Episode 6: Moments to Movements

UNHEALED: A Story of Race, Memory, and a Teaching Hospital
Episode 6: Moments to Movements
Transcript

          Opening: Archival music audio

          Sam Cooke, “A Change is Gonna Come,” 1964: It's been a long, a long time coming, but a change is gonna come. Oh yes it will.

Dr. Damon Tweedy: So that's R&B legend Sam Cook in 1964 singing the classic tune many regard as the anthem of the Civil Rights movement. But that song's resonance has lived on far beyond that era. In 2008, president-elect Barack Obama gave a nod to the song when he told his supporters in Chicago:

          President Barack Obama, November 4, 2008: It's been a long time coming, but tonight, because of what we did on this day in this election at this defining moment, change has come to America.

Dr. Damon Tweedy: That feels like a long time ago.

Dr. Jeff Baker: Yeah, long ago in a galaxy far, far away.

Dr. Damon Tweedy: Oh, here we go. George Lucas, Star Wars here. But in all seriousness, you know, that song really has had a long shelf life and it had a resurgence during the summer of 2020 in the days after George Floyd's murder when there were protests nationwide. Singer and actress Jennifer Hudson actually performed it at the Democratic National Convention that year.

          Archival audio, Jennifer Hudson, August 20, 2020: I was born by the river in a little tent, oh, and just like the river, I’ve been running ever since...

Dr. Jeff Baker: Yeah, that song really has gotten a lot of traction over the years.

Dr. Damon Tweedy: You know it has. We're talking about a 60, 70 year time span in history. So I think for me, that just makes me want to compare then to now. What's changed during that time? What hasn’t? What happened in between and what lessons can we learn as we look to the future? All those things are kind of circling in my mind as I think about that song.

          Music, Jennifer Hudson: A change, a change, gonna com….

Damon Tweedy: So I'm Damon Tweedy, psychiatry professor and author of the book, Black Man in a White Coat.

Dr. Jeff Baker: And I’m Jeff Baker, a pediatrician, historian, and director of the Ethics Center in  the School of Medicine at Duke. And this is episode six of UNHEALED, a podcast by, for, and about Duke Medicine where we look at the past, especially our very local past, to figure out how we got to where we are today and how we can be better tomorrow. Over the last few episodes we've introduced you to a little-known but deeply important story, the story of a young Black man injured in a car accident in 1950 and turned away from Duke Hospital because he was Black. His name was Maltheus Avery. And if you've been listening, you know that he was taken to Lincoln Hospital, the hospital for Black people in Durham, and he died there alone in the emergency room.

Dr. Damon Tweedy: Yeah, and that tragedy turned his family's world upside down.

Dr. Jeff Baker: And his death provoked outrage across the country. But of course, it didn't lead to the end of segregated hospital wards. It was just one of many moments in what we remember as the long freedom struggle.

Dr. Damon Tweedy: So I think it's important for us to remember that a lot happened in the Civil Rights Movement in the 1950s. Some of those names are well known, they're kind of etched in our public consciousness, those names and events like Brown v. Board of Education, Emmett Till, Rosa Parks, and the Montgomery Bus Boycott. But there are others, many others actually, like Maltheus Avery, that have mostly been forgotten.

Dr. Jeff Baker: And most people I know around here have forgotten that the first sit-ins in North Carolina took place right here in Durham. In 1957, seven African-Americans sat down in the whites-only section of Durham's Royal Ice Cream Parlor.

Dr. Damon Tweedy: Yeah, you know, I was here for many years before I actually heard that story. And you're right, it didn't set off any kind of national movement, but it really did help set the stage. Because three years later in 1960, Black students in Greensboro began their own lunch-counter sit-in, and that's the one that everyone does know about.

Dr. Jeff Baker: That's right. Students in Durham and Charlotte quickly followed. And at that instant, the sit-ins changed from a moment to a movement, a movement that swept across the south and in which over 70,000 people eventually participated. Martin Luther King, Jr. came to Durham's White Rock Baptist Church and spoke to an overflow crowd of 1,200. It marked one of the most important turning points in his own life, where for the first time he sided with the younger student activists in the movement as opposed to the more cautious older guard of the civil rights movement.

