Interview by Leslie Lindsay
For a while, I have been drawn to this idea of “book pairings,” that is marrying two books that have similar themes, scope, and journeys.
When I came across Cassandra Jackson’s The Wreck: A Daughter’s Memoir of Becoming a Mother (Viking, May 16 2023) and Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century (Beacon Press, January 2023), I knew I had to speak to both of these authors. Each of these stories braid extensive grit, disempowerment, Black women, erasure, ancestry, and the medical community into a seamless whole. I was in absolute awe of the deft handling of these themes, which both authors do with considerable research and aplomb. What’s more, they are deeply moving and emotional investigations.
About the books and authors:
Twice as Hard delves into the incomplete and long-erased stories of Black women physicians in Brown’s thorough examination of nine profiles of trail-blazing women. I was absolutely stunned and warmed by their achievements, sheer determination, and brilliance; simultaneously cheering them on and being crushed by the power structures in place. A medical student herself, Brown embarked on excavating these histories as a Rhodes scholar at Oxford. She hadn’t intended to write this book, rather the ‘writing found her,’ as mentioned in an interview with Bellevue Literary Press. Brown found the blend of biology, psychology, and neuroscience to be a fascinating pairing and sought to embark on why we are the way we are, particularly the journey of the Black woman physician.
The Wreck is a profound, unforgettable memoir exploring how the medical field has failed thousands of Black Americans while weaving two personal histories; one of post-memory grief involving a harrowing car accident before she was born and the other of her devastating journey through infertility. As Jackson, a professor of English at the College of New Jersey, where she teaches African American literature and visual culture, glimpses forward at family she dreams of having, while finding herself peering back in time to reconcile the ones she lost: five members of her father’s family who were tragically killed.
As a writer intrinsically interested in medicine and social history, motherhood, and well, trauma, myself, I felt compelled to spend time not just reading these books, but having a deeper conversation with Cassandra and Jasmine. Each one of us are writers and daughters. But on a deeper level, what might tie us together is that we are all survivors, of the ones who came before, but also adversity. I once wanted to be a doctor, but was told ‘girls can’t be doctors.’ As a child, I witnessed my mother’s devolve into psychosis, and like both Brown and Jackson, I’ve been in that space of reconstituting a lost family, of working through trauma through language.
I’m so grateful for this opportunity to sit down with both Jasmine and Cassandra to discuss these exceptionally moving stories.
Leslie Lindsay: As a young pig-tailed girl, I carried a plastic medical kit and coveted the shiny stethoscope draped around my (male) pediatrician’s neck. I wanted to be a doctor. Even as recently as 1980, I was told, ‘How about a nurse? Girls can’t be doctors.’ Growing up in the suburbs of a predominately white community, the idea of a girl doctor was…not as a accepted. ‘You have to be really smart to be a doctor,’ I was told. It felt as if they were saying, ‘You’re dumb and not a boy, so you can’t do this.’
My restraints weren’t like some of the women in Twice As Hard; my parents had not been previously enslaved, we had accredited medical schools, we were considered ‘middle-class,’ and yet…this stereotype for girls and women remained. I became a nurse. It reminded me of Dr. Irby Jones’s statement, ‘You cannot be what you don’t see.’ Can you talk a little about sex stereotypes, please?
Cassandra Jackson: I really get this because I grew up as a Black girl in a place where the highest-ranking professionals in the community were white men. All I had to do was look around to recognize that whiteness and maleness were prerequisites for the most respected jobs. When Black elders asked me what I wanted to be when I grew up, I knew that because I was a good student, I was supposed to say a doctor or a lawyer. But I also knew that hardly anyone really believed I would be either of those things because the idea of a Black woman occupying those roles was just too far outside of our reality.
When we talk about imposter syndrome as if it is a creation of the mind only, we forget to acknowledge how disempowering it is to live and work under conditions that constantly remind us that we are not supposed to be here. It’s no coincidence that I couldn’t imagine the path to any professional life clearly until I went to Spelman College, a historically Black women’s institution. That experience completely changed how I moved in the world because for the first time, I was in a space filled with visible possibilities of who I could become.
Jasmine Brown: I’m constantly shocked to learn about how these societal norms/stereotypes are conveyed to individuals and how they impact their journeys. At the turn of the 20th century, women were told that they couldn’t become doctors because that wasn’t becoming of a ‘lady.’
Women weren’t supposed to be seeking work, especially not in a field that required that they be comfortable with the naked body. The rationale for why men are more suited to become physicians has evolved over time, but many people still think of physicians as being men, at least implicitly. I’ve heard of many instances where a female physician introduces herself as the physician, but the patient or another member of the care team assumes that she’s not the physician.
