Legacy

Description

AN INSTANT NEW YORK TIMES BESTSELLER

“This book is more than a memoir—it also serves as a call to action to create a more equitable healthcare system for patients of color, particularly Black women.” —Essence

One of NPR’s 11 Books to Look Forward to in 2024

One of Good Morning America’s 15 New Books to Read for the New Year

“Legacy is both a compelling memoir and an edifying analysis of the inequities in the way we deliver healthcare in America. Uché Blackstock is a force of nature.” —Abraham Verghese, MD, New York Times bestselling author of The Covenant of Water

“[An] extraordinary family story.” —Dr. Damon Tweedy, The New York Times Book Review

“This book should be required reading for all medical students.” —Gayle King, CBS Mornings

The rousing, captivating story of a Black physician, her career in medicine, and the deep inequities that still exist in the U.S. healthcare system

Growing up in Brooklyn, New York, it never occurred to Uché Blackstock and her twin sister, Oni, that they would be anything but physicians. In the 1980s, their mother headed an organization of Black women physicians, and for years the girls watched these fiercely intelligent women in white coats tend to their patients and neighbors, host community health fairs, cure ills, and save lives.

What Dr. Uché Blackstock did not understand as a child—or learn about at Harvard Medical School, where she and her sister had followed in their mother’s footsteps, making them the first Black mother-daughter legacies from the school—were the profound and long-standing systemic inequities that mean just 2 percent of all U.S. physicians today are Black women; the racist practices and policies that ensure Black Americans have far worse health outcomes than any other group in the country; and the flawed system that endangers the well-being of communities like theirs. As an ER physician, and later as a professor in academic medicine, Dr. Blackstock became profoundly aware of the systemic barriers that Black patients and physicians continue to face.

Legacy is a journey through the critical intersection of racism and healthcare. At once a searing indictment of our healthcare system, a generational family memoir, and a call to action, Legacy is Dr. Blackstock’s odyssey from child to medical student to practicing physician—to finally seizing her own power as a health equity advocate against the backdrop of the pandemic and the Black Lives Matter movement.Named one of the Top 13 Innovators Shaping The Future of Health by Fortune magazine

Praise for Legacy

“Ultimately, Legacy’s greatest contribution is in bringing this extraordinary family story to light — as much a part of the American fabric as those of our default narratives of success.”
—Dr. Damon Tweedy, The New York Times Book Review

“This book should be required reading for all medical students.”
—Gayle King, CBS Mornings

“This book is more than a memoir—it also serves as a call to action to create a more equitable healthcare system for patients of color, particularly Black women.”
—Essence

“At once a memoir and an examination of the racism that plagues both patients and physicians.”
—The New York Post

“Blackstock effortlessly weaves her personal story of triumph with contrasting, searing data on how we’ve arrived at this healthcare crisis. . . . While this book is a rousing personal story and an equally rousing cry for change, at its heart is is a beautiful ode to Blackstock’s mother and her continuing legacy.”
—Juhie Bhatia, Ms. magazine

“Readers concerned about their well-being will be glad they read this book. Biography fans will love it for different reasons. Either way, getting what you want out of Legacy is easy, and you’ll feel quite well about it.”
—Terri Schlichenmeyer, The Washington Informer

“Physician and healthcare consultant Blackstock skillfully blends biography and advocacy in this passionate debut memoir. . . . Inspiring. . . . A sobering and knowledgeable study of medical discrimination from someone with a lifetime of experience.”
—Publishers Weekly (starred & boxed review)

“Uché Blackstock has made something abundantly clear: If you want to understand a society, look at its hospitals. Dr. Blackstock, one of the most insightful and impactful public voices in medicine, shares her remarkable personal story and her profound insight regarding race, gender, and health inequality. We meet a person who is vulnerable, human, and brilliant. However, this book is so much more than a compelling memoir. These are marching orders. Armed with concrete steps for addressing inequality, readers will be inspired to become better stewards of our communities and society. Simply put, Legacy makes room for us to freedom dream anew.”
—Imani Perry, National Book Award-winning author of South to America