Dr. Damon Tweedy: And so the floodgates really opened after that and civil rights protests spread all across the south, as did the violent backlash that came along with it. And they both came to an apex in 1963. I think most of us have seen and heard some of the sort of indelible moments that took place that year.

          Archival audio, Reporter in Birmingham Alabama, April 1963: The marchers were blasted with fire hoses, beaten with clubs, attacked by police dogs, and gassed.

Dr. Damon Tweedy: Birmingham's police force assaulting black children with fire hoses...

          Music, Sam Cooke: A change is gonna come…

Dr. Damon Tweedy: Alabama Governor George Wallace blocking a Black student's entrance into the University of Alabama.

          Governor George Wallace, June 11, 1963: As governor and chief magistrate of the state of Alabama, I deem it to be my solemn obligation and duty to stand before you.

Music

Dr. Damon Tweedy: The assassination of Medgar Evers.

          Archival audio, Reporter, June 1963: Medgar Evers’ funeral was held on Saturday, June 15th in Jackson.

          Music

Dr. Damon Tweedy: The March on Washington and Dr. King's "I Have a Dream" speech.

          Martin Luther King, August 28, 1963: I have a dream: free at last, free at last, thank God Almighty we are free at last.

          Music

          Walter Cronkite, TV broadcast, November 22, 1963: From Dallas, Texas, the flash, apparently official, President Kennedy died at 1:00 PM Central Standard Time.

          Music

Dr. Damon Tweedy: It was against this backdrop that Sam Cooke wrote his classic tune after he'd been turned away from a hotel because he and his entourage were all Black.

Dr. Jeff Baker: So you know, we historians don't like to overuse the word turning point, but I think you could argue that 1963 really was a turning point in American history. And that was true in healthcare as well. In November of that same year, the long campaign to end segregated hospitals finally led to a momentous victory in the Simkins versus Cone ruling.

Dr. Damon Tweedy: For those of you who aren't familiar with that name, George Simkins was a Black dentist in Greensboro and he wanted to admit a Black patient with an infected jaw to Moses Cone Hospital, but they refused.

Dr. Jeff Baker: It's not all that different than what happened to Maltheus Avery, though Moses Cone Hospital didn't accept Black patients at all.

Dr. Damon Tweedy: But this time the courts ruled that “separate but equal” healthcare was illegal. Suddenly Jim Crow in healthcare was under fire.

Dr. Jeff Baker: And just a year later, in 1964, Congress passed the Civil Rights Act outlawing discrimination in public places, education and employment.

          President Lyndon Johnson, signing Civil Rights Act, July 2, 1964: Let us hasten that day when our unmeasured strength and our unbounded spirit will be free to do the great works ordained for this nation by the just and wise God.

Dr. Damon Tweedy: And just a year after that, in 1965, the Medicare Act prohibited federal money from being given to any hospital that remained segregated.

Dr. Jeff Baker: And that did the trick. Hospitals weren't going to turn down Medicare dollars.

Dr. Damon Tweedy: Money, money, money…

Dr. Jeff Baker: Okay. Virtually overnight segregated hospital wards vanished around the country, including here at Duke. Here's a white doctor who remembered that moment very clearly.

          Voice-over, Dr. Allen Anderson (Oral history, DUMC Archives): We were all called in and were told we were integrating the next week. And the words were, if any of you can't live with it, you can resign. And believe it or not, a couple residents did leave and go elsewhere and others considered resigning. And Duke was then integrated and it went fairly smoothly.

Dr. Damon Tweedy: Smoothly? I wonder about that.

Dr. Jeff Baker: So that comes from a doctor who'd actually been here as a resident in the 1960s. And I just want to say two things here. First, it's true that those separate Black and white wards vanished almost overnight with little fanfare. And contrary to what so many hospital administrators had feared back in the fifties, the world didn't come to an end. But second, segregation didn't truly come to an end. It survived in a new form. That older system of Black and white wards gave way to a new system of public and private clinics. Listen to this comment by an African-American doctor at Duke who recalled what happened during the 20 years after desegregation.

