One of my most painful experiences in medical school occurred during my junior clerkship in internal medicine. Wearing a lab coat and carry ing a stethoscope, I had walked into a patient's room and introduced myself as a student doctor. He later asked a white male intern, 'Why didn't that girl clean up while she was in here?' Twelve years later, I'm still angry. This incident shook my selfconfidence and threatened to undermine not only my professional identity but my personal one. I was a good student at an Ivy League school, had begun to define myself as an aspiring physician and expected others to see me as one. The episode reminded me that, despite my credentials, achievements and white jacket, my race arid gender would make it impossible for some people to see me as a physician. (I recall thinking that if I had been a white woman, at least I would have been mistaken for a nurse.)
I received support ftom an older black woman physician, Dr. Helen Dickens. Dickens had attended medical school nearly fifty years earlier and had been the first black woman admited to the American College of Surgeons. I remember wondering how, and at what costs, she and other pioneering black women had succeeded in a white-male-dominated profession under circumstances much more difficult than the ones that I faced. How one particular woman, Dr. Margaret Lawrence, did it is described in Balm in Gilead Journey of a Healer, a loving memoir written by her daughter, Sara Lawrence Lightfoot.
Lawrence had a distinguished career as a child psychiatrist. She graduated ftom Cornell University in 1936, and received her medical degree from Columbia University in 1940 and her master's in public health from the same institution in 1943. In 1946 she became the first black trainee at the Columbia Psychoanalytic Clinic, and in 1963 director of the Developmental Psychiatry Service at Harlem Hospital. Lightfoot, a professor of education at Harvard University and the recipient of a MacArthur Prize, makes plain that a simple recitation of these achievements obscures the pain that accompanied them. She demonstrates that trauma and the strength to overcome it are recurrent themes in her mother's professional and personal life.
When Lawrence arrived at Cornell, she entied what would be a career-long obstacle course. The only black undergraduate on campus, she was not allowed to live in the dormitories, and she supported herself by working as a domestic for white families. Nonetheless, she did well academically and expected to be admitted to Cornell Medical School. However, after praising her accomplishments, the dean told her that she could not attend because 'twenty-five years ago there was a Negro man admitted to Cornell Medical School and it didn't work out. . . . He got tuberculosis.'
Lawrence eventually gained admission to Columbia Medical School. She recalled, 'I had fallen apart . . . but I came back.' Once again, she was the only black student. Upon graduation, she faced another hurdle. She was not allowed to work at Babies' Hospital, ostensibly because housing could not be provided for a black woman in the nurses' dormitory, where female interns were housed. The expected track for black physicians was to pursue training at black hospitals, which usually had inferior programs. A few were admitted to municipal hospitals, and Lawrence was eventually accepted at one of them, Harlem Hospital,
Her future triumphs are all the more remarkable because racism was not the only obstacle in her professional path. At Meharry Medical College, a school with a black student body, she was the only woman on the faculty during the early 1940s and encountered blatant sexism. She was excluded from intellectual camaraderie, overburdened with responsibilities and poorly paid in comparison with her male colleagues. The irony of her plight is profound, for the school had been established in response to racial discrimination in medicine.
Lawrence's life can be viewed, on one level, as an archetypal American success story of personal achievement against overwhelming odds. During the Reagan Administration, the Eves and accomphshments of successful African-Americans like her were often held up to discount the impact of systematic racism. Armed with grit, fortitude and talent, the argument went, any individual could conquer any obstacles. Balm in Gilead demonstrates the hollowness of this argument. Its power and timeliness rest in its depiction of the subcutaneous scars of racism borne by those African-Americans who have all the markings of success. Fifty years after her rejection from Cornell Medical School, Lawrence wept as she told the story to her daughter. Lightfoot eloquently notes, 'The ravages of racism run deep, penetrating the subterranean layers of the soul. Even when you emerge victorious and sing songs of sweet success, there are wounds that are not thoroughly healed.'
Only in recent years have historians of American medicine begun to address issues of race. The lives and contributions of black physicians, especially women, remain for the most part unexamined. Balm in Gilead represents a significant addition to American medical biography. But the book is more than that, since Margaret Lawrence had a commitment to family as well as work, It is also the story of a daughter's spiritual and emotional journey to discover her own identity by attempting to understand her mother's life. Along the way she provides us with a candid and personal memoir of a black middle-class family. Her itinerary includes the then-segregated Southern city of Vicksburg, Mississippi, and a diverse Northern black community, Harlem.
Lightfoot describes the continuities and discontinuities of her family's history. She traces its healing/teaching tradition to her maternal grandparents, an Episcopalian minister and a schoolteacher. Her mother embraced this legacy and passed it on to her children, but deliberately abandoned other inherited expectations. Lawrence's family, like many others in the black community at the time, determined a person's value by skin color and hair texture -fair skin and straight hair were especially prized. For Lawrence such beliefs caused not only personal pain but signified community divisiveness. She did not want her children to think that their worth and her love for them were tied to their complexion. Lawrence abandoned another part of her heritage as well: Her family had been dominated by strong women whose fortitude had stemmed from a distance from and a distrust of men. Lawrence wanted autonomy but she did not want to achieve it in the same fashion as her relatives. She also wanted a strong relationship with a man. She found both in her long marriage to Charles Lawrence, a sociologist.
The vitality and complexity of mother daughter relationships is another theme of Balm in Gilead. By book's end it is clear that the writing of it helped Light foot better understand her connection to her mother: 'I look into my mother's eyes and see my own reflections -not mirror images but refracted, valed.' It is not a oneway mirror; Margaret Lawrence, too, sees her own reflection in her daughter's eyes. Their relationship provides each woman with an abundant source of reaffirmation and sustenance. Lightfoot admits that the opportunity to collaborate with her mother on this book was a rich and rare experience. So it is also for the reader.
Lightfoot concentrates on events up to her mother's early adulthood; the book only offers glimpses of Lawrence's life from the late 1940s to the present. I wanted to know more about what happened in the intervening years. How did Margaret Lawrence react to the death of her parents? What were her views on the civil rights movement? What are her feelings about the entrance of more black women into the medical profession? How has she reacted to the changes in life in Harlem? It is a tribute to Lightfoot's work that the omission of later events makes the reader yearn to know more about her mother.
In a recent review in The New York Times Book Review, H. Jack Geiger mistakenly described Balm in Gilead as 'full of interior pain, denial and rage repressed so deeply that it is never felt.' He does not believe Lawrence's assertion that, as a child growing up in a protective family in the segregated South, she did not feel the daily assaults of racial exclusion. But Geiger misses a vital point about African-American psychic survival. We have learned that we cannot feel and react to every act of racism; to do so would keep us from functioning as human beings. As Margaret Lawrence's story makes clear, African-American life contains not only trauma and scars but also strength and healing, and it cannot be measured solely by its reactions to white America. Lawrence's life stands as an affirmation of the spiritual from which the title is derived. Yes, there is a balm in Gilead to make the wounded whole.
