Twice-as-Hard: Black Women Physicians PDF

CONTENTS PROLOGUE Set the Record Straight CHAPTER 1 With Determination and Fearlessness CHAPTER 2 Doing Surgery in the Bedroom CHAPTER 3 Doing Good in the Community CHAPTER4 From Her Family Forward CHAPTER 5 Finding Fulfillment in Giving Back CHAPTER 6 You Can’t Be What You Can’t See CHAPTER 7 Healthcare Is a Human Right CHAPTER 8 “I Will Not Be the Last” CHAPTER Crusading for Public Health EPILOGUE Remember Their Stories Notes Image Credits Index PROLOGUE SET THE RECORD STRAIGHT A s I sat in my cramped dorm room in Oxford, England, I listened to a voice resonating through my laptop. It transported me to the other side of the world. Back home. “After I got a taste of this thing of college, then I had to have more of the same... I loved it... I mean, my getting back to college, I was delighted. Now my only fear there was that I could not possibly make enough money with my mother to go into the next year. So, I decided to make as much of that year as I could, you see. And so that I could at least say that I had two years of college, or three years of college, you see.”1 The sound of Dr. May Chinn’s voice seemed so familiar. It felt as though she was one of my great-grandmothers. Dr. Chinn and I were born a hundred years apart, and she passed away forty years ago. Still, her voice bent through time and touched my soul. I could imagine us sitting on a pillowy couch in a cozy living room, both sipping a hot cup of English Breakfast tea as she told me her life story. She bravely hurdled the challenges of being a black woman entering the unwelcoming field of medicine in the early twentieth century. And she came out on the other side in triumph as a skilled physician who made a huge impact in her patients’ lives. Her story resonated with me. As a black woman medical student who will be the first in my family to become a physician, I’ve faced my own set of trials. When Dr. Chinn recounted her experience with medical colleagues who disregarded and ostracized her, I felt the burn of salt being rubbed into wounds that have not had the opportunity to heal. t was the beginning of my junior year in college at Washington University in St. Louis, and my first day back in my neuroimmunology lab after a few weeks of vacation. I approached the lab’s entry door with my ID in hand. An older white I man whom I didn’t recognize trailed behind me. He didn’t provide any explanation about his connection to the lab. I didn’t request one. While the lab is large and composed of multiple smaller labs within one space, we have a culture of opening the door for one another. We assume good intent. This is the mindset I adopted as I prepared to give this unidentified man access to my lab. Swipe. I placed my ID through the card reader, but a red light flashed in response. I reminded myself that this card reader was finicky. So I tried again. Swipe, swipe. More red light. This time my cheeks flushed to match the color of the reader. It didn’t make sense. My card was supposed to work. It had worked all summer. I had even spoken with technology services before my vacation to ensure that my card would still work when I returned for the school year. I was confident that the problem was with the card reader, not my card. So I tried again. Swipe. Red light blinked back at me in innocence. I relented. Steeped in embarrassment, I asked the mystery man if he would open the door for us. With raised suspicion, he countered, “Are you supposed to be in this lab?” Immediately, my body froze. While his question may have seemed innocent, the doubt laced into his words brought me back to my childhood. Since elementary school, other kids have told me that I am stupid and will never belong in the highly praised realms of science and medicine. “You’re black. Black people aren’t smart.” When my AP calculus teacher announced that I had scored at the top of my class on the midterm exam, my classmates looked at me with shock. I was the only black person in the room. They didn’t understand how I could’ve outperformed them on a test, let alone a math test. Then, as I neared the end of my high school career, people who claimed to be my friends suddenly turned on me. They confidently explained that I would get accepted into college because I was black. Not because I had a near perfect GPA with countless AP classes on my transcript, coupled with the fact that I was president of multiple organizations and a varsity athlete. My academic achievements were worthless in their eyes. The only purpose I served was filling a quota. To make matters worse, numerous classmates told me that I would never succeed in higher education or in a STEM career. I was a black woman, twice disadvantaged. Success was incompatible with my identity. The mystery man’s supposedly harmless question excavated immense pain that I had fought so hard to keep buried. Feeling like a deer in headlights, I answered his question without being able to vocalize the emotions that suddenly rushed over me. “Yes. I’m a student at Washington University, and I work here.” He was not convinced by my explanation. “Can I see your ID?” I readily handed it over. “Why doesn’t it look like my faculty ID?” “Because I’m a student. I’m a student at the university.” My ID read “Washington University in St. Louis” at the top and had a recent photo of me in color, with the word “Student” below. After examining my identification, he remained skeptical. The air between us was tense. It was like I was a thief preparing to break into a lab to steal some chemicals. While I wasn’t the most strategic—choosing to “break in” during work hours when the lab was filled with other people—I was still a threat. And he was the (still-unidentified) cop ready to right my wrongs. But none of this was true. I was just a college student whose excitement to reenter this beloved space had suddenly transformed into sorrow. He continued his line of questioning, and I continued to answer helplessly. Eventually, he gave up his defense of the lab and opened the door. I followed him in and quickly went to my lab bench. Soon, I realized that this man worked right next to my lab. His office adjoined the room where I prepared countless specimen trays for qPCR experiments. With my white coat on and my lab notebook in hand, I tried to walk confidently whenever we crossed paths. I wanted to prove to him that I was truly a scientist in this lab, not a thief, while ignoring the queasiness that arose whenever I saw him. After that incident, he never said anything to me again. Never looked me in the eye. Never acknowledged my presence or the pain that he had caused me. Why did he treat me like that? Why didn’t he believe me when I told him that I was a college student working in the lab? The day with the faulty card was the day that I realized I was the only black person in my lab. When I attended research talks in the building, I was always the only black person in the room. It seemed like I was the only black scientist in the entire seven-floor building. And I was only a student! The only other black people I saw working in the building were members of the janitorial or kitchen staff. I guess based on this data sample, it was reasonable for this man to assume that I wasn’t a scientist in the lab—even though my photo ID should’ve been enough proof that I truly was affiliated with the university. Following the encounter with that man, I no longer felt excited to go to the lab each day. I felt anxious. My fast-beating heart tried to keep my feet from walking to the train station. The smell of urine in the underground station became more repugnant, threatening to induce nausea. The stares I received from people as I shuffled off the train and onto the medical campus seemed more aggressive, echoing the message from the man in my lab: You don’t belong here. I felt like I was walking on eggshells. Something was bound to crack. Then, one day, I was invited to attend a small group session with a visiting Harvard professor, through the John B. Ervin Scholars Program, an organization at WashU that supports students who exhibit leadership potential and a commitment to serving their communities. As a part of our introductions, we were tasked to answer: “What makes you anxious?” Although I typically try not to be vulnerable in large groups, I decided to open up since I knew many of the people in the room. As I retold my experience in the lab, tears rushed down my face. I hadn’t realized how much this encounter had affected me. After the meeting, I spoke more about this issue with the dean of the Ervin Scholars Program. As I laid my wounds bare, a weight lifted off my shoulders. I was not in the wrong. And it was okay for me to feel the pain that I felt. My emotions were valid. Suddenly, I felt more comfortable speaking about the incident. A few weeks later, I presented my research at WashU’s Fall Undergraduate Research Symposium. As I stood crowded around a poster with two other black research students, my mind wandered. Sharing this biomedical space with them reminded me that, while I was the only black scientist in my lab, I was not the only black scientist at my university. That realization was followed by another. I was not the only black researcher who experienced microaggressions. Once I was able to look past my individual experience, memories of others’ experiences rushed back to me. I had numerous black friends from various academic institutions who had reached out to me for solace after facing their own personal traumas in research environments. I wasn’t alone. We weren’t alone. So why had these experiences made each of us feel so lonely? These incidents had seemed like isolated events. We were usually the only black scientist in our respective research spaces, so we oftentimes lacked support during these difficult encounters. Each of us wondered if we had done something that warranted the treatment we received. And it was difficult not to defer to the perspective of the person doing the microaggression, since frequently that person held a superior position in the lab. But these were not isolated events. They were recurring problems that signaled much deeper issues within the research community. Because we were typically siloed in different corners of a research institution, it was hard to see this pattern. But now that we were together at this symposium, the problem became vividly clear to me. This epiphany moved me to act. First, I founded the Minority Association of Rising Scientists (MARS). This organization aims to counteract the detrimental effects of implicit bias and imposter syndrome through programming that promotes community among students of color pursuing research careers. It also brings awareness to the prevalence of imposter syndrome and introduces ways to combat it. Among its events, MARS offered a popular series of meetings where black graduate students spoke about their experiences in science and gave advice on how we undergraduates could be successful in the field. Whenever we had these mentoring sessions, at least one MARS member would tell me how the session helped them with something they were struggling with, either in their current lab or in their pursuit of a research career. The morning after one of these sessions, I walked over the bridge connecting my apartment to my college campus. I was on my way to an organic chemistry class. While a cold wind brushed against my skin, I was warmed by an energy reverberating from deep inside me. A sensation stronger than butterflies kindled in my stomach. I felt like I was walking toward my purpose. And while working to help others, I was tending to my wounds from the day with the faulty ID card, as well as many other related traumas. A year later, I received the incredible news that I was selected as a Rhodes scholar. This provided me with a platform to have an even broader impact within the advocacy space. As my professional interests shifted toward medicine, I decided to apply my experience with MARS to tackle a similar issue within medicine. I pursued a master of philosophy in the history of science, medicine, and technology at the University of Oxford. My dissertation focused on the social and structural barriers