          Dr. Charles Harris (2018 Interview): Even though Duke integrated, I would say they were all still segregated, but they were segregated based on economics. And if you segregate based on economics, you still get Black and white.

Dr. Jeff Baker: I've heard comments like that about private and public patients in lots of interviews. Long after the 1960s, Duke continued to see patients with private health insurance in one clinic and those getting public assistance in a different clinic. And when I think back to the 1980s when I first got here as a medical student, some of those public clinics looked, well, pretty much the way I imagine a clinic for Black patients back in the 1940s. Without getting too much into the weeds, I think it's fair to say that sometimes the words private and public patient can be a code language for race.

Dr. Damon Tweedy: That was still the case when I was a medical student in the 1990s and a young doctor in the 2000s. And I think it's just an example of the battle that we're still fighting. We have different terms that we use now, say implicit bias, health disparities, patient mistrust. But I feel like as we get beneath the layer of all that, we're really talking about a lot of the same problems that we had back in the old days.

Dr. Jeff Baker: So with the start of this podcast, we promised you that we turn the lens on ourselves and we're going to do that. Let's first acknowledge that this is a lot bigger than just talking about doctors. In fact, the heart of Duke Hospital is about nurses, lab workers, housekeepers, food workers, many, many others. This is an incredibly important point. There are just so many stories that need to be told that we just don't have time to tell here. But since doctors have played a rather outsized role in the history of medical racism, we need to know something about how this played out among Duke doctors. So let's talk now about how Duke School of Medicine has changed. In 1960, the medical staff was entirely white, so were all the students.

Dr. Damon Tweedy: That's true. And there's that long wall of photos in the medical student building. It goes back to the 1930s to the very beginning, and it certainly tells that story that Duke was all white for a long time. And there are also those displays, the former deans and the department chairs.

Dr. Jeff Baker: Heritage Hall.

Dr. Damon Tweedy: Exactly. And I got to be honest with you, it might seem kind of overly dramatic, but I've walked through those halls before seeing those photos and sometimes felt like, man, I don't belong here. What am I doing here? And sometimes it feels like at the very least, those photos are kind of saying back to me, or the people in those photos are saying back to me, that maybe we wouldn't have wanted you here.

Dr. Jeff Baker: So imagine how you would've felt if you were here in 1960. So that was the reality. Interesting story: in 1963, Dr. Eugene Stead, the chief of medicine, did try to change things by inviting Dr. Lewis Sullivan down to Duke from Boston University.

Dr. Damon Tweedy: Yeah, that's right. But the deal fell through on the university side because having Dr. Sullivan here would've meant he would have had to get housing in the all-white faculty area.

Dr. Jeff Baker: This was a huge missed opportunity for Duke.

Dr. Damon Tweedy: That's for sure. So Dr. Sullivan, a little bit about him. So he'd gone to Morehouse College, which is a preeminent historically black college in Atlanta. It's the same place where Dr. King went and Dr. Sullivan was there a few years later. And so Dr. Sullivan returned to Morehouse in the 1970s to establish the Morehouse School of Medicine. So how many doctors can say that they've actually founded a medical school? I mean, all I can think about as I'm thinking about that story and about his journey is that Duke definitely missed out.

Dr. Jeff Baker: Yeah, that's for sure. So with no Black faculty, it was left to medical students to break the color barrier at Duke School of Medicine.

Dr. Damon Tweedy: And the first was Delano Meriwether. So he came in 1963, that pivotal year we talked about earlier. And Dr. Meriwether, he grew up in the south and he'd gone to college at Michigan State. But his father was a public school teacher and he persuaded him that he had a duty to come back and transform education in the south and break barriers and get rid of the old Jim Crow guard.

Dr. Jeff Baker: That was no small thing to ask, as Meriwether later told an interviewer.

          Archival Audio, Dr. Delano Meriwether (Oral History, DUMC Archives): The sixties and seventies were serious times, certainly a matter of suffering. And in the days of the sixties, the south was not the place to necessarily choose to spend your college years.

Dr. Damon Tweedy: And here's Duke's first black female medical student, Jean Spalding, who arrived at Duke in 1968, along with her husband.

