Before turning to the present, I want to turn back in time, nearly a century. My aim in doing so is not merely to historicize the way the current pandemic has been racialized. It is also to raise the question of how stories of medical racism are told and how narrative patterns shape political responses.
§1 – Dalton, GA, 1931
The car accident outside Dalton, Georgia in November of 1931 was not anomalous. Nor, in many ways, was the response. Long before 1931, calls for racial justice have been made by means of the exemplary scene, the distillation of a pervasive, atmospheric violence, the singular moment that bring to the foreground what typically remains in the background. This pattern is no less familiar now than it was in 1931.
Juliette Derricotte was a young activist with the NAACP and World Christian movement and dean of women at Fisk University, an historically Black university in Nashville. On 6 November 1931, Derricotte was driving with three of her students to visit their respective families in Georgia. Just outside the town of Dalton, GA, near the Tennessee border, they collided with another car driven by a white couple. Two of the students received relatively minor injuries. Derricotte and the third student, Nina Mae Johnson, were severely hurt. Though they were initially treated by white doctors both at the scene of the accident and at the doctors’ own offices, there was no question of their being admitted to Dalton’s single, white-only hospital. Eyewitness testimony collected in the aftermath of the incident, at the instigation of W.E.B. Du Bois, report local white doctors and nurses expressing surprise at the very suggestion: “Oh, no’m, we don’t take ‘em there,” replied one doctor when asked if any attempt had been made. Instead, Derricotte was moved to the home of a local woman, Mrs Wilson whose house was used as a makeshift hospital for African Americans. Eventually Derricotte and Johnson were transferred by ambulance to Chattanooga, Tennessee, the closest town with a hospital that admitted African Americans, where Derricotte died the following afternoon.
The story is remarkable less for its details than for the fact of Derricotte’s prominence, which led to its relatively widespread coverage – she was involved with the national YWCA leadership, had studied at Columbia, and her position at Fisk placed her in a national network of African-American academics and activists. The most prominent of these was W.E.B. Du Bois, who compiled eyewitness testimony into a narrative published in the Crisis (the NAACP’s magazine, which he edited between 1910 and 1934) by March 1932. A report by the Commission on Interracial Cooperation, a largely white liberal organization based in Atlanta, was similarly damning. In addition to extensive coverage in the black press, a handful of white outlets also mentioned her death. In 1934, Marion Cuthbert, an educator and Harlem Renaissance author published a lyrical fifty-page biography of Derricotte. Of the accident, she wrote:
The hospital of the town stood not far away. Its beds were cool and white. Skilled hands there could gently move poor tortured flesh.
But this was a Negro woman!
§2 – The ruses of empathy
Derricotte’s death was not unique in its injustice. The denial not only of equal treatment, but even of the most basic and minimally adequate care, to African Americans was pervasive throughout the South and by and large the North, even in the absence of de jure segregation. DuBois’s biographer David Levering Lewis describes Derricotte’s story – relevant because of Du Bois role in memorializing her – in terms of “medical sins of omission.” Insofar as we allow that omissions may be politically and morally salient, many instances of medical racism might be so described. Consider all the chronic illnesses that go undiagnosed and untreated, the patients who never make it to the hospital in time.
But in Derricotte’s case “omission” is far too weak. This is no case of neglect, or even or morally culpable omission. What is key about cases like this is precisely the way in which they depart from the “normal,” much less visible or spectacular forms of racial distribution of ill health and, indeed, of death. In a word, they are narratives. The moral tale of murderous neglect is blindingly clear. The victim is the object of tragic identification. In covering the story of Derricotte’s death, writers like Du Bois and Cuthbert were not just memorializing a lost friend and colleague but trying to bring it about that, as the saying goes, her death would not be in vain.
A story like Derricotte’s distilled much broader and more diffuse patterns into a single, clear story with identifiable actions, rather than “mere omissions.” The story was effective because it was both exceptional in the level of its brutality, but also palpable in its hold on the intended reader. For the Black reader, the scene was meant to be the extreme version of a familiar experiences. For the sympathetic white reader, it was meant to be a provocation for empathy, the chance to consider the difference between their own experiences and those of someone like Derricotte.
As I have mentioned, DuBois compiled a dossier of eyewitness reports and interviews that formed the centerpiece of the Crisis’s coverage of Derricotte’s death, introduced with a relatively brief editorial note. The voices included in that dossier include the two survivors of the crash, white Dalton nurses and doctors who speak frankly about their role in the deaths, as well as Derricotte’s colleagues from Fisk. One of the most striking lines, placed by Du Bois at the climactic moment of the collage, is attributed to Ethel Gilbert, a white Fisk administrator and good friend of Derricotte’s: “I shall always have to remember that within one half hour after the accident, I would have been in a modern hospital.”