“Uché Blackstock has gifted us with a brilliant and timely wake-up call of a memoir. In her capable hands, a light is shone upon the deep inequities of our medical system. But more than a lament, this book is a battle cry. And like Dr. Blackstock, so many of us will find through reading Legacy, that we are ready for the fight.”
—Jacqueline Woodson, National Book Award-winning author of Brown Girl Dreaming and Red at the Bone

“Dr. Uché Blackstock’s Legacy offers a blistering indictment of American health care. With the deep knowledge of a physician who has trained and practiced in a system riddled with inequality and the personal perspective of a patient harmed by it, she points out the longstanding inequity inherent in an institution resistant to transformation. Most of all, Legacy is a love letter to Dr. Blackstock’s mother, a physician, who like her twin daughters both believed in the promise of the American medical system and was betrayed by it.” 
—Linda Villarosa, author of Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation

“Legacy is both a compelling memoir and an edifying analysis of the inequities in the way we deliver healthcare in America. Uché Blackstock is a force of nature.”
—Abraham Verghese, MD, New York Times-bestselling author of The Covenant of Water and Cutting for Stone

“Legacy is an illuminating and stirring journey of a book. The illuminating: the devastating cycle of racism in our healthcare system. The stirring: the inimitable family and career of Dr. Uché Blackstock and her quest to dismantle medical racism.”
—Ibram X. Kendi, #1 New York Times-bestselling author of How to Be an Antiracist

“Legacy weaves a beautiful story that feels like a warm, handmade quilt. Each memory of her family took me deeper into understanding Uché’s brave commitment to the health and thriving of Black people. A story that feels like the faith of a mustard seed. Reading it gave me hope. I felt tucked in safely knowing a doctor like her exists in our health care system.”
—Tricia Hersey, New York Times bestselling-author of Rest is Resistance and founder of The Nap Ministry

“This powerful book is both mesmerizing memoir and groundbreaking gift. I will remember Dr. Blackstock’s story and teachings for a long time. Highly recommend for all.”
—Dolly Chugh, Professor at New York University Stern School of Business and author of The Person You Mean to Be and A More Just Future

“Uché Blackstock writes courageously about how antiBlack racism plagues the U.S. healthcare system at every level. This is not a story about abstract systems and institutions but about how individuals—professors, physicians, policy makers and more—are complicit in maintaining the deadly status quo. Legacy is a deeply personal reckoning with our collective inheritance and an invitation for each of us to demand better of ourselves and our society.”
—Ruha Benjamin, author of Viral Justice: How We Grow the World We Want

“A timely and persuasive memoir.”
—Kirkus ReviewsDr. Uché Blackstock is a physician and thought leader on bias and racism in health care. She is the founder and CEO of Advancing Health Equity, appears regularly on MSNBC and NBC News, and is a former associate professor in the Department of Emergency Medicine and the former faculty director for recruitment, retention, and inclusion in the Office of Diversity Affairs at NYU School of Medicine. Dr. Blackstock received both her undergraduate and medical degrees from Harvard University, making her and her twin sister, Oni, the ­first Black mother-daughter legacies from Harvard Medical School. Dr. Blackstock currently lives in her hometown of Brooklyn, New York, with her two school-age children.Questions for Discussion

1. Uché Blackstock and her twin sister, Oni, both followed in their mother’s footsteps to become the first Black female legacy graduates of Harvard Medical School. What role do you think the idea of legacy has played in Dr. Blackstock’s life? What does legacy mean to you?

2. Dr. Blackstock writes that her mother’s patients “had experienced the care of a physician who listened to them, understood their lives and experiences, and was invested in them as a whole human being.” Do you have a trusted doctor in your life? Do you feel seen by them? Has your relationship with a physician affected how you respond to your own health?

3. Dr. Blackstock was not taught about the racism baked into the history of medicine in America. She came to learn about many of these staggering inequalities on her own as a practicing physician. As you read Legacy, did your understanding of the US health care system change?

4. Dr. Blackstock experiences burnout at Kings County hospital, where shifts were incredibly long and demanding, and the hospital was underfunded and short-staffed. Have you experienced burnout in your own life? How do you think burnout can be alleviated on both individual and institutional levels?

