Courtesy of Jasmine Brown.
This week marks the authorial debut of Jasmine Brown, whose new book, Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century (out January 24 from Penguin Random House) traces the historic accomplishments of nine Black women doctors in the United States.
Brown studied biology and neuroscience at Washington University in St. Louis, and in 2018 was named a recipient of the Rhodes Scholarship. Two years later, she graduated with Merit from the University of Oxford, where she completed most of the research for Twice as Hard. Now a medical student at Perelman School of Medicine at the University of Pennsylvania, Brown has continued her advocacy, working to increase the number of underrepresented minorities in science and medicine. Ahead of the publication of Twice as Hard, we spoke to Brown about her time in St. Louis and her buzzed-about new book.
I’m curious about the formative parts of your experience here in St. Louis. I realize that it would have been your first year of college when Michael Brown was killed. How do you reflect back on that time now?
I had a personal connection to St. Louis before coming to WashU. I lived in Indiana for a good bit of my childhood, and I have a lot of family in St. Louis. We would go to St. Louis every Thanksgiving and have this big celebration, a family reunion. I was very familiar with the city from that perspective.
But then Michael Brown was killed a month before I started school. And I remember people having discussions on the Facebook groups that they had for admitted students, where students were asking “Is St. Louis safe?” from a perspective of a non-Black person like, “It’s dangerous there,” in response to Michael Brown being killed. These things became much more present in the public mind after that. There were more discussions about police brutality and the blossoming of the Black Lives Matter movement. It made me think about my family a lot. It made me afraid for my brothers. I don’t think Michael Brown looks much different from someone related to me. My grandmother actually lived in Ferguson for some time while I was at WashU. So I have a connection to that space.
In my first semester of undergrad, I think there was one other Black student in my dorm. No one else on my floor was Black. I remember the night of the non-indictment wanting to go out to protest, but no one else on my floor was interested in doing that, so I didn’t do it. I remember hearing from other friends who had gone—who were 18 and 19—and they had been pepper sprayed and tear gassed.
I know people who got arrested, and I felt fearful that I couldn’t go protest because I was afraid my future could be destroyed by getting a police record for standing up for something that I cared about. I tried to think about ways I could stand up to injustice while still feeling safe. And then I had this realization that I had basically silenced myself. I had been afraid of being labeled the “angry Black woman” by speaking out on things that I felt were wrong. And so by having this constant discussion on campus and seeing how different people navigated their lives being advocates against injustice, I slowly started to speak up more in my own way.
You open the book with a story involving a faculty member on the Washington University medical campus, where you had worked in a neuroimmunology lab your junior year of college. You write: “Following the encounter with that man, I no longer felt excited to go to the lab each day. I felt anxious. […] 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.”
My experience on the medical campus showed me the side of St. Louis that a lot of Black people in St. Louis experience—of stereotyping, of the assumption of socioeconomic status, of being labeled as dangerous. That, compared to the undergraduate campus where I felt like I was in the “WashU bubble,” where as long as I was there, it was assumed that I was a student, that I was supposed to be there. It was pretty drastic, seeing that experience on the medical campus, where multiple Black students were targeted in that way: as they’re doing research, coming in at different hours of the day and night, they’re being viewed as a threat in that space.
So the moment that I speak about in the prologue, when this feeling was building up of being out of place or being assumed to not belong: that was particularly when I was silent about it, when I didn’t feel comfortable talking to my [boss] about it. I wasn’t sure who I could talk to about it. I actually didn’t tell anyone—even my Black friends—for a while because I’m like, “Racism happens. Should I really be talking about this?” But then I opened up and realized how emotional it had been, how much it had been impacting me. After that, it was just this work of speaking up about this.
The science and medicine space became that space where I spoke up. It was a constant process: asking schools that were trying to recruit me what they were doing to address the lack of diversity and what they were doing to support students of color at their schools; creating MARS (Minority Association of Rising Scientists); and reaching out to faculty that I trusted to discuss this issue and to talk about how we were going to address it.