The line succinctly describes the gulf between white and black experiences of medicine – and consequently of life and death – that Cuthbert evokes lyrically. The comparison is effective but deeply fraught. Empathy, after all, is a tricky thing. The point here is not to cast aspersions either on Gilbert’s motives or the sincerity of her grief but to interrogate the structure of racial empathy itself. Nearly a quarter century on, Saidiya Hartman’s descriptions of slipperiness of racial empathy remain arguably the most acute diagnosis of the issue at hand. The prime example is the white abolitionist imagined self-transposition into the position of the slave. The attempt to conjure such empathy risks inadvertently enshrining the white observer as the suffering part: “in making the slave’s suffering his own,” Hartman suggests that the agent here “begins to feel for himself rather than for those whom this exercise in imagination presumably is designed to reach.”
Gilbert, of course, is not explicitly placing herself in Derricotte’s position, but drawing a contrast between their experienced: “That is what befell my friend, this is what would happen to me in such a circumstance. The difference is unjust.” Yet the centrality of the comparison between Gilbert and Derricotte – offered up by Gilbert, and made central to the narrative by Du Bois – leaves unanswered Hartman’s question: “Can the white witness of the spectacle of suffering affirm the materiality of black sentience only by feeling for himself?” The question is not particular to attempts at narrating instances of medical racism specifically, but it is certainly pertinent here. (We might also note that insofar as the question is pertinent in the context at hand, one curated Du Bois in the Crisis, the “white witness” extends beyond white individuals.)
§3 – Chicago, 2015
There are (at least) two dimensions to be investigated here. The first we might call ethical: under what circumstances does the crafting of narrative like Derricotte’s slip into the realm of voyeuristic pleasure, precisely the endpoint that Hartman diagnoses in white antislavery narratives. We should call into question not only the ethical stance of the viewer, but also the political or tactical efficacy of such narratives. (That is, the risk of political failure is embedded in the transmutation of empathy into masochistic identification. Insofar as a narrative like Derricotte’s is meant to be a call to action, it cannot do so by becoming an escape for the reader.)
The second dimension concerns a worry that an emphasis on particularly egregious stories – indeed perhaps on particular stories at all, in contrast with statistics – might risk obscuring the real roots of health disparities. This may be illustrated through the following brief vignette:
About a decade ago, an organizing campaign to expand emergency care on Chicago’s South Side had been started by a youth group after one of their members, Damian Turner, was shot. He died in an ambulance on the way to the nearest trauma center nearly ten miles away, even though a major research hospital was located just a few hundred meters away on the campus of an elite university. A couple years into the campaign, handful of activists – both white students from the university and Black teenagers from the neighborhoods near by – met with a high-profile scholar of African American politics. The aim was both to get advice and also to get a signature for one of the many petitions that had sprung up. During the course of the meeting, the following challenge was posed: “Yes, this is awful, but ultimately the numbers aren’t that huge. If you’re really interested in medical racism, why this, and not diabetes prevention, preventive cardiac care, primary care, maternal health? Those are the real killers.”
I cannot, of course (though I was present), identify the precise motives of the questioner, but one way to read the scene is that this was meant to be a provocation as much as a serious challenge. If that is right, I think it is an important question to address. Why do some kinds of death become foci of outrage, while others fade into the background?
The point of this provocation was not to set up a competition for artificially scarce resources, that is, to ask: “Which of these issues matter, and which don’t?” Nor was it, I think, a submission to the strict utilitarian calculus of marketized healthcare (although the fantasy that we can fully escape that is, at best, optimistic). Rather, the question raised can be seen as posing a challenge about how best to conceptualize the relationship between foreground and background. What are the costs and what are the advantaged, politically speaking, of mobilizing around an issue that may be relatively “minor” in terms of purely numerical terms, but which seems to crystallize and clarify the full extent of medical racism?
§4 – USA, 2020
What I’m trying to suggest is that for the last century or so, writing about and organizing against, medical racism has operated by shuttling between the particular case and the broader social phenomena, between the glaring foreground and the grinding background. This very broad, almost formal point can be made, to be sure, regarding any number of points political action and discourse. But in the case of health and medicine, the pandemic changes that or at least makes clear the need to do so.
The toll the pandemic has had on black, Latino and Native communities, underscores with a particular urgency the continued force of medical racism specifically, and the profound inhumanity of the American medical system generally. An optimist might hope that the pandemic will finally push the United States to adopt some form of genuinely universal, easy-to-access, non-means-tested healthcare system.