put in place to prevent black women from entering medicine in the US. I figured that if I could determine the historical underpinnings of the underrepresentation of black women in medicine, I would be better equipped to help increase the number of black women, and other underrepresented minorities, within the field. Initially, the research and master’s classes were extremely draining. I learned how deeply race- and sex-based prejudice ran. For centuries throughout the world, Europeans and white Americans employed tactics to deprive black people of opportunities and deplete their quality of life. When I studied racial dynamics within medicine, I found countless social and structural obstacles meant to keep white men as the dominant group within medicine. It felt like so much was stacked against me as a black woman interested in medicine. At the same time, I struggled to find information on notable black women physicians. Up to that point, I had never met a black woman physician, and I hadn’t been taught about any in school. I knew they must exist, but their histories were buried or never properly documented to begin with. I became desperate to find them, to get to know their stories, and to understand what inspired them to become physicians. I needed to know how they survived and pushed forward in the face of so many racist and sexist obstacles. After more than six months of mining the internet and archives for these women, I finally struck gold. I found an archive at Harvard Radcliffe Institute’s Schlesinger Library that included interviews from 1976 to 1981 with notable black women who were in their seventies, eighties, and nineties. There were interviews with a handful of black women physicians in the collection. This is how I discovered Dr. May Chinn. Once I found substantive information about one African American woman physician, she led me to the next, and the next. When I felt my knees begin to buckle under the weight of the knowledge that, for well over a century, people like me had been rejected from medical schools and then residency programs solely because of their identities, these black women’s stories were my antidote. They gave me the strength to keep running in my own race toward a career in medicine. So when I earned my master’s degree from the University of Oxford and then began medical school at the Perelman School of Medicine at the University of Pennsylvania in August 2020, I wasn’t scared. Yes, I was in pain from seeing so many of my people killed by police officers while people around the world lost their lives to COVID-19. I also struggled with the isolation of prolonged quarantines at the height of the pandemic. The circumstances of the pandemic made it impossible for me to meet my entire medical school class throughout my first year and postponed my white coat ceremony for over a year. Despite the limited contact with my class, I found that prejudice still managed to seep through. At various points throughout the school year, I encountered colleagues who questioned whether my fellow black medical classmates and I had earned our spots at this prestigious medical school. We could be having a conversation about our medical school application cycle or our feelings about an impending exam, when a classmate would lay bare their views on the black medical students at Penn. They thought that our blackness, not our credentials, had given us access to this prestigious institution. Whenever I met these challenges, I kept my thoughts fixed on the incredible black women physicians who came before me. If they could do it, I could too. As I trekked through those early days of medical school, I recognized that many students in my position didn’t have the stories of these black women physicians to lighten their steps. Inundated with the dominant narrative that white men are the leaders of medicine, they didn’t know how much black women had contributed to the field. If more black girls and women knew, maybe more would be inspired to pursue medicine. Maybe other underrepresented minorities in medicine would be inspired too. Black women physicians’ stories have gone untold for far too long, leaving gaping holes in American medical history, in women’s history, and in black history. It’s time to set the record straight. AUTHOR’S NOTE Throughout the book, I use the terms “black” and “African American” to describe the race and ethnicity of the women who are highlighted. Their varied use is both intentional and emotional. Both “black” and “African American” are terms that have been used to describe descendants of slavery in the United States. “Black” became a popular term to describe this community in the late 1960s and early 1970s.2 Stokely Carmichael, who coined the term “Black Power,” helped garner acceptance of this label within the community. Then, in 1988, Jesse Jackson suggested we replace “black” with “African American.”3 This switch to “African American” slowly gained popularity as a term to describe descendants of slavery in the US. Now, “African American” is thought by many to be the more politically correct way to describe someone with my family history. “Black” has become an umbrella term to describe anyone in America with ancestors from Africa. While black physicians were almost exclusively African American before the 1960s, our representation in the field has decreased markedly. Most black medical students are now recent African or Caribbean immigrants.4 In my medical school class, there are about 160 students; 23 of them are black. While there are ten black women in my class, I am the only African American woman in the cohort. All ten of us can relate to the challenges of being black women in medicine, but there are unique barriers that come with being African American. In particular, the historical deprivation of educational and financial opportunities still makes it difficult for African Americans to access the medical profession today. This is a burden that my fellow black female classmates can’t carry with me. Sadly, this difference in experience has led to tensions in the larger black medical community. A few months before I started medical school, I reached out to older medical students for advice. At this stage, I was talking to students from multiple medical schools, and I hadn’t decided which school I would commit to. I remember speaking to one black medical student from a prestigious school, a first-generation immigrant from an African country. He was trying to shake my fears about the demands of medical school. “Us Africans are so hardworking. You’ll be fine.” My heart stopped. I recognized his bias and feared what he would think of me when he knew the truth. “I’m not African. I’m African American.” “Oh! Well, you’re a Rhodes scholar. You must have a similar work ethic.” His words made me ache with sadness. Was he implying that if I were just an African American, not an African American Rhodes scholar, he would think I wasn’t as hardworking as my black classmates who were recent African or Caribbean immigrants? Too many times, black people from other ethnic groups have told me that African Americans are lazy. When this stereotype was perpetuated in the black medical space, there were few people I could turn to. As I was writing this book, I chose to highlight African American women in particular to challenge this false narrative that African Americans are lazy. We had to work hard and exhibit unwavering determination to break into medicine. The immense obstacles impeding our journeys required nothing less. But we still shared many experiences with other black women physicians, and I hope that connection comes through too. These stories are meant to highlight the incredible achievements of the physicians who led the way, to inspire all people who have had to overcome discrimination along their journeys—and at the same time, I hope African American women, in particular, will recognize themselves in this book. T here are no invented quotes in this book. All scenes and dialogue are drawn either directly from oral history accounts, interviews I conducted, other primary resources, or a recounting of my own firsthand experience. No images that can be verified as Dr. Rebecca Lee Crumpler exist. CHAPTER 1 WITH DETERMINATION AND FEARLESSNESS R ebecca Lee Crumpler, born Rebecca Davis, became the first African American woman to earn a medical degree in the United States of America only fourteen months after President Abraham Lincoln signed the Emancipation Proclamation. Rebecca was born free on February 8, 1831, in Christiana, Delaware, to Matilda Webber and Absolum Davis. During this time, the medical establishment was quite different from what it is today. In 1800, most American physicians were trained as apprentices of practicing physicians. The only American medical schools that offered lectures to augment the clinical apprenticeships were the University of Pennsylvania, Harvard University, and Dartmouth College. Some wealthy men would acquire their medical educations abroad, primarily in Edinburgh, Scotland. In 1800, approximately one hundred Edinburgh-trained physicians, plus the graduates from the three American institutions, constituted a medical elite.1 This group, combined with those who trained as apprentices, were described as the “regular physicians,” or allopaths. This medical sect competed with two others: the homeopaths and the eclectics. They all had different approaches to treating patients, and they all sought to portray their form of medicine as the most logical and effective. Rebecca was raised in Pennsylvania by her aunt, who was likely an herbalist. As a child, Rebecca would see sick people file into her home. They arrived with a sense of urgency and distress. Many of them seemed to leave with newfound hope and relief after visiting her aunt. Seeing the impact her aunt was making in her community sparked a passion inside of Rebecca. She decided that she, too, wanted to be a healer when she grew up. Somehow (and records are absent here) she completed her studies at the prestigious West Newton English and Classical School in Newton, Massachusetts, just miles outside of Boston, and then moved to nearby Charlestown, Massachusetts, in 1852, to work as a nurse.2 What made Rebecca pursue work as a nurse instead of as a doctor? While the unique work experience of being a nurse might have been more appealing than that of being a doctor, access to medical training likely played a role in her decision. Rebecca was not the first African American woman in history to want to become a physician. She was not even the first African American woman who had the skills necessary to be a great physician. Prior to the 1860s, immense social and structural barriers prevented countless aspiring African American women physicians from achieving their dreams. Rebecca was the first to break this near-impenetrable blockade. At the time, physicians were almost exclusively white men. African American men and white women were just starting to gain access to the field. The experiences of these early physicians show some of the impediments that halted many African American women in their medical journeys. These impediments made Rebecca’s path so difficult, and so remarkable. The first person to break the color barrier in medicine was James McCune Smith. Born a slave in 1813, James had more opportunities than many other slaves. His owner allowed him to attend the New York African Free School No. 2, a school that taught black boys. In 1827, a year before he graduated, he gained his freedom through the Emancipation Act of the State of New York. Suddenly, the possibilities for James’s future were endless. He decided he wanted to become a physician. He worked as a blacksmith to support himself while studying Latin and Greek, two languages that medical schools required their students to be fluent in. Following these rigorous studies, James applied to Columbia College and Geneva, two medical schools in New York. The schools’ decisions: denied on account of his race. James was refused an American medical education, but he did not give up on his goal. He applied to the University of Glasgow, a prestigious college in Scotland, and was admitted. Excited about James’s