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Upward Mortality

Nothing could hold my father back. Nothing except for the curse that is felling a generation of successful black men.

SHE HAS NO IDEA HOW MUCH HE HATES HER. And as I watch the perky blond nurse wipe drool from my father’s face, I hate her too. He spits up more mucus when she adjusts the giant caterpillar of a tube that pumps oxygen into his lungs, and I wince. I don’t feel sadness or fear; I’m not even grossed out. I’m just angry. That’s what the old man would want. He’d want me to resent this white girl’s innocence with him, if his brain were still alive.

My father came a long way to arrive at his deathbed at the age of 57. Fifteen years ago, he ranked among Indianapolis’ premier physicians, treating a largely working-class black clientele in this same hospital. But the way he griped about it, you would think he spent the day sweeping floors instead of doing surgery. He’d come home tired and frustrated, complaining about the indignities he’d suffered: The white nurses who snuck behind his back to change a patient’s care. The principal at my all-white elementary school who wanted to put me in special ed because of my “temper problem.” The white lady next door who had made some remark about the length of our grass, or otherwise policed our property. He developed a real attitude about the whole thing; Chris Rock had nothing on Dad’s angry-black-man routine.

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My father excelled in life. He was off to college at 16 and went on to get a medical degree from the nation’s most prestigious black university. His legion of one-time patients and proud former schoolmates would corner me in drugstores and gas stations all over town, “Hey, little doc!” I could go nowhere without bumping into his achievements.

Yet, here we are, both rendered dependent upon this indefatigable young nurse. “How you doing today, Dr. Wright?” she beams as she pokes around the edges of his mouth with one of those loud spit vacuums that dentists use. “I bet you helped soooo many people,” she softly recognizes. Everybody but himself, I snort under my breath.

As disabling diseases go, diabetes is among the most insidious. If it runs its course, as it did with my father, it will shut down most bodily functions: mobility, sight, kidney, and finally the heart. More than 2.5 million African Americans have it, which is 80 percent higher than the disease’s prevalence among whites. More than 9 out of 10 black diabetics have type 2, the version that develops in adulthood. Why some people get it and others don’t is still subject to considerable medical debate, but most opinions fall into two camps: genes versus lifestyle.

The genetics theory is driven by the commonsense observation that adult-onset diabetes runs in the family—if your parents had it, you are more likely to as well—and researchers are frantically searching for a guilty gene. The lifestyle, or “conditioning,” argument blames obesity and inactivity, both of which happen to be more prevalent among African Americans.

This same genes-versus-lifestyle debate applies to a range of deadly illnesses that disproportionately plague black America—and middle-class black America in particular. From heart disease to AIDS, African Americans are dying from preventable illnesses in disturbing numbers. The diabetes mortality rate is 20 percent higher for black men than white men, and 40 percent higher for black women.

Progressive convention says the problem lies in poverty: too many black people uninsured, too few with access to routine care. And there’s certainly clear enough evidence of a link between disease and poverty. But what no one can figure out is why the problem is getting worse even as socioeconomic conditions are improving. How does a successful, educated, and well-insured man like my father die before the age of 60 at the hands of a disease that is totally preventable?

Here’s where the debate turns political. If genes are decisive, then no one is to blame for the racial imbalance in Americans’ health. If it’s lifestyle that divides the sick from the well, then the problem is a matter of personal choice.

But there’s a third way to look at the disparity, one that is both more complex and more disturbing. This theory holds that black folks carry a legacy of disease that isn’t genetic but that nonetheless is transferred from one generation to the next—and eventually catches up even with those who clamber up the socioeconomic ladder. Dad died, according to this theory, from the side effects of racism.

I WAS 13 WHEN I LEARNED what it meant that Dad had “sugar trouble.” We were watching The Simpsons, and during a commercial he told us that he needed an operation. He pointed to his pinkie toe; it was jet black and had dried up like a date. It was dead, he told us, and would have to be cut off—a common problem for diabetics, because poor blood flow allows routine skin injuries to turn infectious.

I soon learned that once they start chopping things off, they rarely stop with a toe. By his mid-40s, Dad had lost everything below the kneecap on his right leg.

My father was around 6 feet tall and on the far side of the 300-pound mark for most of his 40s and 50s. He never figured out how to balance his large frame on the prosthesis, and that gave him a wobbly gait. I was alternately embarrassed and horrified when he came to my football games, awkwardly propelling himself across the grass. Jesus, I’d think, what if he falls? The same thought was written on his face.

