Black Man in a White Coat

 

Begin Reading

Table of Contents

About the Author

Copyright Page

 

Thank you for buying this

Picador ebook.

 

To receive special offers, bonus content,

and info on new releases and other great reads,

sign up for our newsletters.

 

Or visit us online at

us.macmillan.com/newslettersignup

 

For email updates on the author, click
here
.

 

The author and publisher have provided this e-book to you for your personal use only. You may not make this e-book publicly available in any way.
Copyright infringement is against the law. If you believe the copy of this e-book you are reading infringes on the author's copyright, please notify the publisher at:
us.macmillanusa.com/piracy
.

 

Introduction

On a spring morning in 1997, Jim Harper, a young man from Durham, North Carolina, woke up in his two-bedroom apartment with no clue that he would soon become gravely ill.

The first signs of trouble seemed innocent enough: some numbness on the right side of his face and in his right arm and hand, easily chalked up to having slept on that side of his body. He stumbled as he got out of bed, but figured he was simply tired from the previous day's shift managing angry teens at a group home. His fiancée, Regina, asked if he needed to see a doctor; he smiled and told her that she worried too much. Her anxiety ebbed as she went off to her job at Kmart, only to resurface when he didn't answer the phone during her lunch break.

When Regina rushed home a few hours later at the end of her shift, she found Jim sprawled across their bathroom tile. His eyes were wide open and he clearly recognized her, but his words were garbled. He couldn't tell her what was wrong or how long he'd been that way. She frantically dialed 911. Within a half-hour of his arrival at the emergency department, after a neurological exam and rapid CT scan of his brain, it was clear what had transpired: Jim, just a few weeks shy of forty, had suffered a massive stroke.

The doctors learned that Jim had high blood pressure that had been poorly treated, but found nothing else to account for his tragic fate. He had no heart problems. No clotting disorders. No aneurysms. No diabetes or high cholesterol. He didn't smoke, rarely drank, and avoided street drugs. Ultimately, as best they could tell, Jim mostly had a lot of bad luck.

*   *   *

About two weeks later, I stood at the foot of Jim's bed at Duke Hospital. Along with another first-year medical student, I was shadowing Dr. Wilson, a faculty neurologist, as part of a weekly seminar that introduced us to clinical medicine. This class was the highlight of our week, as it gave us a brief break from the lecture hall and laboratory, where we memorized biochemical pathways and microorganism names, and provided a peek at our future lives on the hospital wards. We wore perfectly knotted ties and crisp white coats for the occasion, trying hard to look like the doctors we would one day become.

Jim's future seemed far less promising than ours did. A big man, he had once been a football player. Now he could not move the right side of his body. His face drooped as saliva dribbled out of the corner of his mouth. His words came out choppy, like those of a toddler; when frustrated, he cried like a child in the midst of his “terrible twos.” Given his lack of improvement, the doctors had begun to doubt that he could make any significant recovery. They were preparing to send him to a rehabilitation facility. This place also had a long-term care unit, where, if he made no real progress, Jim might spend the rest of his life. According to the nurses, Regina's visits were already becoming shorter and less frequent.

“It's a very sad case,” Dr. Wilson said, as we left the room and walked to a nearby conference area to discuss our patient and his illness.

He started by telling us that stroke was consistently one of the top five causes of disability and death in America. Then he drilled us about the major risk factors, going back and forth between us in a competition of sorts. In eager medical student fashion, we rattled off the usual suspects: diabetes, hypertension, heart disease, advanced age, smoking, and high cholesterol. When it was my turn again, Dr. Wilson indicated that there was one important risk factor we had yet to mention. He looked at me with a worried frown. Come on, his look said, for you of all people, this should be easy. I sighed. I'd hoped it wouldn't come to this, but, as I was quickly learning, it always did.

“Race,” I said, looking down at my dark hand against my pristine white coat. “Our patient is black.”

“Exactly,” Dr. Wilson responded, as if I'd now earned a top score on my exam. “Some would say that this is the most important variable of all.”

He rattled off damning statistics about race and stroke: “The risk is twice as high for blacks compared to whites for those over sixty-five. And in younger groups, such as with our patient here, the ratio is more like three-to-one or even four-to-one.”

I'd seen the impact of stroke on both sides of my family. When I was fourteen, my dad's brother—who would often drive five hours each way on a Saturday to visit us for a few hours—died within days of collapsing at his home, putting an abrupt end to his unexpected and always enthusiastic visits that I so enjoyed. A few years later, my maternal grandmother—Grandma Flossie—developed dementia from a series of minor strokes that slowly stole her mind and, eventually, her body. Like Jim, both had high blood pressure.