accomplishment, black professionals in his community raised enough money to send him to this school in 1832. Dr. McCune Smith returned to the US from Scotland in 1837 with his BA, MA, and MD degrees from the University of Glasgow. He had found a way to navigate higher education in a country he had never been to, attaining three degrees in five years. This was an incredible feat that required a sharp mind and diligence. Unfortunately, there was also an unspoken requirement. While this school was more open to educating black men than most universities in the world, it refused to teach women, regardless of their ethnicities. It wasn’t until 1892 that women were finally allowed to matriculate into any university in Scotland. The University of Glasgow didn’t become completely coed until the 1930s, and even then women were segregated in separate learning quarters, through to the 1950s.3 These Scottish schools could stomach a man with a different skin color, but a woman was just too much to bear. While Dr. McCune Smith was completing his medical training in Scotland, anti-abolitionist sentiment was brewing in New York. In July 1834, white Americans who feared even baby steps toward racial equality joined forces to incite a three-day riot in New York City. It has been described as the worst riot in antebellum America.4 Mobs targeted dozens of black homes and set them aflame. They also targeted institutions that sought to bring African Americans out of poverty and prepare them for the job market. Dr. McCune Smith’s New York African Free School was one of the black institutions burned down. Were these white people angered that the school helped a black person prepare for medical school? Or was it the school’s general aim to teach black boys how to read and write that incited their violence? Regardless of the specific motivations, this terrorist attack sent fear through the free black community in antebellum America. Like the severe punishment slaves endured when they tried to claim their freedom, this act of violence was a warning for any other black person who strove to have a successful career in America. If they made any advances in society, that black person, along with their beloved community, would experience great loss. Many black and white Americans advocating for a more equal society became more hesitant in their push for change. The backlash likely caused some black children interested in medicine to give up their dream. Rebecca was only three years old at the time. As a consequence, from the moment that she was old enough to interpret social dynamics in her environment, she probably understood that aiming too high in society, as a black American, could result in tragedy. Although Dr. McCune Smith returned to a community whose members had been made to fear their own advancement, he bravely held on to his newfound position within medicine. He opened a medical practice and the country’s first black-owned pharmacy, at 55 West Broadway in New York City. He attracted black and white patients due to his strong reputation. Even racist white doctors respected his expertise, as evidenced by his medical publications.5 He practiced medicine for about twenty-five years. Dr. McCune Smith’s clinical practice was the first foothold in medicine for black Americans. The next necessary step to make medical careers accessible for the black community was to allow them to train in US schools. In the 1830s, medicine was in the process of professionalizing. There was no licensing system. Anyone could practice as a physician. As a result, systematic discrimination occurred primarily around admission to medical school. Fifteen years passed between Dr. McCune Smith’s rejection from American medical schools and the graduation of the first African American from an American medical school. All women were still being excluded from medical training programs in the US. David Jones Peck was born free in 1826 or 1827 in Carlisle, Pennsylvania, to John C. and Sarah (“Sally”) Peck, two freed black people who worked to help other black Americans gain their freedom and attain educations. John Peck was one of the primary financial supporters of the Underground Railroad in Pennsylvania.6 While Pennsylvania became the first of the colonies to pass an abolition law in 1780, white Philadelphians had slaves throughout David’s time at Rush Medical College in Chicago, which was from 1846 to 1847. His parents’ support was essential as he withstood the emotional toll of having classmates who had the ability to own one of his family members as their slave. Some of his medical school classmates likely held the view that African Americans were property, not people, prompting them to object to David’s presence in the class. While the faculty believed that David was qualified to join the medical school, the president of the college allowed the white male students to decide if David could join their class. In a time when a large portion of American society thought that a black American’s main purpose in life was to serve and submit to white men, qualifications didn’t matter. All that mattered was the color of one’s skin. The white male medical students were left alone in a classroom to discuss the issue. With so many white men having roamed the halls before them, they felt assured of their right to hold space in the class. But what about “the darkey,” as one of David’s classmates referred to him? Could he really fit in with them? Would they accept someone who could’ve been their slave to instead be their medical school classmate? There was fierce debate. In the end, there were just enough willing to vote for David’s continued presence at the school. If a few more bigoted white men had been admitted that year, David might not have been allowed to become a doctor. Instead, he was permitted to matriculate. He graduated from Rush in the spring of 1847. If Rebecca had been in David’s place, would the same group of white men have voted in her favor? Because no woman had been allowed to study in a medical school in the US, or anywhere in the world, up to this point, they almost certainly would’ve voted to remove her from the class. The school’s faculty probably wouldn’t have advocated for her based on her credentials. There was still a certain look required to make it in medicine. A woman, white or black, didn’t fit the bill. This demand for all doctors to be men didn’t start to change until 1849, when Elizabeth Blackwell earned her medical degree from Geneva Medical College in New York. Born in 1821 in Bristol, England, to a middle-class family, Elizabeth had more professional connections than a black woman like Rebecca Davis. When she decided to pursue medicine, following her move to the United States, she reached out to physicians whom she knew for advice. The path to medicine is usually difficult, regardless of the aspiring physician’s identity. It is extremely long, with many hidden costs and hurdles. Having a physician-mentor can make a big difference in navigating this journey. The remarkable advantage of having such support explains why the vast majority of medical students today have either parents or family friends who are physicians.7 Elizabeth had this support system. But in an era when most white Americans were against the true equality of the races and almost every physician was white, it was very difficult for a black woman like Rebecca to find a physician-mentor who would guide her along her journey. Unfortunately, many of the physicians in Elizabeth’s network tried to discourage her pursuit of a medical career. She was a woman; it wasn’t practical for her to go into medicine. The conditions were too harsh and the exposed bodies too vulgar. The fact that she would even consider such a profession raised concerns in some physicians: if she could envision herself as a doctor, was she really a lady? These men’s reactions showed Elizabeth that she would be fighting against the suffocating social norms that tried to force women into a peripheral realm of society, limiting what they were capable of achieving in their lives. If Elizabeth was successful, she could loosen the corset on women’s lives and allow them to move freely toward a world filled with possibilities. After talking to multiple physicians, Elizabeth finally found someone who was willing to help. He provided her with a list of US medical schools. This glimmer of support made all the difference. She began by applying to four medical schools in Philadelphia, the epicenter of American medicine in the 1840s. After investing her precious time and money to attend interviews at these schools, she was met with cutting laughter.8 The male physicians found it hilarious that a woman would even attempt to enter the medical field. Who did Elizabeth think she was? She was a woman who was not easily deterred. Even after being rejected from school after school, she stood firm in her ambitions. She was unwilling to concede. One doctor was impressed by her determination. Trying to be helpful, he outlined steps other women had taken in their attempts to acquire medical training: Cut your hair. Trade your dress for pants. Hide a side of yourself that you’ve been taught to accentuate your whole life. This is a men’s club. To be accepted in any capacity, you must look the part.9 He told her she might find some success if she dressed as a man and attended medical lectures in Paris. Because she wasn’t born a male, she wouldn’t be allowed to earn a medical degree, but her disguise would at least grant her access to medical knowledge. Elizabeth refused. She recognized her purpose as paving the way for women in medicine. To do this, she needed to remove the rocks in the road that impeded her medical journey, and those of numerous other women. This required her to face male intolerance and find a way into medicine while remaining easily identifiable as a woman. While the physicians detested her womanhood, they likely found some solace in her whiteness. The image of what a doctor should look like wouldn’t be shattered irrevocably. Elizabeth continued her turbulent path with more applications. The New York College of Physicians and Surgeons. Jefferson Medical College. Yale School of Medicine. University of Vermont College of Medicine. And many more. Rejection, rejection, rejection. Still, she pressed on. Elizabeth’s third round of applications encompassed submissions to twelve smaller medical schools. The response was overwhelming denial. These schools refused to allow a woman to join their ranks, even after she had gained support from established physicians. One medical school was different. The dean of Geneva Medical College, Dr. Charles Lee, wanted to be respectful of the doctor who had recommended Elizabeth. Instead of rejecting Elizabeth outright, he repeated with her the circumstances that Dr. David Jones Peck had endured after he gained admission to his medical school. Dr. Lee left it to a vote. The white men who would be Elizabeth’s classmates had the power to decide her fate. But the dean didn’t want a woman at his medical school, so he tried to stack the odds in his favor. Of the 150 men who composed the medical school body, only one had to say “no” for Elizabeth to be rejected.10 But these white male students responded in a fashion similar to that of some physicians who had interviewed Elizabeth. When they found out that a woman was trying to enter their ranks, they were sent into fits of laughter.11 How could a woman think that she could become a physician? In the end, these men were too entertained by the comic notion of a lady doctor to let the moment pass. Elizabeth’s soon-to-be classmates voted to admit her to the school in October 1847, months after Dr. David Jones Peck earned his medical degree. To her classmates, the vote to accept Elizabeth was simply a hilarious joke. To Elizabeth and the white women who came after her, it was the foothold they needed to finally pierce the medical world. Soon after Dr. Elizabeth Blackwell graduated from medical school in 1849, new colleges of medicine explicitly and exclusively for women began to open, which allowed hundreds of white women to join the medical profession. espite these advances for white women and black