I recently read the novel The Help by Kathryn Stockett, which has also been made into a movie. The story, set mostly in rural Mississippi during the 1960s, describes the many intimate connections—and the harsh social disconnect—between an eclectic cast of women and children spanning the racial divide of that era in the deep South.
One of my closest friends and colleagues called me after seeing the movie to “talk it out.” Both our families have grown up in towns just like those described in Stockett's novel, but we identified with different characters because of the contrast in the color of our skin. The story sparked so many images in my mind of my childhood, stories told by parents and grandparents, and the patients I have treated in rural family medicine in South Carolina. I also thought about some of the recent Musings posts focused on issues of inclusion and diversity, which have triggered some passionate responses from readers. I am no expert in social determinants of health, nor do I have any creative solutions to the complex issue of discrimination. Instead, I want to share a personal story and some advice I received from two special people from my past. I was reminded of this advice by The Help.
Generations of white children in the South—including my grandparents, my parents, my brother, and me—were reared to varying degrees by black women. I use the terms white and black because these speak to the labels that were fixed to this era. My mother and her sister were raised by the same woman who cared for their father during his childhood and who helped raise my older brother until her death. She had the richest, darkest skin I have ever seen, which led her family to call her Jet—the only name I ever heard her called. Jet died when I was young, but I remember being at her home during the final months of her life. She was confined to a hospital bed, and her brother lived with her and took care of her. I never heard her brother say a single word, maybe because Jet did all the talking. She loved to tell stories, and we all loved to listen. She was, in fact, a master storyteller, just like my grandfather. (I sometimes wonder if that's where he learned the art of storytelling.) Jet's death was especially difficult on my mother. I think about Jet every time I visit my grandparents. A picture of her hangs on the breakfast room wall, right behind my seat at the table. It seems naïve to say that we were all part of the same family, but we were.
From the time I was born until I was an older child, Alice took care of me. My parents have always told me stories about my earliest months and years with Alice, like how she would use one foot to rock my bassinet to keep me happy if she was too busy to hold me. I also have my own memories of her. As I read The Help, particularly the chapters about young Mae Mobley and her nanny Aibileen, I thought a lot about Alice. I remembered how she used to hug me tight in our rocking chair. I remembered how I used to rub my hand over hers and how her skin felt. I remembered how much she loved me and how much I loved her. I cannot recall anything about her life that did not happen inside our house. The way my wife is around our two young daughters reminds me of how Alice was with me.
When my brother and I were teenagers and until I went to college, a very charismatic woman named Louretha, who we just called Retha, helped take care of the house and looked after “her boys.” Retha is one of the most unique, memorable people I have ever known. I was much more aware of the issues of discrimination, prejudice, and poverty affecting underrepresented minority groups in the South by this time in my life. Retha was very poor, and she never learned to read having suffered from dyslexia as a child and visual problems later in life. Over the 15 years I knew Retha, she suffered quite a few serious health problems, including insulin-dependent diabetes, glaucoma, hypertension, stroke, and disabling mental illness. What I thought as a teenager was just the way she moved her mouth, I learned in pharmacy school was tardive dyskinesia, a characteristic adverse drug reaction. Her oldest son also suffered from mental illness and constantly was in some kind of trouble. Retha was deeply religious and maintained a strong commitment to her faith. She held a position at her church and was tasked on Sunday mornings to patrol the aisles for folks that needed help. She used to tell me stories about people who would “fall out” at the altar or “get overcome” during a hymn, and her job was to attend to them.
When I think about Retha, I almost always start to think about food. She was such an incredible cook, which in fact contributed to her diabetes complications. After I completed a couple semesters of pharmacy school, I started to teach her about healthy foods and exercise when I came home from college. I would try to convince her to check her fingerstick blood glucose more often, before she gave herself insulin. I don't think she changed her diet, because food was the way she told people she loved them. She also had intense fear of hypoglycemia, which I have observed in other African American patients in the Carolinas and which can influence how tight patients are willing to control their blood glucose levels. In retrospect, the symptoms of mild to moderately elevated blood glucose are probably a lot less scary than hypoglycemia symptoms.
Retha taught me how to cook several key dishes before I left for college, so I wouldn't starve. (Starvation was never a real concern, by the way.) The recipe I have most often reproduced over the years is her buttermilk biscuits. When I was younger, she took a knife and cut ridges in a plastic bowl from the kitchen, so I could see how much flour and milk to add. I took that bowl with me to college. The next addition was Crisco, which also gets high praise in Stockett's novel; then in went both hands until the dough was ready to roll out. Retha taught me to pull a drinking glass out of the kitchen cabinet, dust it with flour, and use it to cut the biscuits. Those biscuits with “a little” butter (that means “a lot” if you're not from the South) and some pear jelly or fig preserves are absolute heaven.
Retha was so proud the day I got married, and she was dressed in white, just like my wife, and she wore a very fancy hat. Retha told me after my first date with the girl I later married that she was “the one.” She reminded me of that at the wedding. Retha proclaimed she could see the future, and she used to ask my brother and me about our dreams, which she would then interpret for us. She also taught me how to properly iron a pair of trousers. Her mental illness worsened, as did her kidney function, during the last few years of her life, and she died just before my first child was born. I regret my children did not get to know her. I visited her at her home a few months after she got too sick to work. There was a round glass display case in her home, the kind you see at gift shops, which was filled with all her treasures. She displayed many of the little gifts and trinkets my brother and I had given her over the years for birthdays and holidays. I remember thinking that my mother did the exact same thing.
These women I knew suffered from discrimination and social injustices, and they lacked the opportunities for education and professional careers that were always in the equation for my family. There is no justification for the racial divide that has long been a part of the South's history, nor is there any easy way to come to terms with some of the harsh realities described in The Help. There is also a lot of joy that coexisted with these harsh realities. The currents of discrimination and prejudice still impact access and quality of health care for many people. But as I reflect on the lives of these women and consider how they shaped my view of the world, I feel like they already knew the secret to dismantling racism. Despite the adversity each faced, they demonstrated enormous respect for the people around them, were kind and loving, celebrated the little joys of life, and left the judging to a higher power. If we could accurately trace the lives and successes of all the children who were raised by women like those from The Help, I bet we would be amazed at how far reaching and important their influence truly has been.
Reamer Bushardt is professor and chair of the Department of Physician Assistant Studies, School of Medicine, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina. He is the editor in chief of JAAPA. This blog post expresses his personal views and does not express or represent the views or policies of AAPA.