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Damon Tweedy says that the goal of his book is to "humanize the dire statistics and bitter racial debates and paint a fuller picture of the experiences of black patients, as well as that of the black doctors who navigate between the black community and the predominantly white medical world" (7). In this capacity, Tweedy's book is a resounding success. Tweedy's text masterfully presents the stark reality of the racial disparities between Blacks and whites with respect to the occurrences of particular diseases, but also with respect to the type and quality of medical care that each group (generally) receives throughout their lives. Through the stories of individual patients who Tweedy encountered first as a medical student and intern at Duke, then as a psychiatry resident, and finally as practicing psychiatrist in the Raleigh-Durham area Tweedy presents the readers with a personalized account of the myriad ways in which race affects, and intersects with, disease and medical care. Tweedy's book begins with his own experience "as one of a handful of black students" (11) in Duke's incoming medical school class of 1996. He notes a particularly jarring experience in which while during a break in class he was asked by his professor, Dr. Gale, "are you here to fix the lights" (12)? This experience sets the stage for the remainder of Tweedy's reflections on race: being viewed as out of place within the medical community, feeling powerless to confront the racism of those in power, and figuring out how to move forward in spite of these experiences.
One of the great successes of Tweedy's text is that it weaves the presentation of statistics with the personal stories of patients, nurses, and doctors in a manner in which the stories of the patients are evidence of the statistics. For instance, as a second year medical student Tweedy encountered a case in which a young pregnant Black woman, Leslie, was rushed to the E.R. and presented with "painful vaginal bleeding" (30). At first Leslie denied she was even pregnant, and she further denied having taken any illegal drugs--however, when another doctor asked outright "when is the last time you smoked crack" (35) Leslie admitted to having smoked two days prior. Leslie's baby died at 22-weeks. Tweedy, without passing judgement, proceeds to tell the reader about the sobering statistics of crack use among Black women in the 1990s. However, Tweedy presents not a condemnation (though there seems to be an element latent in his reaction to the death of Leslie's baby), but an enlarged perspective: "a national survey in the mid-1990s revealed that black women were ten times more likely than white women to use crack during pregnancy. The same survey, however, found that pregnant white women were more likely to abuse alcohol" (40). Tweedy wonders why his supervisor had been so quick and direct as to ask when the last time Leslie smoked crack was, and further, he ponders whether the doctor would have asked a pregnant white woman when was the last time she drank alcohol.
One of the low-points of Tweedy's text is the seventh chapter titled "The Color of HIV/AIDS," in which we are told the stories of George and Monica. George is a married man who is admitted to the hospital "complaining of fatigue, weakness, and short-term memory problems" (153). After running a battery of tests, George's diagnosis is a sombering one: "He's HIV-positive" (154). George's risk factors for HIV were very low: he worked in an office, he was married for 20 years and denied any extramarital affairs, his wife's--Janice--job necessitated routine testing, he claimed he didn't use, much less inject, street drugs, nor had he had a blood transfusion. It was clear that George has not been truthful with the doctors. After telling George, outside of his wife's presence, Tweedy recounts the social worker assigned to George's case as asserting his belief that George is gay. Tweedy then writes that George's "story pointed to something I'd read and heard so much about--black men leading a 'down-low' lifestyle--but had yet to see up close" (163). Tweedy's belief that George was having risky sex with another man, and this was the cause of his HIV infection seems out of place for a medical professional.
Monica's story is basically the mirror of George's story. Monica is a 28-year old woman who overcame tremendous adversity to acquire a bachelor's degree, and who aspired to be an "office manager of a medical practice, or maybe a hospital administrator" (167). During a routine OB/GYN screening Monica's doctor found an abnormal pap smear--she had acquired the human papilloma virus (HPV). Her doctor sent her for further tests for secual transmitted infections (STIs), including HIV. Monica had only had sex with two men in her life: she always used condoms with the first boyfriend, but with her second boyfriend she switched the birth control pills. Monica was HIV-positive. While discussing Monica's care with her mother--Geraldine--Tweedy is taken aback by her assertion that "[her] (Monica) so-called boyfriend. The one that gave her this...disease. He was a fairy. A faggot" (171). Monica had, it seemed, been infected with HIV by another Black man leading a "down-low" lifestyle.