men, progress was still stalled D for black women. The unique obstacles of being black, and those of being a woman, were multiplied for people with both identities, slowing black women’s entry to the medical field. Rebecca Davis heard about, and possibly even encountered, this shifting demographic of physicians while she worked as a nurse. She also developed physician-mentors who pointed her to more progressive institutions. Howard University College of Medicine, the first historically black American medical school, didn’t open until 1868. Therefore, Rebecca’s best chance of being trained as a physician was through one of the new crop of women’s medical colleges. When she ambitiously applied to medical school in 1860, there were only 300 women out of 54,543 physicians in the US. None of those women were black.12 Rebecca was accepted at the New England Female Medical College in 1860. She was the school’s only black student in its twenty-five-year history.13 In this space that supported women, the challenges of being black in America had not even been broached. Rebecca slogged through a demanding medical school curriculum alongside her white classmates with a constant threat hanging over her head. A white person could inflict violence upon her or her community for evading slavery and taking strides toward prosperity. Violent opposition to abolition had persisted in the North for decades. The multiday riot in New York that demolished Dr. McCune Smith’s community in 1834 had not been the first, nor was it the last. Proslavery violence occurred in Boston during Rebecca’s childhood and early adulthood. Hate crimes were a response to the strong abolitionist presence in the city. When Abraham Lincoln was elected president of the United States in November 1860, during Rebecca’s first year of medical school, the violence in Boston intensified. While Lincoln believed that white southerners had the right to enslave other people in perpetuity, he was against the expansion of slavery to the West.14 This outraged many white Americans. Lincoln’s position threatened their pocketbooks and their dominance within society. It prompted eleven southern states to secede and form the Confederacy between his election and his inauguration, a period referred to as the Secession Winter of 1860 and 1861. Although Lincoln spoke only about halting the expansion of slavery, abolitionists saw this as their opportunity to end slavery altogether. They advocated for this change through public demonstrations and political lobbying. On a chilly December day in 1860, Boston abolitionists held a public meeting at Tremont Temple to strategize on how to eradicate American slavery. Frederick Douglass was among many prominent leaders of the abolitionist movement who spoke. White Bostonians who supported slavery caught wind of this meeting and mobilized. They filled the lecture hall, outnumbering the abolitionists. When Douglass tried to deliver his speech, angry white men pulled him off the platform by his gray-streaked curly hair. Immediately, the hall broke out in violence. The police were present and watched this scene. Eventually, they removed the abolitionists from the hall, allowing the white anti-abolitionists to control the event. While this did subdue the crowd, the abolitionists were furious that the white Bostonians who started the violence, and who were in support of slavery, had upended their event with the help of the police. After the leaders of the event lumbered away from Tremont Temple, they regrouped to discuss a way to resume their meeting that evening. They decided on the African Meeting House on Joy Street, only two miles from Rebecca’s medical school. When the anti-abolitionists found out about their plans, they recruited even more white men to intimidate the group holding the event. The police changed their tactics, allowing the abolitionists to speak, while keeping the slavery supporters outside. The street filled with thousands of angry white men, many of whom by their dress appeared to have come from well-paid jobs. They tensely waited to respond to the abolitionists. Once the meeting ended, the police force abandoned the scene, while the irate crowd remained. These white men had brought axes, clubs, and stones to the meeting, and they leveled them at the black Bostonians exiting the African Meeting House. A few rioters even used guns. Cracked bones. Splattered blood. Cries of agony. This was the impact the well-off white men had on a black community that just wanted freedom for their brethren. Some of the black people were brought to the brink of death.15 Not yet satisfied with the torment they had inflicted on the abolitionists in the meeting, the white mob took to nearby black neighborhoods, shattering windows and ripping furniture apart. They wanted to do what they could to destroy the few comforts these freed black families had found in the more progressive North. The terrorists took to the trolley cars traveling on Cambridge Street near the north slope of Beacon Hill. They dragged the black passengers off the trolley and beat them senseless. By this point, the Boston police had been notified of the violence in the black neighborhoods. Large groups of police officers, all white, stalked the streets as the heinous assault occurred. But they did nothing to stop the attack. They must not have been concerned by the severe harm their white brothers were inflicting on this black community. Maybe they applauded their efforts. Maybe they would’ve joined the crowd with their own clubs if they hadn’t been on duty. The only person they arrested was a black boy who tried to defend himself after white assailants broke into and destroyed his home.16 Apparently, it was legal for a white man to ransack a black family’s home. If a black man did this to a white family’s home in the 1800s, he might be punished by hanging. But the rules were different for white men. Incidents of white anti-abolitionists attacking black Bostonians increased dramatically following this tragic event. It is unclear if Rebecca or someone close to her was a victim of the assaults. Since the attacks occurred only two miles away from her school, it’s very possible that she was personally impacted by the violence. But even if Rebecca avoided being physically harmed, fear surely struck her heart. She decided to take time off from medical school and relocate to Richmond, Virginia, for a while.17 The anti-abolitionists in Boston were too dangerous for her to remain there. Rebecca’s medical school did not care that her life was in danger when the Civil War erupted. It stripped her of the scholarship that had made it possible for her to attend. But her foot was already in the door. Refusing to let this deeply rooted dream slip away, she fervently sought other funding. She was eventually awarded the Wade Scholarship, established by abolitionist Benjamin Wade.18 Once she returned to school, she had to keep her nose in her books. She couldn’t worry about what would happen if the Confederacy won the Civil War. She couldn’t entertain the possibility of slavery returning to the North. She was expected to perform on par with her white classmates, so that’s what she did. When Lincoln issued the Emancipation Proclamation on January 1, 1863, Rebecca must have been elated. For the final fourteen months of her medical education, she could breathe more easily. She wouldn’t be sold into slavery. And the African Americans enslaved in the South could finally claim their freedom. Dr. Rebecca Lee Davis triumphantly graduated from medical school in 1864. This was twenty-seven years after black men—and fifteen years after white women—had been allowed to become physicians. O nce Dr. Davis entered the medical sphere, she faced immense resistance and skepticism. She needed a protective shield to weather the harsh conditions of a largely racist and sexist medical community. For her, this armor would be gleaned from her work caring for others in need. After she graduated from medical school, she married Arthur Crumpler and changed her name to Dr. Rebecca Lee Crumpler.19 Arthur understood her need to support disenfranchised people, and he supported her career. Together, they moved to Richmond to serve with the Freedmen’s Bureau, a government-sanctioned group meant to help the four million newly freed African Americans transition into society.20 Many of these people had been deprived of proper healthcare all their lives. While the other healthcare providers claimed to care about the plight of African Americans, they did not wish for a just society. Their treatment of Dr. Crumpler proved that they didn’t want African Americans, or at least not African American women, as their medical colleagues. Administrators tried to prevent her from admitting patients, and pharmacists refused to fill her prescriptions.21 They could not believe that a black woman was capable of being a competent physician. Some of the male physicians jeered: “The MD behind her name stands for nothing more than ‘Mule Driver.’”22 While Dr. Crumpler likely felt disheartened by her colleagues’ demeaning behavior, caring for the African American community kept her going. She remembered the experience as “a proper field for real missionary work, and one that would present ample opportunities to become acquainted with the diseases of women and children. During my stay there nearly every hour was improved in that sphere of labor.”23 In 1869, Dr. Crumpler and her husband moved back to Boston after spending about five years in Virginia. They bought a home on Joy Street in Beacon Hill, the very same black neighborhood that had been destroyed by angry white anti- abolitionists during her first year of medical school. Many of her neighbors likely still had the scars from that horrid day. Dr. Crumpler used her home as her medical office. Members of the community filed in seeking relief for their ailments. She mainly served black women and children, as she had in Virginia. It didn’t matter if they had the funds to pay for their visit. She would treat them regardless.24 During the decade or so that she maintained this private practice, her medical sect, allopathic medicine, was changing drastically. The groundwork for this change was laid while she was still practicing as a nurse. In 1855, German physician Rudolf Virchow proposed that cells came from preexisting cells. This differed from the prevailing view, that new cells arose from a fluid called blastema. Imbalance of blastema was thought to cause disease. Virchow leveraged his opposing theory to develop the field of cellular pathology: the study of disease at the cellular level.25 In 1861, French chemist Louis Pasteur added on to this reductionist approach to medicine.26 He proposed the germ theory, that the invasion of microorganisms into the body can cause disease.27 In 1876, German physician Robert Koch applied Pasteur’s germ theory to investigate the causative agent of the deadly anthrax disease. He found the bacterium Bacillus anthracis to be that agent. This was the first time someone had scientifically proven that a specific microorganism caused a specific disease.28 He later discovered the causative agents of a few other deadly infectious diseases, including tuberculosis and cholera.29 The baton of innovation was passed back to Pasteur in 1879, when he serendipitously immunized chickens against cholera. He accomplished this by inoculating the chickens with a live-attenuated version of Vibrio cholerae, the bacterium that causes cholera. He used this technique to develop vaccines against anthrax and rabies.30 As these European discoveries gained acceptance, they profoundly influenced American medical practice. In the 1870s, allopathic doctors’ use of bleeding and calomel, a popular purgative, decreased drastically.31 Instead, with insight from scientific experiments, they started to use specific therapies for specific diseases. This new therapeutic strategy was easier to tolerate and seemed more effective than the broad and drastic measures that doctors had used traditionally. The shift toward scientific medicine boosted the public’s confidence in allopathic medicine.32 It’s likely that Dr. Crumpler applied these innovations to her