“Shouldn't You Spend Your Time Curing Cancer or Something?” Why an African American Female Physician Chose a Career in Palliative Care

Growing up in a small all-African American town in rural Mississippi, I learned about racism very early. As a child in the 1970s, I remember sitting in a doctor's office on the side reserved for “Blacks only.” I also remember the White owner of a small local store who always insisted that I place the money on the counter because he did not want to touch African Americans. By the time that I was in sixth grade, I knew that whatever career I chose would involve fighting for racial equity. Not surprisingly, my interest in medicine grew out of a desire to ensure equitable access to health care for African Americans. As a resident, I loved caring for seriously ill older adults because of the complexity of medical illness, the emphasis on whole-person care, and the opportunity to help patients and families align their personal values with their health care decisions.

Although I love the work that I do as a geriatrician and palliative care physician, I understand why others may question its importance in the context of widespread racial disparities in health. This happened almost two decades ago during a visit with my paternal grandmother, Ms. Inez Johnson, who asked, “What exactly do you do?” I talked about caring for patients with serious illness who had symptoms that were difficult to manage, breaking bad news, leading family meetings, and helping patients to receive care consistent with their preferences. When I finished, she said, “That's nice, but with all of the problems that Black people have, shouldn't you spend your time curing cancer or something?”

I can't remember how I responded. If I could redo this conversation with my grandmother, who died about 10 years ago, I would acknowledge that her question is a good one. African Americans are more likely than Whites to die from cancer. We need people to address these disparities. I would also say that we need efforts to address health disparities everywhere they exist—from disease prevention to treatment of acute and chronic illnesses to palliative care for patients with serious illness regardless of whether cure is possible. Even if I spent my time “curing cancer,” many African Americans would still find themselves confronting serious illness and eventual death. African Americans with serious illnesses need equitable access both to curative treatment and to high-quality palliative care. I would also say that for many African Americans, who have experienced poor quality health care and are understandably concerned about the intentions of health care institutions, discussions about palliative care can be difficult. It matters that, as an African American physician, I get to sit with them and explain what palliative care is (and isn't) and why it is an important part of equitable high-quality care.

Two stories illustrate this point. A few years ago, my Aunt Janie talked to me about the death of her mom, Ms. Bertha Stokes (my maternal grandmother), who died of cervical cancer in the 1950s. She was diagnosed at advanced stage; had limited access to treatment in rural Mississippi; and end-of-life care that did not include adequate pain management, discussions about prognosis or preferences for care, or other services that are now readily available through hospice or palliative care. My aunt ended her story with a question that highlights the importance of equitable access to palliative care: “If Momma were alive and diagnosed with this cancer today, even if she could not live longer, could she at least live better?”

I told my aunt about palliative care and all of the ways that it could have helped my grandmother to live “better.” Sadly, I did not tell her that today, 7 decades later, not only are African American women, like my grandmother, more likely than White women to die from cervical cancer, they are also less likely to receive care that helps them to “live better.” Compared with Whites, seriously ill African Americans are less likely to have their pain adequately assessed and treated, less likely to participate in advance care planning, less likely to discuss prognosis with providers, less likely to receive care consistent with preferences, more likely to have unmet needs for provider communication, and less likely to use hospice and palliative care. As an African American woman, a geriatrician, and a palliative care physician, the opportunity to help to correct these injustices one patient at a time is one of the things that gets me up in the morning.

A final story—a success—leads me to believe progress is possible. In the last year of my grandmother's life, Grandmother Inez experienced a steady decline related to her advanced heart failure. She shared her wishes to remain in her home, not be kept alive by machines, and not suffer as she neared the end of life. She remained in her home until a few days before death, cared for by her daughters with the help of hospice and died peacefully. She received care that honored her preferences. Her experience is a testament to the importance of creating equitable opportunities for people like my grandmother to receive high-quality palliative care. Although I don't spend my time “curing cancer” (as my grandmother once suggested), I believe that she would agree that palliative care is an important part of efforts to address “all the problems that Black people have.”