I even talked to Damon Tweedy about this, the author of Black Man in a White Coat, because I was nervous about whether I could be retaliated against for speaking up about this issue within medicine. And I think that speaks back to that fear of being viewed as the “angry Black woman” or as “that Black person who sees racism everywhere” or whatever. I’m getting to the point where I’m finding that I just can’t be silent; it builds up inside me if I am. I still don’t feel safe protesting with how police are—I remember later in my years at WashU when there were police arming up in riot gear in one of the dorms, preparing to go out against the protesters with their guns and all this stuff. Having that experience on campus definitely added to it. It’s like: Will I be punished for this?
Alongside the stories of the women in Twice as Hard, you talk about your own journey to become the first physician in your family.
I wanted to help increase the number of Black people going into higher education and STEM. I felt like my family background led me on a different trajectory than some of my friends and peers. There’s some level of imposter syndrome that I’m overcoming to believe that I actually am going to make it to become a physician. My family and other people that I’m close to influenced my decision to go into medicine. In high school there was a decent amount of Black students. But I found while I was in high school that I was almost always the only Black person in my AP classes. There were a lot more of the Black students that were in the standard classes. It’s so common. I’ve heard from other people, where that’s been their experience, too. And I didn’t really think there was really a difference in intellect between me and my Black friends. I saw it as a difference in opportunity and support. In terms of opportunity, a lot of them were working after school in the evenings to help support their families, which meant they had less time to study for their classes. And then they had less encouragement.
I’m trying to predict the trajectory of me versus my friends based off of when we were in school and what they were thinking about college. I felt like there were these systemic issues that could have long-term repercussions on people that I’m growing up with, and that made develop this desire to do something to help increase the number of minorities and Black students in higher education going into STEM careers: there’s stability, a clear path for social mobility by going into those fields. Unfortunately, they’re appreciated in society more than others. I had actually thought about becoming an artist, and that’s part of the reason why I’ve really enjoyed this process. When I started out at WashU, I was double-majoring in painting and psychology-neuroscience-philosophy, but I switched it to biology-neuroscience. I dropped painting completely because the art studios and the science labs conflicted with each other. There was a point in high school when I thought I would pursue my dream and become an artist, then realizing that people don’t appreciate art as much as they should and that it’s hard to survive by being an artist.
Part of my motivation for going into medicine was being aware of the health disparities within America, and then sometimes seeing them myself. With my grandma, who lived in St. Louis, there were multiple times when I was at WashU where I was taking her to the hospital: I felt like they treated her like she was stupid. And it wasn’t until I told them that I was a pre-med student at WashU that they seemed to give her more respect, give her more time and explain their medical management. With the awareness of the larger significant health disparities, I had this fear that as a patient (or other people that I care about as patients) wouldn’t get equal treatment because we were Black. So I wanted to become a physician so that I would at least have assurance that I would be able to take care of myself, and I would be able to take care of my family and friends through the privilege and power of that medical knowledge. I touched on that a bit in the book with Dr. Edith Irby Jones when she was pregnant.
Brown recently shared her story as part of the Philadelphia Inquirer's "Telling Your Health Story" event.
Her story reminded me a lot about the necessary work of doulas in St. Louis, where Black women are two times more likely to die as a complication of pregnancy than their white counterparts. It’s astonishing how disproportionately high the rates of pregnancy related deaths are for Black mothers in this region.
While I was in my second year of medical school, we talked about fetal-maternal mortality, the disparity of those rates. And they said that Black women are more likely to have poor outcomes during pregnancy and childbirth, even when the studies had controlled for education and income. So, when I’m looking around, as the only Black woman in the room, I’m thinking, “Although all of us will become doctors, I’m more likely to die from my pregnancy than you are.” That’s basically what the studies were showing, that even with my level of education and the income that I will make, I’m still more at risk.