There is a persistent myth that the disproportionately high rates of HIV/AIDS among Black women is a result Black men leading a "down-low lifestyle." However, this hypothesized cause was rejected by the medical community. Dr. Kevin Fenton, Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, in response to the question "[s]o, is it fair to say that it is just simply not true that the majority of new infections among black women occur because of having sex with men who have sex with men," (Martin, 2009) replied "[y]es, that would be true. It is crucially important to bear in mind that there are a range of risk factors which face black women in the United States today. And, you know, the reality is that bisexual black men account for a very, very small proportion of the overall black male population in the United States. Our research suggests that about two percent of black men will report being bisexually active" (Martin, 2009). It is simply not true that the high rates of HIV infection among Black women is a result of Black men leading a "down-low" lifestyle. It is disappointing to have a medical professional perpetuate this dangerous myth. This is most certainly my biggest criticism of Tweedy's text.
I cannot know which texts Tweedy might have read concerning philosophical investigations of race and racism, but there is an undercurrent similar to George Yancy's concept of the "phenomenological return of the Black body" that he discusses in his 2008 book Black Body, White Gazes: The Continuing Significance of Race that I found incredibly palpable throughout Tweedy's text. Numerous times Tweedy recounts wondering how white (and Asian) doctors and nurses viewed him, and Blacks in general, after dealing with a Black patient. In one telling passage Tweedy worries that Leslie, the crack-abusing woman who lost her baby, "had put the worst face of black America on full display for this white medical audience" (41) and that "in witnessing the pathology of Leslie's behavior and the doctor's and nurse's reaction to it, I suddenly felt naked, as if someone had stripped me of my white coat and left both of us to share the same degrading spotling" (41). Tweedy, in a different chapter, again worries "that my white colleagues had made unconscious or even conscious negative judgements about these black patients, and thus about black people in general" (63). These constant worries about Blacks, and him specifically, are (or will be) viewed by whites is something that numerous authors have discussed in detail (e.g., Du Bois' "double-consciousness" and Fanon's "Look! A Negro" stand out as examples par excellence), but Yancy's text seems apropos and exceedingly fitting as a philosophical grounding for the experiences discussed by Tweedy. Yancy describes "the phenomenological return of the Black body" as "instances in which the Black body is reduced to instantiations of the white imaginary" (Yancy, 2008, 66). Yancy describes the feeling of being "ontologically locked into" (Yancy, 2008, 68) his body when a teacher told him that he should be more realistic about his life's ambition--which was to be a pilot. In that moment, Yancy argues that the teacher "returned me to myself as something I did not recognize" (Yancy, 2008, 67). This philosophical description of the phenomenological experiences that Tweedy navigated throughout his medical career gives a robustness to Tweedy's text: his memoir is an example of the theories explored by the likes of Du Bois, Fanon, and Yancy.
Tweedy's text was a pleasure to read, and I would recommend the text to anyone interested in medicine or race. The beautiful weaving of statistics and cold facts with personal stories (both Tweedy's and the people he encounters) present the reader with a humanized understanding of a complex topic. It is hard to nitpick Tweedy's text for its lack of philosophical rigor given that he is not an academic philosopher, however, I found Tweedy's text full of not only philosophically relevant topics, but of timely topics as well (e.g., the Supreme Court's recent case on Affirmative Action in higher education). Readers will find Tweedy's text extremely approachable and straightforward, but that is not to indicate that they will find his text light on data, or robust concepts for it is certainly a text which challenges our personal, and societal, presumptions about race and medicine.
Martin, Michael. "Myth: HIV/AIDS Rate Among Black Women Traced to 'Down Low' Black Men." Tell Me More, NPR News, aired October 28, 2009, transcript, http://www.npr.org/templates/story/story.php?storyId=114237523.
Tweedy, Damon. Black Man in a White Coat: A Doctor's Reflections on Race and Medicine. New York, NY: Picador, 2015.
Yancy, George. Black Bodies, White Gazes: The Continuing Significance of Race. Lanham, MD: Rowman & Littlefield Pub., 2008.
© 2016 Jess Otto
Jess Otto, PhD student, SUNY Buffalo