          Archival Audio, Dr. Jean Spaulding (Oral History, DUMC Archives): We were warned not to move into Colonial Apartments cause we weren't welcome there. And so there was a cross burned down the yard, front yard. Racism was alive and well in Durham, North Carolina in the medical school in the sixties. There were confederate flags on the, some of the professors' cars, which demonstrated their sentiment.

Dr. Jeff Baker: Oh, that story, that just sounds completely brutal.

Dr. Damon Tweedy: So Duke Medical School finally got its first Black faculty member in 1970, Dr. Charles Johnson. Dr. Johnson, he'd gone to Howard for medical school and he was also an Air Force pilot where he did a four year tour as an Air Force pilot before he arrived here at Duke. So it was that toughness, I think, that really attracted Dr. Eugene Stead to take him on because he felt like this is someone who can handle that. And even as I'm sort of telling that story, it makes me think about the certainly more famous baseball story where Jackie Robinson in 1947 broke the color line in American sports and how he was sort of hand-selected as someone who could handle all the indignities that came with that, right, because there had been movies and stories written about it. And in some ways I think Charles Johnson was kind of our own version of that here at Duke.

Dr. Jeff Baker: I was about to use the phrase “the right stuff.” There are these stories of ward clerks dropping charts right in front of him and white specialists who refused to see his patients.

Dr. Damon Tweedy: Yeah, I know. I mean, you could imagine some folks just definitely would've just packed up and said, I don't need this stuff, man. Go somewhere else. Think about it. Dr. Charles Johnson, he had a private practice. He could have just worked in the Black community and had a very successful career. I wouldn't have blamed him for it.

Dr. Jeff Baker: Yeah, and yet he hung in there and he actually developed one of the most successful practices at Duke. He stayed here as a full-time faculty until 1996. In fact, I think that overlaps with you. Haven't you met him?

Dr. Damon Tweedy: For sure. Just looking back, he was really tall. He had this sort of super upright posture and he was kind of intimidating, to be honest with you. It's probably that whole kind of military thing, right. I was actually at least a few inches taller than him, maybe more, but I always felt short when I was around him. So go figure. Well, once you got to know him and talked to him a little bit, I really saw that he had this kind of fun side to him and I just felt like he was in my corner if I stumbled or something like that. I think a lot of the other Black medical students and young doctors felt the same.

Dr. Jeff Baker: Well, there are just so many stories and there's others. There's Dr. Onye Akwari, Dr. Don Moore.

Dr. Damon Tweedy: Yeah, there's Dr. Joanne Wilson. There's Dr. James Carter.

Dr. Jeff Baker: Yeah, if we just say names you need to picture each of these has their own amazing stories. I wish we could tell them all. But I think there's one that really bridges the gap between the 1960s and 2020. That's Dr. Brenda Armstrong because she got here at Duke in the sixties and three decades later she was the dean of admissions at the medical school. She's really got an interesting story. She grew up east of here in Rocky Mountain, North Carolina. Her father, Dr. Wiley Armstrong, was a very prominent Black physician, and he would take her on rounds and weekends where he would instill in her the sense that she had a duty to help her community, to give back to it.

Dr. Damon Tweedy: So Brenda Armstrong came to Duke as an undergraduate in 1966, and many people nowadays think of the sixties as the very turbulent period. And so certainly Brenda was here during perhaps one of the most tumultuous times. Think about 1968, when Dr. Martin Luther King Jr. was assassinated. In the aftermath of his death, there was urban confrontations and violence nationwide, and some of that unrest got to the campus world as well. And certainly Brenda was here for that at Duke.

Dr. Jeff Baker: Yeah. So I met her when I was a medical student and she had just been appointed to the faculty in pediatrics as a cardiologist. She was not a tall person. I remember her, she was just a little over five feet tall, but she had so much energy. I remember her giving talks on the heart where she would just take a marker and wield it like a wizard, drawing a diagram of the heart in 10 seconds. It was just an amazing performance. That's kind of how I knew her. But I remember hearing people afterwards whisper about another side to her, that how as an undergraduate at Duke, she had played a really big part in the Allen building takeover of 1969 when about 60 African-American students took over Duke's administrative building to make demands for Black students and workers. So that occupation ended in a clash between protestors and the police with tear gas being fired and really a violent confrontation taking place on Duke's manicured lawns. The struggle for equality had really come to Duke, and Dr. Armstrong as a student was right there in the thick of it all.

