Caring for Patients: African American Women and our Hair

There was a firestorm over remarks made when a young star Zendaya showed up with thick braids on the red carpet.  She was beautiful but a fashion critic made a thoughtless comment about her Locs.   Lupita Nyong’o and Viola Davis wore natural styles and the Selma director Ava DuVarney wore Locs.

Over the years, I made my own transition from the hot-combed hair of my teen years to the permed hair of my 20’s to 30’s to the transition to my natural hair in 1994. The freedom to start thinking about exercise and worry less about my hair allowed me to run and sweat.

Judy4Judy 4P1010252

I have treated my share of what I call “hair catastrophes.” They were due to the common things we black women do to our hair every day.  Burns caused by dropped hot combs and slipped curling irons were serious.  They healed but left scars.  Chemical burns from lye-based and non-lye permanent kits were the most distressing.  The temporary hair loss was heart-breaking for the patient.  Even Oprah Winfrey was a victim.  In the debut of the  first show she is sporting an Afro.  I remember that show. She has talked openly about what happened.

Hair braiding caused hair loss in young girls.  This was caused by pulling the braids too tightly to make a neat row but pulled on the root of the hair so the hairline receded.  This is called Traction  Alopecia. Some women also got severe scalp reaction to the hair used in extension for braids.  It affects the scalp and the face.  I experienced this condition with my braids.  Since that experience, I refuse to add any natural or synthetic hair that isn’t mine to my head.

Hair weaving also has its problems.  If not done correctly, a woman’s own hair can be damaged. Usually corn rowing and adding the hair is the best method.  It has to be cared for by a professional to prevent fungal or bacterial infections of the scalp.

Women also lose hair due to autoimmune diseases.  Patchy hair loss on the scalp or total hair loss from the scalp and body is distressing.  One patient thought she was allergic to her weave but with the help of the dermatologist, we diagnosed Alopecia Universalis.  Alopecia Totalis is hair loss from the scalp alone. This was not the case for her when we noted loss of eyebrows, pubic hair, axillary and hair from the arms and legs.

After menopause, many African-American women develop Alopecia Areata.  This is the same hair loss pattern men develop.  You either wear a wig or just go natural.  The women in my family who have this condition wear wigs.

The debate this week was much-needed.  Everyone weighed in from Solange to Michaela Angela Davis.  The point is that from now on you will see more natural hair because more women of color are breaking barriers and feel free to display non-permed, non-weaved, and non-wigged hair. You will see short afros , natural curls and locs, This is an important change because we are redefining how we talk about beauty especially on the “Red Carpet.” Now, it has to translate into movies and TV. Thanks to Viola Davis in How to Get Away with Murder and  Tracee Ellis Ross in Blackish we are seeing a breakthrough. Lupita Nyong’o in those Lancôme ads is ground-breaking for all women of color all around the world..  As a physician, it is important because of the medical implications.

Caring for Patients: Women and Poverty

I read the latest Shriver Report A Woman’s Nation Pushes Back from the Brink.  The statistics were not surprising to me. We have made great strides in some areas but only for a small percentage of women.  All my life, I have known personally the plight of women in America.  For me, it started at age 5, when my parents were divorced.  My mother was proud, independent and refused child support if it meant having to share custody with my father.  Women had few rights at that time. From that moment in 1962 she was a single mother with three girls and no outside income.  I was the oldest. So she went to work. We were fortunate to have the support of her family.  We first lived with my grandparents and later moved to our own home in the “Projects” or subsidized housing.  In between, we  shared a house with my uncle.  He worked nights and my mother worked days. My mother worked two jobs at times and so we never qualified for  free rent, food stamps or medical care.  It was not easy for her to accept any handouts.  She once tried to stand in line for free Christmas gifts  on her only day off.  She was successful but would never waste another Thursday that way again   At times she was frustrated  over the need to have her brothers co-sign for any loans she made because she had the better credit and always paid her bills on time.

She is from a long line of strong women in her family that started with my great-great-grandmother. They have shaped the person and physician I would later become.  They are a loving and caring group of women. They have cared for all of us in one way or the other and been paid care-givers at times.  I know they all worked for less money than they deserved. I too have had to face pay inequity.

We did not get health insurance until my mother could pay for it. So we received care from the Community Health Center and the Dental Clinic at the University of Alabama in Birmingham. I did not know how far below the poverty level we were until I applied for financial aid to attend college in 1974 and later medical school in 1978.  My mother made sure we had the best of what we needed and much of what we wanted. However, she taught patience and gratitude. These lessons would later serve me well.  As we look at the plight of women, divorce is one that causes significant loss of income for women and children. If fathers are not supportive, there is no support for college. I did qualify for federal loans and repaid them once I started earning an income.