medical practice. In 1880, Dr. Crumpler and her husband moved to Hyde Park, another neighborhood in Boston. There are no records to show whether she continued her medical practice in the new community. But even if she wasn’t seeing patients on a regular basis, she continued working to improve the health of her community. When she was fifty-two years old, she published A Book of Medical Discourses: In Two Parts, which leveraged her more than twenty years of clinical experience, both as a nurse and a doctor, providing medical advice to women on topics such as washing and dressing a newborn, breastfeeding, maintaining proper nutrition, managing diphtheria and measles, and treating burns.33 The book was especially helpful for black women who couldn’t find a doctor that they could afford. It equipped them with the knowledge to care for themselves. The work further marked her as a pioneer; it is the only known medical book written by a nineteenth-century African American woman.34 Dr. Crumpler passed away twelve years later, on March 9, 1895. D id Dr. Crumpler ever know that she was the first black woman physician in the country? Or that she was the only black woman to publish a medical book in America in the nineteenth century? She wasn’t celebrated for breaking these barriers, the way Dr. McCune Smith or Dr. Blackwell were. There were no news articles about her that were published while she was alive. No photographs were taken to cement her legacy. There is an image that accompanies Dr. Crumpler’s name in internet searches, but that image is not of Dr. Crumpler—it’s Mary Eliza Mahoney, the first African American to become a professionally trained nurse in the United States. I had studied Mary’s photo in countless articles describing Dr. Crumpler’s medical journey. Mary’s picture brought Dr. Crumpler’s story to life in my mind. When I stumbled upon an article that revealed that this picture was actually of a different person, I was shocked. I searched Mary Mahoney’s image to double check. Sure enough, the same woman stared back at me. The cognitive dissonance sent a flash of emotion through my body. Is this how little they thought of us black women? That it was unfathomable that we could’ve become physicians in the nineteenth century? At best, we became nurses. I couldn’t point to just sexism or racism. It was sexist because women in the medical sphere were oftentimes assumed to be nurses instead of doctors. It was racist because nineteenth-century white women physicians had been widely recognized, while nineteenth-century black women physicians were ignored. Maybe it was our blackness juxtaposed against our womanliness. As the antithesis of the poster child for medicine—a white male doctor—the image of black women as physicians must’ve been too preposterous to imagine. I felt even worse when I found out that historians didn’t always recognize Dr. Rebecca Crumpler as the first black woman physician. Without sources like newspaper clippings, the introduction of A Book of Medical Discourses: In Two Parts is one of the only primary sources in existence that details Dr. Crumpler’s life. For a while, historians didn’t realize that Dr. Crumpler made this medical milestone. They thought Dr. Rebecca J. Cole, the second black woman physician, was actually the first.35 I couldn’t believe that historians had made this mistake. But even if no one thought her work was important enough to document at the time, Dr. Crumpler’s achievements are too powerful for her to remain invisible. Dr. May Chinn CHAPTER 2 DOING SURGERY IN THE BEDROOM T he nineteenth century passed with a whisper of hope. It seemed like the door that Dr. Rebecca Lee Crumpler had cracked open was gradually widening. More black women joined the medical profession. In 1890, thirty-six years after Dr. Crumpler earned her medical degree, there were 115 black women physicians in the US. The steady rise continued through to 1900, when 160 black women were in the profession.1 But this optimism about progress must be paired with perspective. How did a black woman’s access to the medical profession at the turn of the twentieth century compare to that of her counterparts? In that same year that black women physicians reached 160, there were approximately 88,000 white male physicians, 3,500 white female physicians, and 1,600 black male physicians.2 According to the census of 1901, there were almost 67 million white Americans and 9 million black Americans, both split approximately evenly between men and women.3 Based on this data, 1 out of every 375 white men was a physician. One out of every 2,800 black men was a physician. One out of every 9,430 white women was a physician. And 1 out of every 28,125 black women was a physician. Black women were still drastically underrepresented. When allopathic physicians considered how their medical community was developing at the turn of the twentieth century, many were concerned.4 Their opinions on the demographic shift varied. But a large portion believed that the total number of US physicians was too high. This was due to the significant increase in medical schools. Between 1800 and 1900, approximately four hundred medical schools were founded.5 This heightened competition in the medical workforce, both within the allopathic sect and between the other medical sects. As a result, each individual physician had fewer patients and a lower income. Allopathic physicians had tried, and failed, to reduce this competition in the nineteenth century. But as science-based therapies became more central to the doctors’ practice, eliminating the competition became more feasible. In the nineteenth century, medical faculties relied on student fees for their incomes. The more students they had, the more money they made. This fueled the boom in medical trainees. But once students completed their training, they entered the workforce. With so many physicians, it was difficult for an individual physician to make as much money as they wanted. As a result, the practicing physicians wanted fewer students entering the medical pipeline. The medical faculty members and practicing physicians were on opposing sides of this issue until science-based research made new clinical methods possible. The introduction of anesthesia and antiseptics in the mid to late nineteenth century eliminated intense pain and deadly infections from the typical surgical experience. Physicians could charge more for these specialized surgeries. This became a major source of income for many medical faculty members. As a result, they became invested in promoting “medical science.” These faculty members raised the standards of their medical schools to ensure that they remained abreast of the new scientific approach to medicine, which resulted in fewer medical school admissions every year. Just what the medical practitioners wanted. At the turn of the twentieth century, the new medical scientists joined forces with elite medical practitioners. Together, they took control of the American Medical Association (AMA). They reshaped this national institution, which was founded in 1847, into “the profession’s instrument of political action.”6 They set standards that all medical schools were expected to adhere to. They were to admit students with at least four years of high school education. With only 15 percent of high school age Americans enrolled in high school at the time, this requirement favored middle- and upper-class white men for medical school admissions.7 In addition, the medical schools were to provide four years of education, not short one-year courses that were popular in the nineteenth century. The schools also needed adequate laboratory and clinical teaching facilities, as well as a highly trained laboratory and clinical faculty. Finally, the medical students were to pass an exam before they could attain their state license. Medical education reformers in the AMA joined the state medical licensing boards to push their agenda.8 Reformers pushed for local laws that barred students from taking medical licensing exams if the students attended a medical school that didn’t meet these standards, driving many students to AMA-approved medical schools. This, and multiple other medical education reform efforts, caused forty-four medical schools to close or merge between 1904 and 1909.9 But reformers weren’t satisfied with these results. They enlisted the Carnegie Foundation for the Advancement of Teaching, which was founded in 1905, to create a uniform higher education system to expand reform efforts. Once the foundation was convinced these reforms would align with its own values, it agreed to fund a survey of medical schools throughout the US and Canada. At the suggestion of Rockefeller Institute director Dr. Simon Flexner, the Carnegie Foundation invited Simon’s brother Abraham Flexner to lead the study.10 Abraham Flexner was a trained educator and former high school teacher, but he had no experience with the medical education system. He didn’t have a job when he received the offer from the Carnegie Foundation. Despite his limited knowledge of the field, he happily accepted. Following his tour of medical schools, Abraham Flexner published what is now known as the Flexner Report of 1910. The report’s recommendations closely echoed those of the reformers leading the AMA. Flexner advocated for improved facilities and better, scientifically trained faculties. Johns Hopkins, his alma mater, was the standard he encouraged all medical schools to aspire to. Johns Hopkins University School of Medicine was modeled after the German medical education system, which used evidence from biomedical research to shape their therapeutic interventions. Given the influence that German scientists and physicians were having on the development of biomedicine, this high standard pushed American medical schools to modernize. It helped our medical education system gain the eminence it enjoys to this day. However, Flexner criticized medical schools for training too many doctors. He advised schools to require all incoming students to have at least two years of college education. With only 5 percent of college age Americans in college at the time, this steered medical schools even further to draw incoming students primarily from the elite classes, now welcoming only those with a high school diploma and some college education.11 Purging the physician workforce of poor and working-class people is something that the reformers wanted. Flexner’s recommendations helped them achieve it. The report also introduced new barriers for black Americans interested in medicine, particularly impacting black women. The report suggested that male and female medical students should be trained together but perpetuated the segregation of black students from their white counterparts. The New England Female Medical College, Dr. Crumpler’s alma mater, and Woman’s Medical College of Pennsylvania, Dr. Cole’s alma mater, were among a handful of women’s medical colleges founded in the nineteenth century. They played a central role in training women from all backgrounds. Following the Flexner Report, the three women’s medical colleges that had survived into the twentieth century were forced to merge with white male-dominated medical schools. Because racial segregation was maintained, the mergers meant fewer opportunities for black women to be trained in medicine. The limited spots designated for women at the white male-dominated schools would be given almost exclusively to white women. Aligned with the racist views of the time, Flexner argued that black physicians should treat only black patients. And, as he wrote in his report, “the fewer, the better.”12 At least fourteen black medical schools or departments had been founded in the late nineteenth century.13 Only seven survived to the early twentieth century. After Flexner’s report, the number was slashed to two: Howard University College of Medicine and Meharry Medical College.14 The medical reformers in the AMA were happy with this change. There would be fewer black physicians to threaten the racial hierarchy or to compete with white physicians in the job market. In 1918, the AMA pushed for the closure of Meharry. But the Carnegie Foundation stepped