Editor’s note: This article contains a racial slur crucial to the writer’s story.

It took only 57 hours of working as a new attending physician in Charlottesville, Virginia for a patient to call me the N-word.

Fifty-seven hours. In fact, a racial slur found me before I found the shortcut to the hospital cafeteria. So, when torch-bearing White supremacists gathered downtown earlier this year, I saw more confirmation of my conclusion that bigotry feels right at home in Charlottesville.

Over the past decade, I have taken care of thousands of patients in North Carolina, Chicago, and New York City. Many have been grateful, some angry, a few have cussed at me and one, recently, even wrote me a poem. But, until a few weeks ago — on my fourth day of work in Charlottesville — no patient of mine ever directed the N-word at me during a clinical encounter.

This particular encounter with racism started routinely enough with a page to the emergency department to admit an elderly man with new-onset confusion. His race — though not an important detail at the time — was white. I walked into his room and introduced myself as his doctor. He responded by offering me a graham cracker. I imagined we’d get along famously.

I kept our interaction light and free-flowing, as is my nature in patients with altered mental status. I wanted to assess his thinking patterns through our conversation. I wanted to know if he could explain to me the circumstances that landed him in our emergency department and led the physicians there to recommend admission to the hospital. More than that, I hoped to build rapport that would be the foundation for our partnership in his care.

Perhaps I was too easy-going and affable because our seeming familiarity piqued his interest. He asked me if I was from the area, and I replied that I lived in Charlottesville for a few years during college. His eyes lit up, and he cracked a knowing smile.

“I do know you!” he exclaimed, preparing his revelation. “You’re that little nigger who used to hang out in Jimmy’s backyard!”

I assured him that he was mistaken, and instructed him — as though it was for the first time in his life — that he should never use that word. He smiled and shrugged, seeming more surprised by his misrecollection than he was by the offense that his racial slur had caused.

I paused, more to punctuate the moment than to attempt to process it. Quickly, though, I returned to my assessment. In standard fashion, I examined my patient, shared my clinical impressions and plan, and asked if he had any questions before I exited the room. I was there to do a job, but more importantly, I was not going to allow him to have thrown me off my game.

Only after I stepped outside did I begin processing the deluge of emotions. I was both stunned and speechless. His word hurt — like a verbal lash of a whip, or thud of a baton, or tightening of a chokehold. It flung its illegitimate power at me, and I hated that I gave it any recognition at all. I felt silly for trusting that my white coat could protect me from moments like this. The chorus of Jay-Z’s “The Story of O.J.” came to mind. “Still nigger.”

The casual way that he said it added a layer of unfamiliarity. In the past, when I have been called nigger, it was always my assailant’s intent to punctuate their disdain. This didn’t appear to be my patient’s purpose. He said it simply as though it belonged to me. He said it assured that it was, and would always be my most appropriate descriptor.

Given my patient’s easy use of the word in conversation with me, a black physician, I wondered how many times he must have casually used the word “nigger” in conversations with friends, family members and coworkers over the years. For those who didn’t share his racist beliefs, how many missed opportunities were there to tell him he was wrong to think and speak this way? Sure, it would require courage and conviction to speak up in those moments. On the other hand, when they were silent in the face of his slurs, that did, in some ways, make them complicit in his racism.

Let’s take a timeout for a second. Did you cringe when you saw the N-word written out so many times? Did it bother you that I didn’t spare you the discomfort of reading it after he rang that bell? Did you try to dismiss or rationalize his exchange with me, retreating to subconscious exceptions for his age or his confusion? Were you relieved that I did not perceive his intention as overtly hateful or hurtful?

If any of those thoughts crossed your mind, you should know that you are missing a bigger picture. Those blind spots are precisely why we need to have this conversation. We need to learn how to confront every last drop of racism in our society if we are to have any hope of eradicating it. We have to acknowledge these moments of offhand and casual racism as a reality and not as an outlier. Moments like these are our windows into the very real racism that still assaults black Americans — from many sides.

To be clear, the urgency behind these kinds of conversations is not purely a matter of human decency or political correctness. Of the dozens of white supremacists who gathered in Charlottesville in October — or the hundreds who descended on the town in August — surely many were once casual racists, too. Right now, countless casual racists are being recruited and called to join the next white supremacist rally. It is their smoldering intolerance and hate that is at great risk for radicalization and mobilization amidst the racial division that grips our nation. But only those who know them best — those who can lovingly and tactfully correct their ignorance — have the opportunity and the agency to change hearts, minds, and vocabulary.

While this year’s fourth convening of white supremacists in Charlottesville made national news yet again, the signs and symptoms of those most likely to rally to their cause go unnoticed far too often. Preventing the hate speech, the fear-mongering and the tragedy starts with a commitment to recognizing racism in all forms with each of us taking responsibility to name it as unacceptable, intolerable and un-American. It starts by demanding a higher standard of the conversations we have about our neighbors in those moments when we’re sorted homogeneously.

So, if I could make one request of my fellow Americans, it is that we all be brave enough to make it a teachable moment the next time we hear someone casually use a racial slur around the kitchen table, at the bar or over the group text. You never know, you might stop the next hateful demonstration before it starts. At the very least, you can make sure your friend or loved one doesn’t look like a bigot in front of their doctor.

B. Cameron Webb is an internal medicine physician.

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