The (Unspoken) Black Covenant
In the 1990s, my family and I lived in Colorado, where Blacks were about 3% of the population. When I turned 16, I got a job at a local retail store. I was obviously one of very few Black employees on staff.
Since I would be starting a job interacting with customers soon, my big brother thought it would be important to teach me a lesson in diversity.
“Nod downward to White people,” he pulled down a serious face and quickly bounced it back up like a bobble-head genie. “But nod upward to Black people,” he said with a light-hearted confidence and a hinting smile.
The way he issued the instruction made me think this had worked well for him over the years. He seemed sure it would serve me in a way that would protect my social credibility among both people groups, so I trusted him.
It worked. White people seemed to see me as non-threatening, and Black people responded to the greeting like a secret handshake of sorts, granting a reciprocal, approving upward nod.
In my conversation with Jeremy Taylor, a 20-year veteran in respiratory care, he passionately detailed stories around his work as a practitioner serving Black patients at a major healthcare facility in Philadelphia, and the unspoken Black covenant of trust he sensed there.
Mockingbird: “When you were providing services to your Black patients in Philly, did you feel that they actually trusted you as a provider?”
Jeremy: “There’s this collective nod to our shared struggle—this understanding that even though I was walking around in that white coat, it must’ve been a hard journey to get there, and that every day was an ongoing battle for me to stay there as a Black man. African American patients responded better to me than others just because they could relate to me.”
Black Advocate vs. Black Employee
There are times when African Americans in professional roles feel they are being regarded as the unspoken, designated representation of an entire people group in a particular setting. Often, it is for White people to gain insight, and other times there is a sense of pressure to speak up against insensitive or unjust practices negatively impacting Black people or another marginalized group.
During this moment in our dialogue, I could tell that Jeremy could see himself seated at the long meeting table in the staff room of the medical facility where he served patients as these encounters replayed in his mind.
Jeremy: “During grand rounds, my superiors would always wonder how I could get Black patients to cooperate when non-Black providers had been trying unsuccessfully for weeks. I’d pause and ask them to look around the table and count the people of color on staff and compare that number to the patient ratio—then consider that his could be part of the issue.”
He went on to share that he suggested solutions around onboarding more African American staff, which were usually ignored. He felt that as a Black man, he could only go so far in these kinds of conversations without risk. He needed to balance his advocacy for his patients with his reputation as an amiable, competitive and promotable staff member.
Jeremy: “With certain issues [around race]—even though I knew my boss’s boss’ boss, because of how our country is set up, there was simply nowhere to go.”
Hi, Agony—Meet Apathy
While in the hospital, the call bell has been referred to as a patient’s lifeline because it often speaks for them in scenarios where they are unable to talk. Its purpose is to connect the patient to the nurse, and it can make the difference between life and death. There is over-usage, but Jeremy talked about witnessing nurses unplugging Black patients’ call bell from the wall to avoid providing medical service to them.
Mockingbird: “Did you ever notice any sort of disparity between the frequency at which providers were responsive to Black patients versus White patients?”
Jeremy: “Absolutely. Primarily with Black women, who have been made to endure some of the worst mistreatment from the medical community I’ve seen. Their pain is so often misunderstood, ignored, mis-diagnosed and mistreated.”
Mockingbird: “There is evidence supporting the prevalence of the outrageous and false notion among White healthcare providers that African Americans somehow have a higher biological threshold for pain tolerance. Is there also a similar racist misnomer about pain and Black women among White medical professionals [you’ve worked alongside] when compared to Black men?”
His eyes began to swell.
Jeremy: “Yes. In addition to old-fashioned racism, patriarchy is also a factor that Black women have to contend with. Many times, they’re seen as liars and exaggerators. Ironically, white providers don’t trust these patients to know and accurately communicate what they’re feeling. It’s horrible. As Black men, we definitely have our disadvantages. On the other hand, when Black women are in care, they are even more underserved and unheard than any other marginalized group I’ve seen.”
Although he felt limited in his ability to speak out at work, Jeremy used what he learned through his experiences as a healthcare worker to educate his loved ones about how to advocate for themselves as Black patients in medical settings.
The Walking Dead
Jeremy recalls a grieving and confused son whose mother passed away while in the care of the medical facility.
With traumatized eyes, the mother’s dear son, appearing to be in his thirties, was disheveled and walking in circles after being delivered the news of his mother’s death.
“She was just up cooking dinner yesterday and went to church with the family two days ago!”