Dr. Damon Tweedy: But I think if we really want to understand Dr. Armstrong's activism during that time as an undergraduate, we have to really know the story about what happened to her much earlier in her life.

          Dr. Brenda Armstrong (Interview, Duke Archives): Well, there was an incident even before my residency that is important for you to know about why I feel the way that I feel about equity for everybody. In our town, we could not use the hospital. It's called Parkview Hospital. Even though my father was a physician, my uncle was a physician, we couldn't use the hospital. My mom, for her final pregnancy was a big pregnancy, and my dad went to the hospital to say that my mom was going to need a C-section and could she please be delivered there? And they
refused. She went into labor and they couldn't get her to Duke, to the Duke had, what was called colored rewards. And they were afraid that she and or the baby might be in jeopardy. So they delivered her at home. And my brother, I'm going to have a hard time with this, my brother sustained a stroke because of it. And I was young enough to know that something was going on that I couldn't figure out why everybody was so worried and why my mom was crying. He survived. He was probably going to be the most brilliant of the three of us. That moment is why I am a physician. It also was the defining moment for me about what disparities really were.

Dr. Jeff Baker: Wow. That's a powerful story. And I hear echoes again of the Matheus Avery story.

Dr. Damon Tweedy: And Dr. Armstrong reacted to this in a similar way that Matheus Avery's younger brothers did as well. They all devoted their lives to healthcare and to addressing the social justice inequities that existed within it.

Dr. Jeff Baker: Yeah, there's a pretty striking parallel here. And when Dr. Armstrong later asked why she had come back to Duke, she said that she had unfinished business. And what that unfinished business was, was to see Duke Medical School become a place where students of all races and backgrounds were welcomed as valued members of the community.

Dr. Damon Tweedy: So Dr. Armstrong was an example of the extraordinary people, I mean truly amazing people, who came to Duke in the 1960s and seventies to challenge the status quo and to break those barriers. And even though their numbers were really small, they banded together and they really worked to try and change this place. And they did this even as things around them were changing. So the country was changing, and Duke itself, they were all kind of becoming more conservative during that time. But they persisted.

Dr. Jeff Baker: Yeah, the pendulum was swinging around the country. So maybe this is a good time to hit the fast forward button and get to our own time.

Dr. Damon Tweedy: Wow, that's a lot of time to skip over, man.

Dr. Jeff Baker: It is a lot. And it just hurts my historian's heart. I'll work it out. But to be honest, there's not as much to talk about in terms of activism.

Dr. Damon Tweedy: Okay. So Jeff, you came here as a medical student in 1980, so that's during the beginning of the Reagan- Bush era. I mean, to be honest, I was just in kindergarten then, but it sounds like you were a little bit older. So what was it like in those days?

Dr. Jeff Baker: Just for the record, it was 1980, not 1880. Okay. So look, there were a few pockets where there were still some of the sixties living on, I think at that time. So at the end of my first year of medical school, I spent the whole summer in Eastern North Carolina doing health fairs. Looking back, it was a real immersion experience in southern rural poverty. We actually stayed with families. We shared their food, I should say they shared their food with us, and we had to ride a ferry across the river each morning to pick up vaccines. It was like going back in time. It was a powerful experience, but there are only like a dozen students from both Duke and UNC doing this. So really if I stand back, I'd have to say that overall this was not the norm for medical school at this time. We were going into a quieter period. I don't remember any mass demonstrations. I definitely don't remember anybody talking about taking over the Allen building. We were there to study medicine. I don't even remember any lectures about racism or disparities or anything like that.

Dr. Damon Tweedy: I can imagine professors thinking that none of that had anything to do with real medicine. That's what you guys are there for, right? You guys are going to be real doctors.