5. Discuss some of the ways structural inequities like systemic racism impact a person’s biological health and health outcomes. How do environmental exposures, job opportunities, and lack of access to health care influence the social determinants of health?

6. Dr. Blackstock writes about the impact mentorship can have, and the tendency people have to choose mentors who look like them. Talk about the experience you’ve had being a mentor or being mentored. Have you gravitated toward mentors who look like you?

7. Dr. Blackstock mourns not having an out-of-hospital birth. Despite her career and education, she was still not aware of the benefits of that birthing model. Were you aware of the Black maternity crisis before reading Legacy?

8. Discuss how the COVID-19 pandemic has exposed racist practices in medicine and deep preexisting racial health disparities. What role do underperforming hospitals in economically distressed communities play in these outcomes? How has the pandemic further revealed fault lines in our social institutions?

9. Dr. Blackstock does not think of her mother in terms of exceptionalism but as one of the lucky ones who made it through, and a reminder of all those who weren’t able to. How do you think it’s harmful to frame the successes of people like the original Dr. Blackstock in terms of exceptionalism?

10. Dr. Blackstock left academic medicine to become a full-time health equity advocate and fully use her voice to speak out about racial injustice. Which call to action enumerated in chapter 15 resonates the most with you? Do you feel more galvanized to work toward dismantling racism in medicine? What will you do?Introduction

When I was a little girl, my twin sister, Oni, and I used to visit our mother at work. Her name was Dr. Dale Gloria Blackstock, and in the 1980s and ’90s she was an attending physician at Kings County Hospital Center, one of the public hospitals affiliated with SUNY Downstate Health Sciences University, in Brooklyn, not far from our home in Crown Heights. Our mother worked long hours at her job and so sometimes we’d head to the hospital after school to see her and do our homework. Walking down the disinfectant-scented hallways, our shoes squeaking on the linoleum floors, we’d make our way to the large, echoing cafeteria, where we’d pull out textbooks from our backpacks and settle down to work alongside the physicians, nurses, technicians, and aides taking a break. The staff behind the counter knew us well, especially because we strongly resembled our mother, and would smile warmly and ask, “Visiting your mother today?”

After homework was done, we’d sneak into her clinic to ask for small change to spend on our favorite red Jell‑O. She’d hand it to us and, if we were quiet, let us stay and observe for a minute or two as she examined a patient. Our mother was warm, but serious with those in her care. Occasionally, her face would reveal a smile, but more often than not, she was extremely focused on what they were saying and what was going on in their lives. She’d grown up in the same Brooklyn neighborhood where the hospital was located. The daughter of a single mother from New Jersey, raised on public assistance, she’d become the first person in her family to graduate college, and after graduating from Harvard Medical School in 1976, she’d returned home to her community. At Kings County/ SUNY Downstate, she wasn’t just taking care of patients; she was tending to her neighbors. In her interactions with them, she always seemed to know as much about their children and families as she did about their respective medical problems. When you came in for a visit with Dr. Blackstock, you weren’t only having your blood pressure or cholesterol checked, you were also meeting with someone who was going to assess how your whole being was faring. I believe our mother practiced what is now known as structurally competent and culturally responsive care, which means that the entire complex nature of the patient’s background and the social context in which they live, work, love, and pray is considered during evaluation. And her patients loved her for it. She was always bringing home little gifts from them—a knitted shawl, homemade cookies or cake, tokens of appreciation.

My sister and I were only nineteen years old in 1997 when we lost our mother to leukemia—and she was just forty-seven. She died too young, but by then her influence had indelibly rubbed off on us. Our mother’s passion for learning, her dogged persever­ance, and her commitment to serving her community heavily in­fluenced our own decisions to become physicians. Oni and I both graduated from Harvard University and then attended Harvard Medical School, the school’s first Black mother-daughter legacy graduates. Like her, we both went to work with historically un­derserved populations after graduating, my sister at a hospital in the Bronx, while I went to train at Kings County/ SUNY Down­state in Brooklyn, following in our mother’s footsteps. In the years since then, I have felt her by my side in so many of my own inter­actions with patients: her ability to listen to and truly care contin­ues to be a model for me. And it’s something that our patients are crying out for, now more than ever.