The young man seemed to be suggesting that the hospital was directly responsible for his mom’s death—ideas that have stemmed from medical mistreatment, a form of historically-documented racist behavior according to Jeremy.
“When I looked at the CT scan, her heart was this big…”
Jeremy stretched his fingers apart about 8 inches wide.
“Her ankles were as wide as the bottoms of this table in front of us,” he said, pointing at downward at the thick wooden table holding our drinks.
“Yes, she was cooking dinner—and yes she was attending church—but she was dying. The lack of preventive care is a horrible cycle for Black people!”
Our Neglect to Check
There are indeed factual stories from our history passed down to us that recall atrocities committed against our people that cause many of us to question our safety in the hands of modern-day medical professionals.
Fear is a consistent emotion that is aligned with what many African Americans have expressed throughout the years. This sentiment has been passed down like a family tradition. The fear has birthed a recurring question in the corner of many of our minds:
What might happen to me (or someone I love) if I fully surrender myself (or them) into the care of a medical facility run by White people who aren’t that fond of people who look like me (or us)?
Is our fear of what may happen to us causing us to stay away from preventive treatments like vaccinations, physicals and other important, perhaps life-saving health procedures?
Could staying away from the doctor be killing us more than going to a doctor who doesn’t love Black people ever could?
Over the years, we’ve come to learn that preventive health is important in preserving your body’s longevity. Waiting until you are experiencing a health condition that is exacerbated to the point of requiring immediate medical care and treatment is likely to cause long-term harm.
As an example, despite the stigma sickness and death HIV/AIDS has carried in our community for over forty years, the facts are in.
Evidence has shown that people living with HIV (who detect the virus early, remain adherent to their treatment plan and attend regular medical appointments) are most likely to become virally suppressed.
In present times, people who are HIV positive (but virally suppressed) are living long, healthy lives comparable to those who are HIV negative. This demonstrates the broad difference in health outcomes between those who are proactive about their health versus those who are reactive.
Paying it Forward
Mockingbird: “Do you think that your work in healthcare, servicing patients and understanding the science of disease has had an impact on the way your family thinks about their own health?”
Jeremy: “Yes. My brother called me every day—putting me on speakerphone. If I agreed with his doctor, my brother went with it. If I didn’t, he shut it down. I could call his physician and talk to him about options he hadn’t even considered. One of his doctors was African—also a disconnect. He came from the perspective—‘I’m not Black—I’m a doctor.”
Mockingbird: “Because he was foreign?”
Other Anti-Blackness in Healthcare
Mockingbird: “We’ve talked a lot in black and white. Philly is very diverse. Let’s talk about those who are also American from different heritages and how those particular clinicians interacted Black people in the healthcare setting where you worked.”
Jeremy: “It depends on which group the clinician belonged to. Many of my foreign colleagues, even if they were technically considered ‘people of color,’ were white-adjacent. Their friends, where they lived, the places they hung out and how they identified were not reflective of our lived experiences as Black people. As a result, their perspectives and posture were often similar to those held by their White colleagues—and Black patients could sense that disconnected disposition.”
Mockingbird: “In my last interview with a Black Pharmacist, we began to uncover some medical mistrust that exists between White patients and Black providers. Have you ever experienced anything that resembles this in your work?”
Jeremy: ”[Pauses and smirks] “I’ve seen two nurses in the same room; one Black, and the other White. The Black nurse with more education, more experience, and better bedside manner, explaining a treatment plan to a White patient while changing their bed. The White patient looked over at the inexperienced White nurse for validation of what the Black nurse just said. It used to really piss me off.”
Words to Die By
Mockingbird: “What have you been most impacted by in your medical career?”
Jeremy: “Death. I’ve seen it so much over the last twenty years that it doesn’t make me feel anymore. Our body is nothing—and everything at the same time. COVID has proven that our existence is made up of moments. I’ve been inspired to make the most of every one of mine.”
Words to Live By
Mockingbird: “How do Black people set themselves up for success? How do we learn to trust this healthcare system enough to live given all the grievances we’ve suffered and continue to endure?”
Jeremy: “The world evolves. A computer in your pocket was unheard of 25 years ago. Attitudes in the practice of healthcare are no different. We have to allow people and systems to change, even if those changes are gradual. My grandmother was resistant to her food being heated up on a metal plate. Today, most of us don’t even think twice about warming our dinner in a microwave. Change is slow, but it is constant and inevitable. We will get there.”