Dr. Jeff Baker: Well, that was 1980 though. What about your class you got here in 1996?

Dr. Damon Tweedy: That was the Clinton era, and my peers were focused on prosperity. I was too. I can be honest with myself. That summer health fair thing, as you were describing, by the time I came around, it had gotten diluted to a few Saturday mornings spread out throughout the whole year. So it had really been diluted and there definitely wasn't any talk about social justice and racism. And this was definitely not the sixties--how about we say that.

Dr. Jeff Baker: Okay. I think our listeners have a sense of that 30-year period that we're kind of glossing over, and I think we are ready to take the finger off of the fast forward button. Let's talk about the last 10 years.

Dr. Damon Tweedy: Yeah. We all know the last decade plus has been different, and we've all seen those racial justice protests in the news and spread all over the country. And it actually made its way into the medical schools this time around. And let's just remember, this did not start with George Floyd in 2020. Let's go back to 2012. There was Trayvon Martin. He was a black teenager in Florida who was shot and killed by this so-called neighborhood watch person while he was walking home from the store. And his death was a shock to the nation, and the acquittal was even more shocking for many of us. And the protests around that really set off this movement called the Black Lives Matter Movement, it all kind of got started there.

The following year, there were some police killings that really got national attention. Michael Brown. Then there was Eric Garner. So both of those men, they were unarmed and killed by police in these sort of unclear circumstances. And it was really that last one, particularly Eric Garner, that really kind of galvanized a lot of the medical students nationwide, including here at Duke. And so it was in December, 2014 that more than 70 of those students joined with thousands of students across the country, places like Harvard, UCSF, you name all the sort of usual suspects. And they did this demonstration at noon and they called it a “White Coat Die In.” It really was designed to draw attention to all this sort of racial bias and social injustice that was happening all over America.

          Dr. Michael Ongele: We all need to come to a Fannie Lou Hamer moment where we all get sick and tired of being sick and tired. See, some of us here today may have not experienced racial profiling personally or even been a victim of police harassment or even felt the effects of racial disparities in healthcare. But this problem, it is our problem, those issues that affect our future patients and their communities, and their families, is our problem just as much as it is theirs.

Dr. Damon Tweedy: That's Dr. Michael Ongele, then a first-year medical student at Duke.

Dr. Jeff Baker: This was a pretty different student body, Damon, than my class in 1980.

Dr. Damon Tweedy: Or certainly mine from 1996.

Dr. Jeff Baker: How do we explain the difference? Do you think young people were just becoming more socially conscious?

Dr. Damon Tweedy: You know, I think they were. Obviously social media, which wasn't around in our days, it was clearly a factor that helped kind of connect like-minded people locally, but also nationwide. But I think there's also really a different type of student that was coming here from our days. And Brenda Armstrong I think was a big factor in that change.

Dr. Jeff Baker: Yeah, I agree. And I was on her admissions committee, and I remember how, when she would give talks at the start of each year, her talks were kind of like a sermon. And what she would do was she would push us to admit students based on what she called distance traveled. She said, don't just look at their CV, what they've done, look at what they were given and look how far they went with what they were given. Don't get me wrong--they still had to qualify academically--but we didn't penalize students whose financial circumstances required them to work part time rather than add on more extracurricular activities. So, she expanded the kind of students that Duke was seeking, not just future researchers and specialists, but students who wanted to change the system, a more diverse and socially-conscious group of students.

Dr. Damon Tweedy: You're right, Jeff. Even before she became head of admissions, Dr. Armstrong was really active in recruiting Black students to Duke. So when I interviewed a couple years before she took over, she was with me and I was with another Black applicant, and she sat us down and she told us how far Duke had come. But she talked about how much further we still needed to go and how it was her mission to bring people like myself and my friend with me to come to Duke to really be part of that change. And I think a great example is Dr. Michael Ongele, that's that medical student we had just heard from talking at that Duke die in demonstration in 2014.

          Dr. Michael Ongele: I think Dr. Armstrong was arguably one of the best gifts to medical education. And I think that the work that she did at Duke is something that'll be felt for generations to come. She kind of led with this spirit of truth. She was never afraid to speak truth to power.