During the height of the COVID‑19 pandemic, in spring 2020, I found myself working at an urgent care center in Brooklyn, see­ing in the region of eighty to ninety COVID patients per twelve-hour shift. One day, I remember walking into one of what seemed like an endless number of patient exam rooms to find a young Black woman in her early twenties waiting for me. She was hunched over and staring at her restless fingers, but when I said hello, she glanced up at me and gave me a quick once-over. The electronic chart said that she was visiting for shortness of breath after being diagnosed with COVID‑19 a few weeks earlier. Although she was wearing a mask, I could tell from the look in her eyes that she was scared.

In those pre-vaccine days, I spent the twelve hours of each shift covered head‑to‑toe in layers of personal protective equip­ment (PPE): gloves on my hands, my bulging surgical cap barely containing my locs, a surgical mask over the N95 covering my nose and mouth, and a clear plastic shield that would often fog up over my eyes. Not only did the heavy PPE make it difficult to move and breathe in the small airless clinic rooms, there was no way for me to express my encouragement to a patient, offer a smile of reassurance or a look of sympathy.

That day, I introduced myself and then asked the young woman to tell me about why she had come in. But before I got the chance to continue, she stopped me.

“Can I ask you something?”

I told her yes, of course, nodding vigorously in case my voice was muffled through the double mask and shield.

“Are you Black?”

I realized she couldn’t see my skin color under all the layers of PPE.

“Yes, I’m Black,” I replied, hoping she could see the smile in my eyes.

I could sense the tension leaving her body.

“Thank you, doctor,” she sighed. “At least I know you’ll listen to me.”

“I promise.”

In that moment, I knew that I was the physician she needed—someone who looked like her and whom she could instinctively trust.

The reality is that patients like the young Black woman in my clinic have much reason to be suspicious of a medical profession that continues to minimize their concerns and, intentionally or not, cause harm. One of the promises in the Hippocratic oath is “do no harm”; however, we know from multiple studies that clini­cians have repeatedly caused harm to Black patients by dismiss­ing their concerns and undertreating their pain. The good news is that racial concordance in clinician-patient interactions—the kind that my young patient craved and that my mother experi­enced with her patients—has been shown to actively improve health outcomes, particularly among Black patients. Studies in­dicate that Black babies who are cared for by Black neonatologists and pediatricians in their first year of life are more likely to sur­vive than those treated by white neonatologists and pediatri­cians. What’s more, Black physicians are more likely to specialize in primary care and practice in underserved communities where patients are most vulnerable and in need of expert care. Racially concordant care for Black people is a matter of life and death!

The bad news is that there aren’t enough of us. Although I was fortunate to grow up with a Black physician mother, it’s impor­tant to understand that our mother was a rarity, as are my sister and I. The number of Black physicians in this country remains stubbornly low, with only 5.4 percent of all US physicians identi­fying as Black, 2.6 percent as Black men, and 2.8 percent as Black women—although Black people make up 13 percent of the popula­tion. There is actually a smaller percentage of Black male phy­sicians now than there was in 1940, when Black men made up 2.7 percent of Black physicians.

Training more Black physicians is only one of the many solu­tions needed to address the glaring and persistent health inequi­ties that exist, but we need multiple fixes, and we need them now, because it’s not just one thing that is going to solve this. The fact is that since the days, thirty years ago, when my mother was practic­ing medicine in Brooklyn, health outcomes have gotten worse, not better, for Black Americans. Despite the extraordinary advance­ments in health-care technology and innovation, structural racism continues to inflict heavy blows on the health of Black Americans.

US data collection on maternal mortality rates began in 1915. At that time, Black birthing people* were almost twice as likely to die from pregnancy-related complications as their white peers. Today, we are in the midst of an undeniable maternal mortality crisis in the United States, largely driven by the deaths of Black birthing people, who are three to four times more likely to die than their white peers. For decades in the US and around the world, maternal mortality rates had decreased due to improved living conditions, maternity services, surgical procedures, and access to antibiotics. However, around 2000, the US maternal mortality rate began to rise again.