in and provided financial support for the school.15 Howard and Meharry became the primary avenues for black Americans to acquire medical training. At this time, it was a popular view that men should predominate within the medical profession. Thus, these two medical schools likely favored admission of black men in the early twentieth century, further stifling opportunities for black women. The adoption of Flexner’s suggestions by medical schools around the country immediately halted the progress of black women in medicine. The wide-reaching and long-lasting impediments still exist today. By 1920, the number of black women physicians had toppled to sixty-five, less than half the number in 1900.16 Strikingly, the changes implemented due to this report became a persistent blockade to African Americans’ access to medicine. Almost one hundred years after the report was published, the percentage of black physicians was actually lower than it had been right before the implementation of Flexner’s recommendations. In 1910, 2.5 percent of all physicians were black; by 2006, that number had dropped to 2.2 percent.17 How did this changing climate impact African American women who sought to enter medicine, when there were only sixty-five in the field? Dr. May Chinn’s story gives us a clue of the broader experience of black women entering medicine at this time. n a crisp spring day in 1896, May Chinn was born in Great Barrington, Massachusetts. Neither her mother, Lulu Ann, nor her father, William Lafayette Chinn, had a college education. They represented the vast majority of African O Americans at the time, who were not allowed to attain an education. May’s father had been born into slavery. He seized his freedom at eleven years old when he bravely ran away from the Chinn plantation in Virginia. He never spoke about his painful experiences as a slave. He focused on the pride he felt from outwitting his captors with his escape. May’s mother, Lulu, was twenty-four years younger than May’s father. She was born free in 1876 but worked as a servant for a wealthy white family who moved from Virginia to Massachusetts. Lulu was determined to lead her daughter down a different path. She believed that a strong education would give May an easier life. But the Plessy v. Ferguson Supreme Court case was decided a month after May was born. The ruling codified racial segregation laws in numerous societal institutions, including the education system. This left May to be taught at all-black schools that were deprived of educational resources and adequate government funding. Despite these challenges, Lulu did what she could to support her child. She worked as a live-in cook for Charles Tiffany, the founder of Tiffany & Co. jewelers, and his family. She earned an extremely modest income. William’s job prospects were even worse. Like many African American men in the early 1900s, he was unable to acquire a skilled job due to racial discrimination.18 His only options were low-paying jobs, like mail carrier. His employment status was unstable, his income sparse. The heavy burden of providing for the family lay on Lulu with her meager income. Still, she saved every penny that she could for May’s education. Eventually, she saved up enough money to send May to the Bordentown Manual Training and Industrial School, a New Jersey boarding school for African Americans. While May was at boarding school, she fell ill. Her forehead was hot to the touch. Her legs and arms swelled in pain. She had osteomyelitis, a bone infection, and had to undergo an extensive surgery, which required a long period in recovery. This prevented May from fulfilling her responsibilities at school. She was taken out of school and brought to live with her mother at the Tiffany family’s Irvington estate, in upstate New York. Life with the Tiffanys exposed May to a whole new world: the bright lights of New York City, the vibrant colors of the circus, exquisite musical arrangements at Walter Damrosch concerts. May accompanied the Tiffany children on many of their adventures. She even sat in on their homeschool lessons on topics like French and German.19 This rich cultural exposure planted in May seeds of interest in areas such as music, which bloomed later in her life. Maybe wealthy families like the Tiffanys took pity on their black domestic workers’ children. The children weren’t a direct threat to the family’s superior position in society. Even if the children were educated, they couldn’t compete with the white children for job opportunities when they grew up. As a result, some black children in the early twentieth century gained secondhand exposure to educational enrichment activities from their mothers’ wealthy employers.20 Not long after May moved to the Irvington estate, Charles Tiffany died, and the estate was broken up. May and her mother moved back in with May’s father, in Lower Manhattan. From that point on, the family constantly hopped from one neighborhood to another. At one point they lived at Columbus Circle, right across from the lush Central Park. After May completed grammar school, the family uprooted again and moved to the Bronx. It wasn’t until May was much older that she realized their constant moving was motivated by her mother’s attempts to get her into the best schools possible. When May was a teenager, some schools had started to desegregate. Lulu saw this as an opportunity to get her baby in a school with better resources. First, she enrolled May in Washington Irving High School, a good, predominantly black high school in Manhattan. But when the highly regarded Morris High School in the Bronx desegregated, Lulu jumped at the opportunity to enroll her daughter. When Lulu realized that Morris High was too far of a commute from their Manhattan residence, she promptly moved her family closer to the school. May didn’t always appreciate the sacrifices her mother made for her. She didn’t understand the long-term implications of attending a well-resourced high school. Like many teenagers, she was just living in the moment. May followed her mother’s plan during freshman and sophomore year of high school. But when she became a junior, things changed. May felt cheated by her eleventh- grade Latin teacher, who gave her a lower grade than she felt she deserved. This may have been due to racism. Or the teacher may have graded her fairly. Regardless of what caused it, the low Latin grade haunted her. May was used to performing well in school. If this wasn’t bad enough, her spirits were further dampened by a love turned sour. She was charmed by an older, Greek man with olive-colored skin. He was a vegetable store owner, a widower with three children. Things started off light and fun. May would go to the store after school to see him and play with his children. She was moved by her emotions for him, but she didn’t realize his intentions. Being a widower, the man wanted a woman to complete his family. Someone to take care of his kids. May was only sixteen years old, but the man decided May could fill this motherly role. With little warning, he asked May to be his wife and the mother to his children. May was completely shocked. She wasn’t ready to be a mother. She was still figuring out who she was. So, she bravely turned down the proposal. But her decision had consequences. First, turning down the man’s proposal meant ending her romance with him. This left her heartbroken.21 Even worse for May than this new feeling of grief, the decision fractured her relationship with her father. In a 1979 interview, despite her eighty-three years, May easily recalled this change. “My father just washed his hands completely of me. He hardly spoke with me.”22 Her father’s denouncement left May completely distraught. This was the blow that finally broke her. May lost the drive to continue working hard in school. With only a year left of high school, she dropped out. May was quickly plunged into the adult world. She needed a job to support herself, so she gravitated toward music. Throughout her childhood, she had attended piano lessons funded by her mother’s scant income. May used this training to teach kindergarten-age children. The lessons ranged from traditional piano lessons to complex skits that the kids performed at the YMCA and at social events. This work gave her great joy. She didn’t feel like she was missing out by not finishing high school. Her mother, on the other hand, was grieved. She wanted more for her daughter. So she continued to push May to further her education. Through fervent networking, Lulu found out that May could still gain admission into college if she took an entrance exam. She begged May to take the test, and May hesitantly agreed. May assumed that she wouldn’t do well. Instead, her potential shone through; she performed so well that she gained admission to the prestigious Teachers College at Columbia University. May was shocked by these results. They made her believe that maybe she could achieve more than she had previously thought possible. She started to see college as a great opportunity to challenge herself and further her knowledge. When May’s father found out about her college plans, his disapproval of her deepened. May explained: “His idea of a girl was that you got married and had children. See, he was a different generation. A girl that went to college became a queer woman. She didn’t act like a woman. And he didn’t want to be the father of a queer girl.”23 Because May didn’t follow traditional gender roles, William refused to contribute to her education. He also avoided speaking to her for many years, even though they continued to live in the same house. Despite the tensions it brought to the family, Lulu and May remained committed to getting May through college. In 1917, May began her studies at Columbia as a music major. Thanks to her high exam score, she had preemptively fulfilled almost all of her liberal arts requirements. She needed only one more prerequisite before she could fill her schedule exclusively with music classes, so she took two classes during her first semester of college. One was a music class with a German professor whose prejudiced thinking led him to use his position in the department to hinder May’s advancement. May recognized this and sought a way to remedy the situation. May’s solace came from Dr. Jean Broadhurst, the professor of her sole non- music class, a biology course with a focus on bacteriology. Dr. Broadhurst was a white woman who did not allow any prejudice she had against African Americans to cloud her judgment of May. At the end of the semester, each student was assigned a topic for their final paper. Three days after turning hers in, May received a note from Dr. Broadhurst asking her to come by the office. When they met, Dr. Broadhurst explained that she wanted to meet May because she was impressed by her paper, especially since May was a music major. The professor spotted a blooming interest in science between the lines of May’s writing. After discussing May’s paper at length, Dr. Broadhurst said a handful of words that were like magic: “Well, if you ever make up your mind, if you decide to change your major, I think you have a future in science. So... you think about it.”24 This suggestion piqued May’s interest, so she talked it over with her mom. The following year, with Lulu’s approval, May switched her major from music to biological sciences. As May progressed through college, the financial burden wore on her. She worked two jobs, as a piano accompanist of students majoring in music and as a lab technician in Dr. Broadhurst’s lab. May fell in love with the process of learning. But she always feared that her next semester could be her last. She tried her best to enjoy each minute of learning while working as hard as she could to raise money for the next semester. And her mother was constantly fighting to earn enough to help May cover the cost of school. Dr. Broadhurst helped by looking for new ways to make school more affordable for May. She encouraged May to take some clinical pathology classes at a postgraduate school in New York. These were less expensive classes that counted toward her degree requirements. They also made her a competitive job applicant in