But at least he was still working back then, still showing up for the games in a suit and tie, with his meticulously groomed mustache and tidy modified Afro, looking every bit like a ridiculously out-of-shape Apollo Creed. Only the unsteady stride set him apart from the other parents—that, and the fact that everyone else was white.

Throughout his adult life, the closest Dad ever got to exercise was stalking the halls of the downtown Indianapolis hospital he worked and died in. Obesity had been the norm in his family. Both of his siblings were overweight, and both developed diabetes and heart disease before middle age.

The only organ any of them ever really took care of was their brain. Like most upwardly mobile black boomers, my dad had a belief in education that bordered on reverence. “Mind like a steel trap!” he’d belt out after reciting some arcane piece of data. His intellectual cockiness was boundless, and whether he was instructing my attorney brother on the finer points of law or lecturing me on the value of a hip-hop song he’d never heard, I had to give it to the old man—he always had the marrow of it right. “Boy, I read,” he’d laugh, mocking our challenges to whether he knew as much as he thought he did. “The problem with your generation is that you actually celebrate ignorance.”

Education had been the key to his end run around Jim Crow, his defiant response to people like the grade-school teacher who told him that black boys from the East Side don’t grow up to be doctors. But in the midst of all that learning and achieving he never got around to the walks in the park or turns on the treadmill that will keep you alive despite diabetes or heart disease.

By 50, a series of strokes had turned Dad’s precision hands into clubs. The diabetes next started chipping away at his sight. It eventually all but immobilized him, and it sparked the kidney failure that landed him in the hospital for the last time.

Toward the end, when his illness gave him all the time in the world to sit and think, my father was keenly aware of the irony of his situation: He had spent his career counseling black folks about how to stay healthy. I’d ask him why he never followed his own advice, and he’d twist his face into that same disbelieving stare, shocked I couldn’t do the math on my own. “When would I have the time to go to Fall Creek and take a walk, Kai?”

True, but the answer was never quite sufficient. In his medical practice, he witnessed every day the hidden tragedy of the late-20th-century tale of racial progress. Since the civil rights movement, African Americans have improved their lot in life by almost every measure: Black and white incomes are more equal, the racial gap in school dropout rates has been cut by a third, the glass ceilings of many professions have at least cracked. But in that same period, black America has made no progress on what may be the most important measure of all: living to see old age.

According to a paper coauthored by former Surgeon General David Satcher that appeared in Health Affairs last year, the gap between black and white mortality rates exploded among middle-aged men during my father’s lifetime—rising by just over 20 percent between 1960 and 2000—while the overall black-white death gap hasn’t budged from an alarming 40 percent since Dad was a grade-schooler. In an accompanying article, University of Michigan sociology and epidemiology professor David Williams highlighted specific trends. Black and white death rates from heart disease were equal in 1950; by 2002 blacks died 30 percent more often. Blacks had a 10 percent lower cancer death rate than whites in 1950; now it’s 25 percent higher. The infant mortality gap doubled between 1950 and 2002.

As you move up the economic ladder, black health drastically improves, but the disparities between blacks and whites do not. One dramatic study showed that infants of college-educated black women are twice as likely to die as their white counterparts, largely owing to low birth weight. If genetics isn’t the explanation for those sorts of counterintuitive facts, what is?

The answer, a growing number of researchers say, is that the vaunted black middle class simply ain’t all it’s cracked up to be. Black strivers have a much harder time turning their paychecks into the status, opportunity, and security that white yuppies take for granted. “Maybe one of the sources of the anger of the black middle class,” suggests Brandeis University sociologist Thomas Shapiro, a leading proponent of the theory of differential realities for bourgeois blacks and whites, “is that they look in the mirror and they know how hard they’ve had to work. But they understand that they’ve not ‘made it’ in the same way as their white office mates.”

The resulting dissonance—harder work and longer hours to reach success, stress from discrimination that you can neither mistake nor prove—eventually manifests itself in the bodies of people like my dad. They don’t have time to take care of themselves, and even when they do, wellness is just not a priority. So as the white middle class has grown more healthy in recent decades, the tenuousness of black middle-class life has left many stumbling through a vicious circle. It’s harder for “bourgie” blacks to leverage the advantages of our nominal status, so we are more likely to be plagued by health problems associated with poverty, which in turn undermines our ability to sustain what class mobility we’ve eked out. Despite all of the material success he achieved in life, my father died deeply in debt, largely from unpaid taxes on the symbols of middle-class life he had once accumulated—a nice house, a nice car, his own business. By the time he got hold of his dream, he could no longer stay healthy enough to keep it.

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