Chapter 1 Solid It's Time to Establish a Dependable Medical Home Dear Sis, Quick: What's your internist's name? When was the last time you went to the gynecologist? Have you had a bone density test? Did you get and keep the results of your most recent colonoscopy? How? And when was that? You should know the answers to these questions cold! If you don't, we're going to get you there--and everywhere else you need to be to have better control of your health and a better life. First, you need a team of sound and reliable healthcare professionals, and that's about having more than board certifications and a decent bedside manner, although both are important. It's also about convenience. If your doctors are hard to get to, you won't go as often as you should. And you'll be better served if your doctors know each other and are affiliated with the same hospital system. At this stage of your life, lots of things can get in the way of good care, from your socioeconomic status and politics to your gender and race. You cannot ignore that but you also can't control that. That said, you are your primary caregiver! Not your significant other, your BFF, your parent, or your grown child. Not even your primary care physician. No one is going to care more about your health than you do. No one is in a better position to do more about your health than you are. And no one has more to gain when you handle your business than you! xo, Dr. Sharon We know that whatever, whomever, and wherever we come from shapes us. But it also shapes our relationships with our bodies, with food and fitness, and with healthcare and self-care. Even as a doctor, I am no exception. Caregiving, I got. But, like most of us, I have a complicated relationship with care-getting. And that's rooted in how and where I grew up ["Home"]. It is hard to describe my hometown. It is neither a small town nor a big city. It is urban without being urbane. Mobile, Alabama, sits at the mouth of the Mobile Bay and at the anus of the Mobile River. It marks both the beginning and end of things. For those fleeing the oppressive poverty and lack of opportunity of the state's interior farmlands, as my parents did, Mobile was a beacon of hope. As a way station, it served its purpose. But for many, Mobile was just a rest stop on the way to a better life. In 1944, shortly before the end of World War II, my parents left the Black Belt, a large swath of rural Alabama named not only for its rich, dark soil but also for the preponderance of descendants of the enslaved who toiled there for generations. I have often wondered what made my parents, Bertha and Willie Malone, leave "the country," which is what city folk called the 95 percent of Alabama that didn't have streetlights or paved roads. I mean, what makes a man and woman with no money, little education, and four babies uproot their lives in the midst of a war to move to the giant and scary unknown? Were the crops failing? Was there unspeakable violence? I can only speculate, because my parents never spoke of it, but the answer must lie in the notion that whatever they were leaving was intolerable and whatever lay ahead could be no worse. Like millions of other Black people who fled the South during the Great Migration, they may have simply been searching for a better life for their growing family. And, to them, Mobile was The Big City--a mecca of possibility unlike anything they'd ever known. Ultimately, they found jobs at Brookley Air Force Base--Mom as a maid and Dad in maintenance--and, indeed, they were able to create for us what had been denied to them. By 1949, they had managed to buy our two-bedroom house at 760 St. Anthony Street. They filled it with three more kids and my paternal grandfather, aunties, and a host of cousins who needed a place to stay until they got on their feet. How ironic that they made a home there, on the street named for the patron saint of lost and stolen things. How many things had my parents lost or had stolen away? I will never know, but I know that they moved there with the sincere hope to find them. Our neighborhood was unique. Although segregation was de rigueur in Mobile, it had once been white. I knew this because there were remnants of that whiteness all around. We lived next door to the old Marine hospital, which during the Civil War supposedly treated both Union and Confederate soldiers, although I have my doubts about how many Union soldiers were treated there before the city was taken. By the time my family moved in beside it, the once-grand Greek Revival building had been repurposed into a tuberculosis asylum, never mind that a cure for tuberculosis had already been discovered. And who thought it was a good idea to put a TB hospital directly across the street from an elementary school in the middle of a residential area? As a child, I watched TB patients scale the six-foot brick wall that was supposed to keep them in. Then I watched them blend seamlessly into the neighborhood, only to return by nightfall. One block to our west was the city hospital, Old Mobile General. Another approximation of neoclassical architecture, Old Mobile General provided a lovely facade for the completely separate and unequal medical care it delivered inside. Black patients entered through the "colored only" entrances in the rear and were attended by white doctors and white staff in segregated wards. In the 130 years of its existence, no Black doctors were allowed to admit patients there. I say all of this to illustrate how much has changed in our orientation to medical care and its orientation toward us--and how much has not. Too many of the geographic, economic, and cultural barriers that shaped healthcare in the Jim Crow South of my childhood persist throughout the country to this day. The world's most recent pandemic refocused our attention on preexisting inadequacies and biases in our healthcare system but offered no new solutions. And the same issues that have disfigured the system since its inception have given rise to our often dysfunctional relationships with it. Case in point: My four oldest siblings were born at home on the farm in my mother's tiny birthplace, a town so small and rural it didn't have a proper name. It shouldn't surprise you to know it didn't have a hospital either. After moving to the city, my parents' fifth child was born in a "colored" maternity hospital run by Catholic nuns. Surely my mother expected the care there would be at least marginally better than a home delivery--but it must not have been, because baby number six was born at home. My mother delivered her next child at Old Mobile General, the segregated hospital a block away from our house. Seven years later, she gave birth to me, her eighth and last child, in her bedroom on St. Anthony Street. Just twelve years later, she died. So, I was never able to ask my mom why she made the choices she did, or to learn how her treatment compared in these very different institutions. But without uttering a word, her actions spoke volumes. One doesn't need psychic powers to know that neither Mobile's segregated hospital, with its white-only physicians and "colored only" wards, nor the crowded "colored" hospital, with its substandard tools, made my mother feel cared for, or safe. Bear in mind that Mom had come of age in a place with no hospital, no doctors nearby, and truth be told, no effective treatments for most illnesses even when a doctor was summoned--and doing so was no small thing. First of all, you had to have the money to pay the doctor. Most folks did not. Second, you had to get in your horse-drawn buggy (remember, this was the 1920s in rural Alabama--very few people owned cars) and travel miles to go get him (it was always a "him" in those days). Just imagine if nearly every time a doctor was summoned, someone was grievously ill and quite possibly near death. And so you were rarely sure whether the doctor had actually helped or hurt. Would you be quick to seek medical help? Exactly. And let's not forget that in my parents' day, these doctors were practicing medicine before antibiotics or insulin, before high blood pressure medicine, and in many cases, without anesthesia. There really wasn't much in that old black bag except maybe a stethoscope, some bandages, a tourniquet, catgut sutures, and a bone saw. Doctors were associated with trauma, some of which they caused. Given that, even house calls must have been a terrifying experience. Imagine the agony that was witnessed; imagine how it felt to be sick and in a doctor's so-called "care." These deeply disturbing associations were cemented in the minds of generations of people, my mother's included. Mom believed in hard work, education, and the power of God--not necessarily in that order. She insisted on a clean house and did virtually no socializing outside of her church and family. And she was deeply suspicious of white people, especially of white doctors and their versions of care. With this history, is it any wonder that when my proud, self-contained mother got sick in her mid-50s, she didn't seek help until she was so ill that there was no viable option for treatment? Excerpted from Grown Woman Talk: Your Guide to Getting and Staying Healthy by Sharon Malone All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
