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After reading the only first part of “Black Man in a White Coat,” I can already sense that this will be an impactful book. Dr. Tweedy states that, as a medical student, he was not particularly preoccupied with health disparities; instead, he was more focused on proving himself in a rigorous and competitive academic setting. As a student from a lesser-known public school given a full-tuition scholarship due to affirmative action programs, compared to his Ivy League classmates, Tweedy mentions his insecurities several times. Even the medical vulnerabilities of black people which his professors mentioned in class “picked at the scab of [his] insecurities” (Tweedy 5). Once able to prove himself by excelling in the classroom, his encounters with individuals in the clinical environment later made it impossible for him to ignore the fact that “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” (Tweedy 4). Dr. Tweedy infuses this statement with powerful imagery that evokes emotion and fury at its injustice. For me, his description of Leslie’s case was particularly emotional and frustrating. The nurse, Carla, on her case showed little empathy for the pregnant 19-year old about to give birth to a stillborn. Carla engaged in what was described as “narrative mind reading” in the Mattingly article. Carla “read” Leslie’s story in a way that “reflected received cultural identities, often in a manner that only intensifies stigmatized and racialized portraits of the ‘‘Other” (Mattingly 150). She perceived Leslie as a reckless crack-addict who had no regard for her child, without taking the time to learn about her extremely difficult life story and realize she cared greatly for the baby. I believe this is a powerful example of the importance of narrative in health care, because had Carla been more understanding instead of judgmental, perhaps the correct, potentially life-saving care could have been given earlier.
I think that this acknowledgement of vulnerability and anxiety over health disparities itself is a central facet of health inequality. It is vital to acknowledge the structural barriers that are inexplicably tied to racially discontinuous health outcomes, as access to care, education, a parental history of drugs and alcohol that feeds to subsequent generations, etc., are all vital in the success of a child. This structural violence is only exacerbated by narratives that place blame on those suffering, and see this distribution of health as a ‘natural outcome’.
It is important to observe the language used in scientific literature to showcase health outcomes. Theories such as the “slavery hypertension hypothesis” attempt to normalize the conception of inherently different racial biologies that lead to differing risks. Rather, theories such as that of allostatic load better encapsulate these inequalities. The narrative that you describe above feeds into a continuous stress on the body, and small microaggressions feed into insecurities that have a very real impact. Stigma and ‘racialized portraits’ lead to a culture of exclusion and anxiety that affects the health outcomes of black people. The anxiety, fear, and fury that Tweedy describes is thus itself vital in health outcomes.
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