Leslie Lindsay: In The Wreck, Cassandra, you write about how one of your infertility doctors, who was Black herself, flat-out told you that Black women weren’t infertile. I think this speaks not just to naivete, but systemic racism. There’s inequality, in a sense, because even though you are both educated Black women in the exam room, one was in an ‘expert’ role (the doctor), and the other in a more dependent role, that of patient. With women, would you agree that we have much work still to even the playing field? That between women particularly, power structures remain a true barrier.
Cassandra Jackson: I think about that moment with the gynecologist a lot because at the time I was someone who thought I could weasel my way out of medical racism. When I was a kid, my mom told me we had to dress up when we went to the doctor as if clothes could protect us from medical negligence. I took that advice to heart. Even as an adult seeing doctors, I tried to dress and behave in ways that would make me recognizable as a professional with health insurance. Having had humiliating experiences with white male doctors as a kid, I tried to choose Black doctors or Black adjacent ones, i.e. people of color whom I thought had a higher likelihood of seeing my humanity.
But that moment when a Black woman gynecologist denied my infertility because she believed it didn’t happen to Black women, crystallizes how the problem is not about which doctors you choose but the healthcare system that created them. That’s why it’s called “systemic” racism. It’s not about a single instance of discrimination, but a whole body of ideas that inform our belief systems. My guess is that like me, my doctor grew up hearing warnings about how easy it was for a Black girl to end up pregnant. The message was that Black girls and women are oversexed and too fertile for their own good. And, that doctor’s training, instead of disabusing her of that idea, had only reinforced it.
“…the problem is not about which doctors you choose but the healthcare system that created them. That’s why it’s called ‘systemic’ racism.” —Cassandra Jackson
Leslie Lindsay: I see both Twice as Hard and The Wreck, not ‘just’ as memoirs, but a call to action, encouraging readers to fight for Black women going into medicine and Black women seeking medical care. That really brings goosebumps to my skin. My own physician is a Black woman. When I told her about these books, she promptly wrote down the titles–and then dove into stories of how challenging it is to be a Black doctor, even in the early-aughts, when she graduated. Her first child was born on the last day of her residency.
That brings to mind the harrowing statistics of Black (women, particularly) are not treated as holistically or seriously for pain as their non-BIPOC counterparts; more Black women have complications during labor and delivery and often die from childbirth, for example. Can you expand on this please? And what might we do to improve this inequality?
Jasmine Brown: Systemic issues within the practice of medicine is a major contributor to the healthcare disparities that we see today. As practitioners, we used algorithms to guide our medical management. One of the more clear-cut examples is how the estimated glomerular filtration rate (eGFR), a marker for kidney function, has used race in its calculations. But race is a social construct. Physicians oftentimes look at a patient, make assumptions about their racial background, and then integrate that assumption into the eGFR algorithm. Patients are rarely asked how they identify.
And there is a spectrum of Blackness. If a patient has a Black parent and a white parent, do we classify them as Black? What if only one grandparent is Black? These calculations don’t create space for this complexity. And if a patient is assumed to be Black, their kidney damage must reach a higher threshold before they’re eligible for a kidney transplant. This is a life-saving intervention that Black patients have reduced access to because of an assumption and an algorithm that has been considered essential for medical management of kidney disease. Examples like this exist in obstetrics and most other specialties. There have been efforts to address the disparities caused by algorithms like eGFR, but we still have a long ways to go.
Cassandra Jackson: We have to start with the premise that everyone should have the right to the highest standard of healthcare and acknowledge the fact that American healthcare systems were not built on that presumption. Racial segregation in healthcare essentially meant that Black people had no right to care. I, along with a lot of people, have been a bit forgetful and naïve about the recentness of that practice and the reality that we are living with the fallout of that system.
It wasn’t until I was researching The Wreck that I discovered my own siblings were born in a Colored ward. I had such a hard time wrapping my head around this fact that I told everyone I know, and they all looked as stupefied as I did. If we can accept that the system was unequal by design, we have a better chance of rooting out and addressing systemic inequities. And that requires work. Occasionally, students tell me that they were taught that change for the better happens because of the passing of time—like we are all riding an escalator to a world that is morally and ethically better than the current one. I think that’s an incredibly disempowering viewpoint—like we should all just wait out oppression. Change requires a lot of work, investigation, activism, testimony, and lots of voices demanding equity and accountability.