the burgeoning new field of clinical pathology. After May’s junior year, she was hired as a clinical pathology technician at Flower Hospital on Fifth Avenue near the Rockefeller Institute. To manage her new day job and her coursework, she worked during the day and took her classes at night, as advised by Dr. Broadhurst. At what point in May’s schedule did she find time to study the material for the class? When did she have time for family obligations, never mind herself? I’m not sure how she was able to juggle these demanding commitments, especially since she finished her bachelor’s degree far faster than students with fewer responsibilities completed theirs. As someone who was also on the premed track in college, I know it’s a huge accomplishment to make it through this program in four years, especially while managing multiple jobs. I had friends who had jobs while school was in session. As they juggled the demands of school and work, many found themselves exhausted and extremely stressed. Some of them became so burnt out that they had to take time off to regain their energy or had to pivot toward a different career path. Only a few managed to hold multiple jobs, excel in their premedical classes, and maintain enough energy to overcome the unexpected hurdles along their medical journeys. Music helped May stave off burnout in the midst of this demanding schedule. In addition to tutoring and accompanying students in Columbia’s music department, May participated in small concerts at churches and at the YMCA. During one of these performances, a man approached her and said, “I understand that you’re quite an accompanist. Would you mind accompanying me? Because it looks as though my accompanist is late.” May didn’t have to turn around to see his face. She would recognize that voice anywhere. “Of course, Paul.”25 It was Paul Robeson. They went on to perform at many incredible music venues together. She accompanied Robeson and, sometimes, did a full performance by herself too. Paul Robeson was, of course, a famous African American bass baritone concert artist and a leader of the Harlem Renaissance. May’s time in the Tiffany household had introduced her to musical professionals and developed in her an abiding passion for the arts. This led her to continue to prioritize music in the midst of her demanding premedical curriculum. Serendipitously, May’s need to work while she studied introduced her to a flourishing community of influential black musicians, whom she kept up with throughout her life. During the few nights that she did go out, she had experiences that some might call historic. A friend would tell May the place and time for a hangout. Directions would lead to a humble storefront in Harlem. She would enter to find her friends seated at a round table. A candle at the center of the table created a warm and intimate atmosphere. After exchanging pleasantries, people would begin sharing their work. There were various black artists who held the floor, including famous writers like Langston Hughes, Countee Cullen, Jean Toomer, and Claude McKay.26 After sharing what they had written, they would wait to see how their friends around the table responded. Sometimes May, or someone else at the table, would make a suggestion. This was where some popular works from the Harlem Renaissance came alive. All the while, May continued performing with Paul Robeson. Sometimes they would sing and play piano at Madam C. J. Walker’s recitals. Walker was an African American woman best known for her black haircare products, which helped her climb from poverty to become America’s first female self-made millionaire.27 May’s relationships with these other black leaders and influencers indicate how small, and possibly tight-knit, the more professionally successful African American community was in New York in the late nineteenth and early twentieth centuries. But May didn’t let these awe-inspiring nights distract her from her research. The faculty at Flower Hospital’s associated medical school, which taught homeopathic medicine, took note of May’s work in the clinical pathology lab. The faculty members were so impressed that they offered her a full scholarship for four years of study in medicine if she would agree to teach her classmates clinical pathology. This news likely filled May with excitement. She had experienced countless instances where people told her she couldn’t thrive in higher education because she was a black woman. Yet these faculty members believed in her and were convinced that May would be such a great contributor to medicine and their medical school, that they were willing to invest in her education. Unsure of how to navigate this new situation, May went to her trusted mentor, Dr. Broadhurst, for advice. She was over the moon that May was considering a career in medicine but suggested a tweak in May’s plans. She encouraged May to pursue allopathic schools, which were incorporating more scientific research- informed therapies into their practice. By the 1920s, this medical sect had gained definitive favor in American society over homeopathy. (Allopathic medicine has maintained its dominance to this day. What many people refer to as Western medicine, or biomedicine, is the modern form of allopathic medicine.) As someone with parents who hadn’t even been to college, May needed an advisor who could help her maximize her professional potential. American medicine was changing rapidly as May matured. How could she know that homeopathy, which had been popular for a large portion of the 1800s, was losing its prominence in society? To May, a medical school was a medical school. She didn’t realize that her choice of a particular institution could have long-term implications for her career. May might not have understood Dr. Broadhurst’s preference for an allopathic school, but her professor hadn’t steered her wrong yet. Following Dr. Broadhurst’s advice, May applied to two allopathic medical schools: Columbia University Vagelos College of Physicians and Surgeons and New York University School of Medicine. Both medical schools have maintained prominence in the medical education world: in 2021, a hundred years after May applied to medical school, U.S. News & World Report ranked New York University number four and Columbia University number six in the category of best medical schools for research.28 May would’ve happily accepted the offer to attend Flower Hospital’s associated medical school, even though it practiced a sect of medicine that was quickly losing acceptance within the US. But with a mentor providing a slight course correction, May instead set her sights on two medical schools that are still considered some of the best in the US, and arguably the world. Impressively, May was admitted to both schools. Columbia gave her a conditional acceptance; she would be allowed to join the medical class in the fall if she took a chemistry course over the summer. Medical schools still do this today. Unfortunately, this was a hurdle May couldn’t surmount. She was already breaking her back to pay for college. Saving up for medical school just added to that burden. After graduating from college, she worked for a year in the pathology lab, and she needed every penny of that income to pay for medical school. She didn’t have the luxury of taking time off over the summer to take the chemistry course. Thankfully, NYU didn’t have the same prerequisite. She happily accepted NYU’s offer and joined the entering class of 1922. NYU maintained an unofficial quota, as did many medical schools, and May recalled that NYU usually accepted only two women. Her medical class was different. The school admitted five women. One female student was the daughter of a wealthy donor to the hospital. Another was the relative of one of the college’s professors. A third was the highest-ranked undergraduate student at Hunter College. It took incredible circumstances like those for the school to willingly train more women than it had predetermined for its quota. The number of black students was also kept low. There were only four black students in the class, three of whom were men. May stood at the intersection of these two underrepresented groups: she was the only black woman in the group of five female students, and the only woman in the group of four black students. Even more discouraging than the initial class demographics are the demographics of the graduating class. While all four of the white women graduated, the black men didn’t fare as well. One of the black male students was discharged, and another died of tuberculosis. So on graduation day in 1926, only two black students remained to don their celebratory gowns: Dr. May Chinn and Dr. Aubre Maynard, who later became the chief surgeon of Harlem Hospital. They were the only two black students who made it to the end. While Dr. Chinn remembers the clear racial discrimination that Dr. Maynard experienced in medical school due to his dark complexion, the most significant barrier she experienced was due to her financial constraints. Dr. Chinn worked throughout medical school in multiple labs, including Dr. Broadhurst’s bacteriology lab and a clinical pathology lab at the New York State Department of Health.29 She worked over summer break and during the school year. Of all the medical students I know at Penn and across the country, there are very few I know who are working while in medical school. And I can’t think of anyone who works multiple jobs during the school year. If today’s norms are any indicator, it was very unusual for a medical student to work during the school year. The demands of medical school were just too great. The workload for a medical student today can give insight into what it was like to study medicine in the 1920s. Each day, students are responsible for attending hours of didactic lectures. This is just the first exposure to the material. They must digest the information so thoroughly that they can see the connections between multiple complex concepts. This level of understanding is necessary to apply the basic scientific ideas to dynamic clinical cases. To reach this level of comprehension, most students spend hours reviewing the material they have learned in the past few days. This is difficult for any student. But the task is much harder for a working student. May’s intense schedule proved that. Every day, she woke up around the time that the sun peeked into the sky. She was likely still sleepy when she got dressed and packed her bag for the day. Before eight in the morning, she scrambled to catch her bus. As the bus jumped from bumps in the road, medical facts hopped around in May’s mind. This was her prime studying time. She would arrive at school by nine and file into the lecture hall with her classmates. There, she sat in on hours of lecture. Once that was finally done, she participated in labs, engaged in clinical visits, or studied new material. By six in the evening, she was out of the medical school, heading to the lab, say at the New York State Department of Health, for work. She remained in that windowless workspace until eleven at night. About five hours of research allowed for some solid experiments. Then, she used the moon in the sky and any streetlamps to navigate her way to the bus stop. She was trying to catch the Number 2 bus back home. If she felt up to it, she would fit in another study session. She must have gotten good at shutting out any rowdiness from her fellow passengers. By midnight, she’d arrive back home. Surely exhausted, May climbed into bed. She needed her energy to do all this again the next day.30 May had to be incredibly intelligent to get through medical school with this schedule. Nowadays, students often liken attending medical school to drinking out of a firehose. To me, it feels more like being a hamster running on a wheel, but at speeds comparable to those of marathon races in the Summer Olympics. We’re constantly on the move. And when we’re gasping for air, yearning to be done with the race, we take another turn and just keep going. Although it feels impossible for many when we’re in the thick of it, we make it through. Still, to meet the intense demands of medical school while managing a twenty-five-hour- plus