Judy_grad5       Judy_grad_Res

High School Graduation                            Graduation from Residency

When I started my practice in 1990, a large percentage of my patients were women who worked every day but made too much to get Medicaid and food stamps and, whose employers did not provide health coverage.  If they worked and had health insurance, they were providing coverage for the entire family because their spouses worked for employers who did not provide health insurance.  Like my mother, many of them were divorced. Their children received needed vaccines under the Vaccine for Children Program (VFC) and they could qualify for the Breast and Cervical Cancer Early Detection Program (free pap smears and mammograms).  However, sick care was an out-of-pocket expense.  Their children could get sick care from the Health Department Clinic.  The Affordable Care Act will change this for women and children.  However, the real solution as pointed out in the report is to raise the minimum wage and to have equality in pay for women.  Another key point in the Shriver Report is that to improve the plight of women will make significant gains for men and children. Women are the primary wage earners in a large number of families where there are children.

One of my favorite quotes from Dr. Martin Luther King:

“The curse of poverty has no justification in our age. It is socially as cruel and blind as the practice of cannibalism at the dawn of civilization… The time has come for us to civilize ourselves by the total, direct and immediate abolition of poverty”.

I am a physician and it is  difficult for me not to support the ACA.  As a child of a single mother who overcame all the odds and made it possible for me to go to college and medical school, I have to support measures to raise the minimum wage and ensure equity in wages.

As we celebrate the Dr. King Holiday tomorrow, let’s recommit to serve others .

Happy New Year


I am going to make Gumbo New Year’s Eve. Instead of a Lenox Crystal Ball, in New Orleans they drop the Gumbo Pot.  The first time I made it was while we were living on the Eastern Shore.  I had what I thought was a great recipe in a cookbook titled “One of a Kind: Recipes from the Junior League of Mobile.”  It was a wedding gift.  I was making the Gumbo for our Mardi Gras Party at a colleague’s house. A group of us decided to bring Mardi Gras to us. Being the only true southerner, I volunteered to make the Gumbo.

I took my cookbook to my husband’s aunt, Tommie.  She was a New Orleans native and true Cajun ( her father was from Paris and her mother, African-American). She was known for her Gumbo recipe which she guarded like a state secret.  She took the book and crossed out (with great emotion) some of listed the ingredients and added no new ones.  I did not know that really good gumbo is simple.  She did not use crab meat, chicken or the gumbo file. It’s just good Andouille sausage and lots of shrimp.  The secret is the roux and the cooking time.  The best okra is frozen and do not cook it long.  Add the shrimp and do not over cook.  It only takes a few minutes if the gumbo is hot.

We always purchased  the shrimp in Baltimore at Lexington Market for years.  That meant, we always had an ice chest in the trunk and we have transported shrimp as far as Chattanooga, Tennessee.  I always tried to get the sausage there too.  One year, we almost did not find the sausage.   Well the Gumbo was the hit of that party and many more.  Over the years I have made it so many times and it never fails to impress. I have had to toss out a couple of bad batches of roux.

What is unfortunate is that our beloved aunt has Alzheimer’s.  I always made sure we talked for hours when we visited her in Baltimore. So I know a great deal of family secrets.  She lived two row houses down from my mother-in law.  The two of them were more like sisters than sisters-in-law. My mother-in-law passed first.  Tommie was heart-broken. We cleared the  house together. When she started showing signs of memory loss and became more difficult to manage: Roy and I would visit, take her to lunch at her favorite place, the “Cheese Cake Factory, and then to church.  We also would take her to the mall and to visit friends and relatives.  Roy had a calming effect on her.  He would drive and talk to her.  She had taken care of him when his mother was working. He always made her laugh.

I made the Gumbo a few years before we lost Tommie’s husband. It was the year Christmas Eve was on a Friday. When I told them I was making it, they all reminisced about Tommie’s Gumbo and told such sweet stories. Well, when I told them I was using her recipe they were in disbelief. They asked how I had been so lucky and I told them. That was a special pot of Gumbo and I was so proud to make it. It was downed with love. We had leftovers for Christmas dinner. They all said it was indeed her recipe. It was also the year after we lost our great hostess, Sylvia. She was the wife of Tommie’s son Jack. Jack is like my husband’s baby brother. Sylvia was the one who put together all the holiday dinners. So that pot of Gumbo was in honor of two great ladies.

I can’t help but speak of Tommie in the past tense.  That is what Alzheimer’s does.  It robs you of the person and leaves just the body. The woman I knew is not here but I did take her to lunch right before she had a turn for the worse. We had a great time..  We may have even gone to church.

New Year’s is a time of reflection. I always talk to friends and family.  I call my mother at midnight in Birmingham which is 1 am EST.  I will make collard greens and black-eyed peas and maybe even cornbread and remember my grandmother and other friends and relatives no longer here.  My New Year’s commitment is to catchup with old friends and colleagues.

Happy New Year!

Caring for the Ladies

I have had the privilege to be the doctor for a magnificent collection of women of all races, age-groups, socio-economic status and professions.  Seeing the trailer for “Lee Daniel’s The Butler” triggered thoughts of some of these women. I think it was the character of the wife, Gloria, played by Oprah Winfrey.   So, I wanted to start with the elderly African-American females who paraded in and out of my office like characters from a fading Jonathan Green painting.  Each still elegant though they were well into their 80’s, 90’s and even over 100.  They came in dressed in hats, gloves, stockings and carrying old purses as if they were off to church.  A close look at these garments would show the fraying material or stains that come with age.  The fading of the once brilliant colors of these garments did not diminish their elegance.


