by rank--the 120th student, 119th, 118th--they were the blacks." When Smoot took his administrative post, he immediately homed in on the problem. To orchestrate a social scene for them, Smoot paid out of pocket to host a reception that would bring together black medical trainees and introduce them to practicing physicians in the community. The informal event turned out to hit the nail on the head, creating friendships and establishing networks that extended throughout the city. Over the years, the guest list climbed to 700, and grew to include dental and pharmacy students from Hopkins and the University of Maryland whose departments chipped in to support the affair. Says Smoot, "The students knew that there were people behind them." For the Hopkins crowd, he notes, the strategy worked. Their grades and class ranks shot upward. Underscoring Hopkins' internal network, cardiac surgeon Levi Watkins, M.D., in the early 1980s  started a tradition of holding a first-day-of-school welcoming reception for Hopkins' 10 to 20 black students and house staff at his home. Watkins, who had been the first black medical student at Vanderbilt, became Hopkins' first black professor in 1991. Today, the event he initiated and continues to plan every year is held in a hotel, sponsored by the School, and attended by a vibrant crowd of more than 200. Students meet each other, establish contacts with house staff and faculty ("black as well as white faculty who have worked with us side by side," notes Watkins), black deans (Hopkins has three) and adminstrators, and a handful of community leaders, business people and politicians. "It's a banquet the likes of which students have never seen and will never see again," Watkins asserts. "We let them know where our hearts are." In impromptu speeches, everyone from Dean/CEO Ed Miller, M.D., to community preachers offer encouragement. The festivities are rounded out with food and inspirational music like "Wind Beneath My Wings." But what's crucial about the receptions (there's a third one in the spring at the home of pediatric neurosurgeon Ben Carson for prospective students still deciding between schools) is that they affirm the presence of what Smoot calls "a critical mass." A support system. In a school that--unlike many of its peer institutions--determinedly has never had an administrative office dedicated specifically to minority affairs and does not use scholarships to affirm its commitment to recruit top minority candidates, the network is a detail that's not lost on students. A Sense of Belonging aegan Durant, a tall, soft-spoken second-year student who did his undergraduate work at Howard University, says when he began looking at medical institutions that were predominantly white, "I   did look at top schools, but I also looked for a place that would offer strong support." As he traveled for admissions interviews, he noticed whether black people were visible on the faculty and house staff at each school, whether those he met--from the students to the support staff--were encouraging. "Hopkins was superb at that," he says. "People were constantly asking me, 'How are you doing? Is everything going okay?'" Ojikutu agrees: "This was the only school I considered where the black faculty was truly visible and outspoken. They made their faces known." The sense of community is so strong, in fact, that for some prospective students who have been admitted to several schools, it counterbalances often hefty scholarships offered by other places. "I and just about everybody I know had very big offers," says second-year student J. Anthony Graves, who earned a Ph.D. in molecular genetics at Carnegie Mellon before heading into medicine. "The feeling here is too good to pass up." The one gathering where many of the School of Medicine's full complement of black students meet is at the extracurricular Student National Medical Association (SNMA) that gathers monthly in a preclinical basement classroom. With a page-long agenda in tiny type, the group energetically spearheads a long list of community service activities including making recruitment phone calls to undergraduates applying to medical school and teaching sex education in nearby middle schools. It's also in the SNMA meetings that students socialize, let down their guard, discuss irritating incidents on campus and tell stories about occasionally being singled out or feeling completely invisible on the units. They talk about unthinking clinical details entrenched in textbooks, like a dermatological condition that's defined by a red rash. "It's not the sort of thing you'd bring up in lecture," admits Durant, "but what are these students going to do when they're seeing black patients and looking for a red rash?" And they talk about occasional frustrating comments they hear about the area surrounding the medical school. "People say Hopkins is in a bad neighborhood," says Griffin Davis, a fourth-year student from Baker, La., who came to Hopkins from the Massachusetts Institute of Technology with his twin brother Garvin, "but we came here because of East Baltimore--to take care of our people and be medical students that patients from the area could relate to. We've never lived more than a mile from the school. We wanted to be part of the community." What students regret most about Hopkins is that the total number of African-Americans at the medical school is still low. Blacks make up only 2 percent of Hopkins faculty, below the national average, and the enrollment of medical students fluctuates dramatically from year to year. Of 287 black applicants for the class of 2000, 13 were admitted, and only seven finally chose Hopkins over other medical schools where they'd gotten in (one of the seven headed for a year of research). "As a result, the small group is very close," Durant acknowledges. "We've really bonded, since there are only six of us." Though his friends cross racial boundaries ("I'm well-liked among my classmates," he admits modestly), his closest relationships these days are with African-Americans. Other students echo him: They've held onto ties with black friends from college who are nearby in Washington, D.C., or bonded most with blacks they've met in school or on campus in administrative offices. "But that's natural with any group, whether the distinction is based on culture or ethnicity, race, sexual orientation," Durant says. "Hopkins does do a lot to create a diverse class of people with different backgrounds, interests and personalities. It's still nice to have some black classmates to share [the experience] with." Now, with the looming national threat of falling applications, the students talk with concern about the national backlash against affirmative action. They're working harder than ever to entice other black students to apply. Nurse-Findlay, for one, will make half a dozen phone calls to talk with prospects, many of whom ask right off about the nature of the environment. "It's been too long that medicine has been closed to black folk on my side of the stethoscope," he says emphatically. "And Hopkins is too good a place for them not to be here." *