work week schedule? That sounds nothing short of miraculous. One thing that likely helped her manage the hectic schedule was her background in clinical pathology. It afforded her skills that the typical medical student didn’t have. For instance, she knew how to administer anesthesia to a patient, thanks to her experience giving anesthesia to animals. Her school’s clinical pathology professor recognized her relative expertise in the field. He insisted that she serve as a student assistant for her classmates during their second year of medical school. Consider the cognitive dissonance May’s classmates experienced when they realized they were going to learn this complex topic from not only a classmate but the sole black woman in their class. She was probably the last person they’d expect to have teach them anything. Even as a black woman in medicine, I would be surprised at such a situation. My shock would come not from prejudiced beliefs about the capabilities of black women. Instead, I would be more surprised that a predominantly white medical institution would allow a black female medical student to have that kind of influence, even in the 2020s. In the 1920s, racist acts against African Americans were surging. There were numerous deadly Ku Klux Klan attacks in the US in the period after World War I.31 Based on this social context, I would assume black women had fewer opportunities then than they do today. But almost one hundred years after Dr. Chinn completed her medical training, the percentage of black female medical educators is scant. In 2018, only 2 percent of all US medical faculty were black women, and only about 15 percent of those black women faculty were full professors.32 This discrepancy was made obvious to me during my first year of medical school. I was constantly exposed to new professors; physicians deemed experts on specific topics were selected to give talks. For example, different professors would lecture on childbirth and on cervical cancer. Despite this diversity of clinical topics, it wasn’t until March 1, 2021, that a black physician delivered a lecture for my class. This was after more than six months of classes and having studied under more than 150 physician lecturers and lab preceptors. To me, this scenario signals who medical schools believe is competent enough to train the next generation of physicians, and who is not. May’s pathology professor likely had a small pool of people to choose from, since clinical pathology was an emerging field. Still, her appointment to this position may have challenged her classmates’ preconceptions of the capabilities of black women. It showed that she was their intellectual equal, that she could hold her own in medicine. After four years of hard work and persistence, Dr. May Chinn graduated from New York University Medical College in 1926 as the school’s first African American woman graduate. After clearing one hurdle, Dr. Chinn immediately faced yet another. Following graduation, she experienced intense racial discrimination. Residency programs, a crucial step in postgraduate training, refused to admit her. Hospitals refused to hire her. Every black physician in Harlem faced this form of discrimination, but she was not deterred. To further her medical training, she worked for a group of male physicians who had a private practice at the Edgecombe Sanitarium on Edgecombe Avenue and 137th Street in New York City. She was treated like the grunt worker of this practice. On call 24/7, Dr. Chinn was the one woken up in the middle of the night to care for the other doctors’ patients. The other doctors treated Dr. Chinn like their personal servant, not their colleague. She endured long hours. Even worse, she experienced disrespectful attitudes from the doctors in the practice who didn’t believe she should be a physician because she was a black woman. Some of the doctors didn’t even acknowledge her presence. Dr. Chinn recalled, “One said that I didn’t exist—you know; I just didn’t exist.”33 Despite all of Dr. Chinn’s contributions to the private practice, the doctors rarely paid her for her clinical services. They went as far as making her pay rent to stay in the building that housed the office even though she was doing them a favor. The Department of Health required a physician to be a resident on the property. While physicians often cite residency as a particularly grueling stage of their training, Dr. Chinn’s apprenticeship-like postgraduate training was made especially difficult by these harsh conditions. Because Dr. Chinn was isolated from her community, her situation was even harder to cope with. She was the only black woman physician practicing in Harlem for many years. Though she faced similar challenges as the black male physicians, even some of them didn’t support her. They looked down on her because she was a woman. When Dr. Chinn sought a job in public health, numerous black and white male physicians joined together to protest her hiring at the Department of Health. They said that they “didn’t want to be tied to the apron strings of a woman.”34 Dr. Chinn stayed at the Edgecombe practice for twelve years because it was one of the only places where she could get substantial clinical work experience. She was finally pushed out from the clinic in the 1930s, when the other doctors increased rent to a point that she couldn’t afford. Dr. Chinn’s next step was to open her own practice. To maintain the practice with her limited funds, innovation was essential. She treated patients who had been turned away by the regular hospitals. When a hospital turned away a black patient because of their race, the patient turned to Dr. Chinn. Japan’s attack on the US Pacific Fleet at Pearl Harbor in Hawaii on December 7, 1941, prompted the formal entry of the United States into World War II the next day, and the conflict prompted many white doctors in New York City to turn away their Japanese patients. Dr. Chinn cared for those patients too. The patients had a variety of ailments. Some needed surgery. In these situations, Dr. Chinn teamed up with Dr. Peter Marshall Murray, a trained surgeon from Howard University College of Medicine. Dr. Chinn described her medical practice as reminiscent of practices “a hundred years before.”35 When these two African American doctors entered a patient’s home, they carefully surveyed the space. They needed to figure out how they were going to adapt the area for an antiseptic surgery. Depending on the size of the patient, the bed or an ironing board might be designated as the operating table. The presence of a coal stove was vital. The doctors would wrap up their dressings in newspapers and bake them in the oven. In less time than it took to bake a loaf of bread, the dressing was sterilized and safe to use. Then, Dr. Chinn or Dr. Murray would ask the family to show them to the washroom. The family’s wash boiler, which usually washed clothes, could also disinfect their surgical instruments. With their tools cleaned, the doctors’ next step was finding light that was strong enough to give them a clear view during the surgery. The patients generally used kerosene lamps to light their homes. The fire in the center of a lamp’s glass bowl lit the room only dimly. They needed something strong. Dr. Chinn and Dr. Murray decided to bring their office lamps with batteries to ensure enough lighting during surgery. With everything set up, Dr. Chinn would administer the anesthesia. Once a patient was stabilized, Dr. Murray would start the surgery. Whenever a patient needed a blood transfusion, Dr. Chinn and Dr. Murray worked together against the clock. Dr. Chinn would conduct blood counts, blood typing, and urinalysis in a makeshift lab she had built in her home. Then they would prepare the blood donor, who oftentimes was a family member or a neighbor. Relying on direct transfusion, the doctors needed only a few small needle pokes for the blood to flow from the donor to the recipient. Dr. Chinn and Dr. Murray could complete the entire transfusion process within twelve hours. Once the surgery was done, the two doctors took turns watching over the patient. They were both on call until the patient was able to get up. They didn’t let their fatigue impair their clinical care. While it was risky to conduct a surgery without the help of a larger medical team, the doctors found support in the family. A patient’s grandmother, or another family member, would serve as their nurse. With some help and a heap of innovation, these doctors were accomplishing the remarkable feat of providing care for patients who had been discarded by the medical system. Over the course of her private practice, Dr. Chinn noticed a concerning trend among her older patients. In spite of great care from their family members, many appeared to be wasting away. Dr. Chinn suspected that they were afflicted by cancer. Many of these patients’ cancers had progressed too far for Dr. Chinn to help them. All she could do was prescribe them medication to ease their pain. Wanting to, and believing she could, do more, Dr. Chinn dedicated herself to figuring out how to diagnose cancer earlier. This, in her view, was the key to better outcomes for her patients. In the 1940s, Sloan Kettering Institute, which is now known as the Memorial Sloan Kettering Cancer Center, was the only New York City hospital that studied cancer.36 When Dr. Chinn had a patient who was well enough to walk on their own, she sent them to Memorial Hospital to be examined. Initially, they would be turned away. The hospital received a high volume of patients, and the black patients could not afford the hospital’s fees. In response, Dr. Chinn started going to the clinic with her patients and requesting to watch the doctor examine them. The clinic did not always accept her requests, but on the few occasions when it did, Dr. Chinn was able to learn new techniques, which she added to examinations at her office. One of the techniques that she learned was how to collect a biopsy—a tissue sample. She started obtaining biopsies from the patients she suspected might have cancer. Then, she sent the samples to the diagnostic section of Memorial Hospital. These samples would typically have been refused because she was a black physician, but she had a connection on the inside: some of the white male physicians at the hospital were her former classmates. They would accept her samples and analyze them for her. After Dr. Chinn had been doing this for about twelve years, black male physicians and white physicians finally started to recognize her expertise. They began referring their patients to her for biopsies. She would send the samples to Memorial with her name attached to them. Thanks to her growing reputation, Dr. Chinn received a phone call from Dr. Elise L’Esperance, a white woman physician who founded the Kate Depew Strang Clinic for Cancer and Allied Diseases at the New York Infirmary, a cancer detection clinic in New York City. During this call, Dr. L’Esperance offered Dr. Chinn a position at her clinic. Dr. Chinn was shocked because black physicians were still excluded from working in clinics in the early 1940s. She tried to suspend her excitement until she met Dr. L’Esperance in person. Dr. Chinn suspected that Dr. L’Esperance assumed she was Chinese, based on Chinn’s last name. Many had made that mistake before. When Dr. Chinn showed up at the appointment, Dr. L’Esperance was shocked. She didn’t expect a black woman to appear in her office. Dr. L’Esperance probably would not have offered Dr. Chinn the job if she had known that Dr. Chinn was African American. Thankfully, Dr. L’Esperance didn’t rescind the offer once she found out. She might have had little choice because the number of white men practicing medicine at that time in the US had declined, as they were abroad serving in the war. Dr. Chinn’s racially ambiguous name had helped her sidestep some of the systematic discrimination she had experienced for much of her career, allowing her to be judged based on her credentials rather than negative stereotypes about her race. Dr. Chinn worked at Memorial Hospital from 1945 through 1976. After many years on the job, she

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