These matriarchs were respected in the community as dedicated church members, retired teachers and sorority members (including my own).  Some had just worked in restaurants as cooks or been housewives. They were often widows or unmarried.  The widows had lost their husbands before I took over their care.  They were living proof of the shorter lifespan of the African-American male. They all had been my colleagues’ patients but they gravitated to me.

When I told them I had graduated from Meharry Medical College, they beamed with pride.  They too were graduates of Historically Black Colleges and Universities or had sent their children off to attend one of them.  Many were known as Teacher’s Colleges when they were attending them.  We shared stories because I had grown up in Birmingham and they had lived through the racial tension in their tiny community.  Most of them had children who had gone off to college and successful careers in cities from the West Coast to the East Coast and everywhere in between. When I had a problem or if they were concerned, I spoke with doctors, lawyers, college professors, business leaders and teachers.  Each one concerned about a parent, grandparent or an aunt.  Each frustrated at the refusal to leave the community and move closer to them.  When one of these ladies had an illness, they packed up and flew in to be by their side.  The reality was that they had a circle of friends and a social network; they were not willing to leave.

Each came to the office with a brown bag filled with bottles of pills from the medicine cabinet.  That was my request.  I reviewed them and they were shocked when I tossed out outdated bottles and made a new list.  I think they thought I was being wasteful when I tossed out pills but it was the safer option.  I had a group of three retired teachers who always came together.  The older one of the three was the driver.  One of the ladies experienced several episodes of blood in her urine. I had to do a vaginal examination first not easily accomplished but was necessary.  We thankfully diagnosed a benign tumor on her kidney.  She sailed through the entire ordeal. The other two cared for her and made sure she made every appointment. They were amazing.

One lovely woman came in for an examination.  I found a small mass in her breast.  It was a localized tumor.  She had no problems during surgery and recovery.  The surgeon was amazed because she had no medical problems. She too had a strong network of friends and family.  The nurses and all the staff in the hospital knew her and made sure she did well.

They were all addressed as “Miss.”  It was just what was done. Being from the south it was easy for me to continue this gesture of respect. Miss B was known for her biscuits.  She got up every morning and made the biscuits for a local restaurant.  I admit I had succumbed to the sausage biscuit sandwich which featured her biscuit.  It was a heavenly treat.  She unfortunately had a stroke and could not work.  It left her fortunately with a minor deficit.  The owner decided to keep her own just to supervise the new biscuit maker. Thankfully, she had the opportunity to pass on that skill. She was proud of her skills and proud to share.

One of my favorites was a retired nurse.  I removed several moles from her chest.  She formed a small keloid but some quick thinking by us both prevented it from being a problem. She had worked in the local hospital but before had been in a larger city.  She worked with residents and as she stated made them into good doctors.  I always knew even then that good nurses made good doctors.

Miss C had two daughters who always took her to specialist because she always complained of being sick.  They failed to see it was her way of getting them to come home to visit.  I had to intervene after several hospitalizations for medication side effects.  I called them and explained that she was just trying to get their attention.  I spoke with the Cardiologist and the Gastroenterologist.  I also required all medications to be approved by me before being taken.  I did such a good job that she begged my staff to get her brother in.  I was not taking new patients.  One of them came to me with a smile and said I had to take him.  When I asked “Why?” the answer left me nearly speechless.  I quote” All he has to do is touch the hem of her garment and I know he will be healed.  That woman was sent here by God to care for us.” A little embarrassed I said “Then I have to see him.”  They all laughed and so did I.  Unfortunately, I did not heal him but he did have good care.

Miss LR was over 100.  She always came in smiling and dressed for church.  She did make it past 102.  She developed an anemia after all those years that required blood transfusions but they caused Congestive Heart Failure.  The Hematologist just smiled and said he thought her bone marrow just “pooped out.”  A medical term for; “I do not know why but we better not try too hard to find out or we could really kill her.”  She eventually had to go to the local nursing home but she was cared for with love.  Everyone who worked there knew her and care for her with respect.  She was showered with hugs every day.  I think she made it to 103. It was a great day when her funeral was held.

Miss M  was another dear patient.  She was blind from glaucoma.  She lost her beloved husband and never recovered.  They were a cute little couple. She would call the answering service saying she woke up and couldn’t see.  These were panic attacks. I would take her calls and calm her down. One hot summer, we gave her an air conditioner.  We made her use it and had her utility bills taken care of.  There were funds for that back then.  She would die in the hospital.  She just stopped eating.  I even had a feeding tube placed and that was a decision I later regretted.

The church and community played an important role in their lives and their longevity. However, for each there was one illness that would lead to decline despite flu shots, pneumonia shots and careful monitoring of blood work and medications.  They each touched my life and shaped my medical career.  I was honored that they allowed me to be their doctor.