Currently, Black men have the shortest life expectancy of any major demographic group. Black babies have the highest infant mortality rate. These horrifying trends were all true even before the pandemic was permitted to devastate our communities, bru­tally disabling and ending lives and exposing the deep racist fault lines in our society.

What’s perhaps most shocking about racial health inequities is that these outcomes often persist across socioeconomic status strata and levels of formal education. Think of Beyoncé or Serena Williams, both powerful, famous, and wealthy Black women who were at the pinnacle of their careers when they had their babies. Beyoncé is a world-class singer and performer. Serena is one of the greatest athletes of all time. Both women are healthy, are in­credibly physically fit, and know their bodies well. Both women suffered near-fatal childbirth experiences. Serena reported that her medical team did not listen to her, endangering her survival and that of her child. Beyoncé experienced the same pregnancy complications as other Black women with considerably fewer re­sources. Even with my two Harvard degrees, I have a pregnancy-related mortality ratio five times that of a white woman who never finished high school. As the saying goes, if you’re not furious about this, you’re not paying attention.

Since the summer of 2020, there have been increasing general public demands to urgently reform racist policies in this country and a stronger desire and substantial need to start addressing systemic inequities at their root. There are finally discussions within medicine and health care about including education on systemic racism within medical school curricula and the other systemic factors that influence health, like poverty, inequality, inadequate housing, and lack of employment opportunities. There has been a call for health-care institutions to be more thought­ful and transformative in considering how we are educating and training anyone interacting with patients. The health-care system needs to give practitioners of all backgrounds a framework for understanding what Black patients and communities have gone through in this country for centuries and what they are still en­during. There is palpable urgency to move toward a model of structurally competent health care. The framework of struc­tural competency, first described by Dr. Jonathan M. Metzl and Dr. Helena Hansen in 2014, offers a paradigm for training health professionals to recognize and respond to the impact of upstream structural factors, like poverty and systemic racism, on patient health and health care.

But we can’t fix the problem until we can see it clearly. It took me many years to fully understand the centuries of history un­derpinning racism in medicine today. There were many steps in my own education, glaring gaps in my learning and understand­ing as a young person and student. It took me until well into my career as physician to recognize the sheer scale of the problem, to free myself from the institutional status quo so that I could begin to fully speak my truth. It wasn’t until the time of COVID‑19 and the Black Lives Matter protests of 2020 that I finally came into my power and truth as a Black physician advocate on these issues. It was also at this time that I began to write this book.

In the chapters to follow, I will trace my mother’s journey and my own as a physician, identifying, as I go, the fault lines both within and outside our medical system. My hope is that our story will speak to anyone who is concerned about dismantling racism and centering equity and justice in this country, because it’s im­possible to truly understand these phenomena until you under­stand the ways Black people have been excluded, ignored, and ill-served by our health-care system. We can and must do better for our Black patients and other patients of color, and by exten­sion create communities that are fairer, more equitable, and healthier for everyone. Yet, progress has been far too slow.

Recently, I discovered an introductory letter my mother wrote, over three decades ago, for the event program of a 1990 conven­tion of local Black physicians, in which she grapples with so many of the same problems we’re confronting today. “It is ironic that as we enter the age of neotechnology,” my mother wrote thirty years ago, “we do not have a health-care system in place that is equitable for all participants. Worse, a health-care system that refuses to embrace all in need.” Although she died prematurely, my mother’s spirit lives on in my sister and me, her patients, the communities she served, the future physicians she mentored, and the organiza­tions she led. It will live on in this book too.US

Additional information

Weight	14.2 oz
Dimensions	0.9900 × 5.7200 × 8.6100 in
Imprint	Viking
ISBN-13	09780593491287
ISBN-10	0593491289
Author	Uché Blackstock, MD
Audience	General / adult
BISAC	BIO002010, MED026000
Subjects	new york times best sellers, health care, doctors, nursing, autobiographies, books best sellers, biographies of famous people, black history books, african american books, medical books, memoirs, nurse gifts, medicine books, bestselling books, black history books for adults, emergency medicine, MED026000, legacies, physician, medicine, african american, wellness, BIO002010, healthcare, health, biography, Memoir, medical, emt, racism, race, black history, black history month, nurse, doctor, public health, autobiography, biographies
Format	General Trade