But the pandemic might also change the way in which stories of medical racism are told. There have already been cases reported of egregious discrimination by doctors, hospitals, insurance companies – the list goes on – and more are sure to come. But important as those are, they hardly capture the toll of the pandemic or its racist distribution. Background and foreground have, to some extent, merged. The United States and the world are living in the midst of what appears to be an unprecedented and impossible to predict calamity. But in fact, neither the pandemic nor its particular local patterns were unpredictable or unpredicted: warnings about pandemics have been made occasionally for years. And the nature of American racism generally and medical racism in particular made the unequal effects of a pandemic – this or any other – even more predictable. In short, precisely the conditions that allow the pandemic to stand out as particularly monstrous are those which have long formed the basic, background conditions of life, health, and death. The distinction between relatively “extraordinary” forms of violence and the everyday, mundane, background is unstable at best, illusory at worst. Whether individual stories are essential to creating the urgency required for political mobilization, but the current calamity that is unfolding is a reminder that we must keep totality in sight too.
§5 Post-script – July 2020
I wrote out an initial draft of these thoughts in mid-May, at a moment where the American epidemic was on a brief downward trend. Since then, as states reopened, cases have started increasing faster than ever. As I write, the US – and the world – just recorded the highest ever daily case increase. The last month and a half has also witnessed the largest and most sustained uprising for racial justice in a generation, sparked by the police killing of George Floyd in Minneapolis on 25 May.
The relation between the pandemic and the protests is one that continues to evolve. Early fears that mass gatherings for marches and rallies would function as super-spreader events appear not to have come to pass. New York City, for example, has seen some of the largest and most consistent crowds, without a rise in new cases. More importantly, however, is the role that the pandemic has played in creating the conditions in which the uprisings arose. What clearer spark for an uprising than the murder of a black man by police during a pandemic disproportionately affecting African Americans? What more predictable a context for looting than a period of the worst unemployment in nearly a century? What better time to be in the streets than after nearly three months of isolation and the disruption of habitual sociability?
A relative of the tension between foreground and background, between spectacular and mundane forms of (medical) racism, discussed above can be seen here. Demands to arrest and prosecute police officers jostle against calls to dismantle the police and the criminal system of which it forms a part. There are at least two related problems that can be identified in the reform approach. The first is that such demands accept – and indeed, shore up – the notion that criminal prosecution and incarceration are adequate avenues for justice. The second is that focusing too narrowly on individual police officers obscures the fundamentally racist and exploitative nature of policing as such. That is, attending to the foreground in a manner that comes at the expense of seeing the background.
A similar cautionary note has been sounded in the related case of the prison complex. Attention to the depravity of the American prison system has been on the rise for the last decade or so. In the most widely diffused discussions of mass incarceration, however, there has been a particular focus first on for-profit private prisons and second on “non-violent” offenders, particularly those convicted of racist drug laws.
- Pointing to the “tiny role of private prison firms in the prison-industrial complex,” Ruth Wilson Gilmore asks, “What kind of future will prison divestment campaigns produce if they pay no attention to the money that flows through and is extracted from the public prisons and jails, where 95 percent of inmates are held?”
- A disproportionate focus on non-violent offenses risks legitimating incarceration as a sound response to violence. This longstanding abolitionist point is heard more commonly now than even two or three years ago. increasingly common. Writers like Michelle Alexander – in a departure from her book The New Jim Crow (2010), which helped draw public attention to mass incarceration by focusing on the War on Drugs – have recently begun drawing attention to the inadequacy of focusing solely on the disastrous effects of the War on Drugs, mandatory minimum sentencing, and three-strikes laws. Nevertheless, the abolitionist demand for a comprehensive restructuring of the justice system remains overshadowed in the broader public sphere by focus on easy cases and sympathetic victims of injustice.
A clearly delineated foreground figure, easier to comprehend, can become a too narrow focus, not only leaving untouched the background, but obscuring. As in the case of medicine, the imperative is to articulate a shift from the necessary pull of the particular toward the full expanse of social totality.
 W.E.B. DuBois, “Dalton, GA,” 4, March 1932, W.E.B. DuBois Papers, (MS 312), Special Collections and University Archives, University of Massachusetts Amherst Libraries.
 “Mrs. Wilson stated to me that her house was used for colored people who needed hospital care and that the white physicians who operated on colored patients used a room in her house — the inference being that they could not be taken to a hospital.” p. 5.
 E.g. the New York Times ran a brief obituary on 11/8/31; a longer article, ‘The Death of Miss Derricotte,’ appeared in The Christian Century, Jan. 13, 1932 and obituaries appeared in all the major Black newspapers.
 Marion Cuthbert, Juliette Derricotte (NY: The Woman’s Press, 1933), 52.
 p. 7.
 Saidiya V Hartman, Scenes of Subjection: Terror, Slavery, and Self-Making in Nineteenth-Century America (Oxford and New York: Oxford University Press, 1997), 19.
 Ruth Wilson Gilmore, “The Worrying State of the Anti-Prison Movement,” Social Justice, February 2015, http://www.socialjusticejournal.org/the-worrying-state-of-the-anti-prison-movement/; See also Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California (Berkeley: University of California Press, 2007), 21-22; 125.