Leslie Lindsay: It seems as if storytelling has become a great medium for you to share your experiences with memory and the past, as Jasmine shows with Dr. Lena Edwards, the complex structure of legacy comes into play. Who can be doctors because their mother or father (or both!) were physicians? (In fact, in nursing school, this notion came up, as well). Cassandra, you’re on a quest to understand and ‘know’ the ambiguous loss of the family you never, the ones who were tragically killed. For me, I’m curious about the legacy of mental illness in my family, and establishing and more palatable future. This bears a look at the connectedness we share with our ancestors as a way to move forward in the present. I’m curious to hear more of your thoughts on this.
Cassandra Jackson: Recent controversies over Nikole Hannah-Jones’s “The 1619 Project” might be the best example not just of how we define ourselves through stories, but also of how our narrative choices are weighted with personal and cultural meaning. In that case, the question is where does the story begin, how does that beginning require revisions to the rest of the story, and who are we as a people and a nation when we revise the narrative.
Black storytelling as a tradition has always been about revising dominant narratives and recognizing the magic and power in our ability to remake meaning. When my extended family was together, the conversation always turned to stories about my grandmother who was killed in the wreck. The stories highlighted her bravery and ferocity in defense of her family. Those stories served so many needs. They were a way to acknowledge her absence, but also to make her present for new generations. For the youngest family members, those stories were reminders that we were never really alone. The stories gifted us with a profound sense of belonging to something greater than our individual selves. I want The Wreck to add to that tradition.
Leslie Lindsay: I want to shift a bit to craft. Both The Wreck and Twice as Hard are thoughtfully and thoroughly researched. The Wreck moves seamlessly between Cassandra’s research as an infertility patient and reconstructing the wreck, giving her ancestors a greater sense of existence. Twice as Hard does just for Black women physicians who were often improperly (if at all) documented and recognized. You’ve both written–and recorded–such beautiful and important accounts of these (mostly) erased individuals (one who died in the accident was a man). I’d really love a glimpse into your research…how you compiled this into a cohesive narrative, the joys and challenges.
Cassandra Jackson: I think the hardest part of writing is trying to figure out how to make clear connections between images and ideas that feel connected in your head, but seem disparate to everyone else. For me, the story of past family and the possibility of a future one were always intuitively connected. But there were also so many pieces to each of those stories that it got pretty messy as I wrote. I knew that the book had to move back and forth in time between different strands of my life, but I didn’t stumble on the form that ties the pieces together, until pretty late in the process. As I wrote I needed to trust that I would figure out the form in the process. Honestly, I wasn’t very good at that trust part, but since obsessing over the form didn’t help either, I really had no choice but to keep writing and thinking until I could see a way to let the stories live together as they had in my mind. One day, I started thinking like a reader and I realized that if each chapter wasn’t going to be a traditional chronology, then the chapters needed a thematic anchor that could situate the reader, if not in time, then in a specific set of ideas or experiences. That breakthrough was when The Wreck started to feel like a book.
Leslie Lindsay: I’d like to end on legacy. You both invoke your ancestors as you write–Cassandra in praying and talking to your late family members about hope to continue your lineage, and Jasmine in imagining some of the physicians who came before as her (great-) grandparents. I love that. As a mother, I am curious what parts of your legacy you hope to pass on to your children, real or imagined? And thank you for this enlightening and empowering conversation.
Cassandra Jackson: I am always trying to pass on to my children how miraculous it is that they are here given what their ancestors had to survive to make them possible. But I also find that emphasizing that connectedness to a past of suffering is tricky. On the one hand, I want them to take pride in the remarkable resilience of their ancestors, but I also want them to realize that their ancestors fought for a world that would not require as much resilience from their grandchildren and great-grandchildren.
There’s a dangerously fine line between telling Black kids that they have to be resilient and telling them that they should suffer because their ancestors did. It can completely erase the idea of joy as a valid pursuit for Black people. I want my kids to recognize their freedom to seek joy, pleasure, and rest. When I think of the stories of my grandmother that I heard as a child, so many of them were about her strength, but that strength was always rooted in tenderness toward her children—her desire to protect them from a world that she knew would not love them. I don’t want that wish to get lost. I want my kids to know that they deserve protection and ferocious love.
Jasmine Brown is a medical student at the Perelman School of Medicine at the University of Pennsylvania. She completed an MPhil in the history of science, medicine, and technology at the University of Oxford on a Rhodes Scholarship. As an undergraduate at Washington University in St. Louis, she founded the Minority Association of Rising Scientists and served as its president, working to increase the number of underrepresented minorities in science and medicine.
Cassandra Jackson is a professor of English at the College of New Jersey, where she teaches classes about African American literature and visual culture. She is a co-author of The Toni Morrison Book Club (2020), and has also published two books on race in U.S. literature and art, and she has written about racial oppression in everyday life in HuffPost and The Washington Post. She lives in New Jersey with her husband and two children.