Dr. Irby Jones lived in times when structural racism was even more apparent and integrated within medical practice. I was just so shocked by that part of her story where I’d assumed that since you’re a physician, you’ll be safe. She literally planned ahead to give birth at the hospital where she had been training in residency, and she still wasn’t safe. They sent her home early. She had to teach her husband how to circumcise their child on the kitchen table. So I’m actually not safe. That’s what I’m getting from this.
When I was seeing my family over the holidays in the hospital, I’m not always wearing my scrubs, so people can’t always identify me as a medical professional. I do feel more protected by being within the medical space and having this knowledge, that I can be an advocate for my family and friends when they’re in that position. But it shouldn’t be like that. Why should somebody have to become a doctor in order to feel like the doctors are doing their job? I think it’s larger than an individual level: going through my rotations has made me feel that way, has given me more hope in doctors. A big part of it is systemic.
Your book is such a generous corrective to the phenomenon of historical amnesia. The women you write about were invested with love and care and hope by the people around them, women whose lives might have otherwise been lost to history. It reminds me of a question that Tiya Alicia Miles, professor of history at Harvard University, asks in her book, All That She Carried: What can Black women’s creative response to the worst of circumstances teach us about the past and offer us for the future?
A big goal of this work for me was to look at the past, in order to move forward in the future. Seeing how prevalent discrimination was within the research and medical field throughout the U.S., I wanted to understand: where did this come from? That’s why I decided to do this master's in history of medicine and really delve deeply into the past of Black woman physicians.
My hope was that, by better understanding how these social and structural barriers were built through time, we can better identify those that exist now and more effectively work to bring them down. I can't even imagine going through some of the things that those women went through. I learned about the amount of resilience that it took to keep moving forward, and to have an impact the way that they did. It inspired me, in my own future, to keep taking one step in front of the other.
At times while I was working on this book in medical school, there were challenges that I faced that I spoke to at different points, but some that I didn't speak to. And I questioned: could I make it through? Did I even want to? And I would look to those women for inspiration, starting med school in the midst of this pandemic, with immense isolation, with the racism and sexism that persists in our country, all those challenges that I had to face. It feels like they had overcome so much more, and it really motivated me to keep moving forward.
There are so many different identities or backgrounds that make people targets for prejudice and hate. And that makes it difficult to succeed in an extremely demanding career like medicine, in a space that can feel like it's made for one type of person to succeed. But I hope that by sharing these stories, those readers will find inspiration for themselves to keep pushing forward towards their dreams, regardless of what other people may tell them that they're capable of achieving.
Throughout the book, you describe how these women restored dignity to the lives and experiences of so many of their patients. How did writing their stories make you think differently about the value of Black professional mentorship and of Black institutional spaces, like historically Black colleges and universities (HBCUs) where many of these physicians were trained?
It’s really incredible to me about how these predominantly white institutions (PWIs) like to talk so much about their diversity efforts and all the strides that they’re making. But when you zoom out, you realize that there are literally four Black medical schools in the country, while there are hundreds of predominantly white medical schools. Yet these four institutions are carrying the load of training the vast majority of Black physicians.
In terms of the impact that HBCUs had on the undergraduate level and on the medical training level, I definitely wanted to make that clear, because they’re so important. I saw how the 1910 Flexner Report was one significant policy that changed the demographics within medicine. It became the rationale for closing multiple Black medical schools, and the number of Black medical students and physicians plummeted. It literally said that Black physicians should only be treating Black patients, and the fewer the better.
In terms of Black professional communities, whether it be sororities or fraternities, those spaces became a safe haven and a space of healing and encouragement and growth for Black people when the general professional communities worked to leave them on the margins. They’re extremely impactful. For me, as an AKA (the sorority), Black Greek life has been a source of community. It’s felt like family since I was a child because my mom’s also an AKA. And as I’ve gone on into this professional space, it’s been this wonderful network for growth, support, and mentorship.