“Our patient's other major risk factor is hypertension,” Dr. Wilson continued. “This also is much more prevalent in blacks—nearly twice as common. No matter how you slice it, race is a very big deal when it comes to stroke.”

Dr. Wilson had hammered home something I would learn time and again, both at Duke and beyond: Being black can be bad for your health.

*   *   *

“Of all the forms of inequality,” Martin Luther King Jr. told a gathering of the Medical Committee for Human Rights in 1966, “injustice in health is the most shocking and the most inhumane.”

At the time of his remarks, the United States had begun to take several formal steps to end its century-long practice of state-sponsored segregation that had followed the end of slavery. In medicine, this meant that black people could begin to receive treatment side by side with whites rather than being relegated to separate and unequal facilities or sectioned off in run-down areas of white hospitals. Such practices had undoubtedly contributed to their poorer health, especially in the Deep South of Dr. King's time, where black people on average had a life expectancy nearly nine years less than whites. While the civil rights movement ultimately stirred remarkable racial progress in various areas of American life, many of King's concerns about health and health care remain valid to this day.

From cradle to grave, these health differences, often called health disparities, are found virtually anywhere one might choose to look. Whether it is premature birth, infant mortality, homicide, childhood obesity, or HIV infection, black children and young adults disproportionately bear the brunt of these medical and social ills. By middle age, heart disease, diabetes, stroke, kidney failure, and cancer have a suffocating grip on the health of black people and maintain this stranglehold on them well into their senior years.

Thus, it is no surprise that the life expectancy among black people, despite real progress over the last twenty-five years, still significantly lags behind whites. In suffering a crippling stroke at age thirty-nine, Jim had become another casualty of inequality, a fresh case that Dr. Wilson could use to illustrate the health burden of being black.

*   *   *

Three decades after Dr. King's 1966 remarks, I entered Duke University School of Medicine as one of a half-dozen black students on scholarship. With the scholarships, Duke sought to cast aside its history of racial exclusion and become a national leader in producing a new generation of black physicians who could change the face of medicine. My goal as I headed for Durham was much less ambitious and civic-minded. I simply wanted to make my parents proud of me and set myself up to earn a good living. Race-based concerns ranked low on my list of priorities.

But my professors couldn't stop talking about race. During my early months, as they taught us about diseases both common and rare, they inevitably cited the demographics, explaining which disorders were more common in the young or old, women or men, and one racial group or another. When they spoke about race, they would sometimes mention Asians, Hispanics, and Native Americans. Yet invariably, as it always seems to in America, their analysis came down to comparing blacks and whites.

It seemed that no matter the body part or organ system affected, the lecturers would sound a familiar refrain: “It's more common in blacks than in whites.”

Each time the demographics of a new disease came up in a lecture, my stomach twisted. I knew where this was heading. Seated in a sea of mostly white and Asian faces, I wondered how this information affected their views of black people, whether they already had biases against us, and whether any of this impacted the way they saw me. This racial health data intensified my already uneasy feelings about my place at Duke. My classmates largely hailed from well-to-do suburbs and had attended prestigious, brand-name schools; I came from a working-class neighborhood and had attended a state university with little name recognition. Their parents all seemed to be doctors, lawyers, or professors. My dad didn't finish high school and worked as a meatcutter in a grocery store; my mom attended segregated inner-city public schools before embarking on a forty-year career in the federal government. From the moment I walked along Duke's manicured lawns and inside its Gothic buildings, I worried that I was at a stark disadvantage, both socially and academically.

Constantly hearing about the medical frailties of black people picked at the scab of my insecurity. Over time, I came to dread this racial aspect of the lectures so much that I felt intense, perverse relief whenever a professor mentioned that a disease was more common among white people. But this list was short and the refrain that accompanied it proved equally painful. For example, while breast cancer got diagnosed more often in white women, “black women who get this disease do much worse,” the professors would say.

While I was learning about the health woes of my race, my own body began to betray me. The first sign occurred not long after I'd met Jim, the young stroke victim. As part of that same introductory course, my classmates and I learned basic medical skills by practicing on each other. One day, we measured blood pressures. My classmate frowned as she took mine. The reading was 150/95. Our supervisor, a family physician, rechecked and confirmed the reading. The doctor I saw soon afterward gave even worse news: My kidneys were showing early signs of failure.