The Myth of the Entitled Single Mother

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There is a disconcerting myth about single mothers that has been circulating in our society for some time. It was popularized in the Regan Era as a denunciation of US social welfare policy and resulted in a pointed caricature of a woman on welfare, forever to be known as the “welfare queen” or the entitled single mother.

The narrative of such a woman goes something like this: Not only is she poor, but worse yet, she is unpatriotic and weak. She is nothing more than the vessel for her lascivious desires as she has child after child out-of-wedlock, abusing the luxury of government aid to ensure herself a life of leisure. Her welfare dependency is as much a result of her moral failings as it is of society’s willingness to foot the bill. If “real Americans” get by on what they make out of their bootstraps, then her crime is never wanting bootstraps at all.

Sound intense? Apparently not for Senator Rand Paul of Kentucky, who invoked this relic of American political discourse this week to shame single mothers out of their welfare benefits. He was quoted at a Lexington Commerce Meeting as saying, “Maybe we have to say ‘enough’s enough, you shouldn’t be having kids after a certain amount.’ I don’t know how you do all that because then it’s tough to tell a woman with four kids that she’s got a fifth kid we’re not going to give her any more money. But we have to figure out how to get that message through because that is part of the answer.”

It is clear that at a time when both Democrats and Republicans seem primed to address the issue of growing income inequality in our country, the myth of the entitled single mother remains as relevant as ever. That problem is, this false characterization of single mothers, particularly those receiving government benefits, ignores the real lives these working mothers lead, undermines the contribution of women to the American economy, and ultimately prevents society from understanding how government funding should be spent to address income inequality.

The bottom line is, the myth of the entitled single mother separates us from the reality that women are the core of the American economy, including single mothers. In the words of President Obama, “when women succeed, America succeeds.” And the truth is, single mothers are single-handedly controlling the future of America. Let me tell you why.

Women are bringing home the bacon unlike ever before.

Since 1960, the number of women who are the primary wage-earners for their household has almost quadrupled, such that women now comprise nearly two-thirds of the breadwinners or co-breadwinners in their family. And as it turns out, more than 6 and 10 of the women who are the primary breadwinners in their home, are single mothers.

Women are using that money to boost the American economy.

Although some have speculated that women influence anywhere from 70-80% of the consumer spending in their household, it is hard to argue that single mothers don’t control 100% of their household spending. That’s anything from buying cars and computers to purchasing healthcare. With the struggling auto industry, surge in online technology, and new changes in healthcare, that means single mothers are literally at the center of the markets that are defining the ways we live, move, communicate, and stay healthy.

Women are redefining the social contract.

Without a second income in the household, families lead by single mothers are also the most vulnerable to economic stress, and in the words of Maria Shiver’s latest report, many are living on the brink of poverty. Growing income inequality and poverty may be the defining issues of our time. The urgency of these problems require us to push new boundaries. Although the traditional social contract exists between the US government and the people, in which we give the government authority to rule if the government will protect our rights and help us when we fall on hard times; the new social contract defines the relationship between businesses and the people. That if we are to work for you and buy your goods, then businesses must also contribute to the general well-being of society by paying fair wages and providing various benefits (health insurance etc).

To make a long story short, businesses aren’t holding up their end of the deal, and it is time to remind them and raise the minimum wage. It is estimated that doing so may be a real solution to lifting some families out of poverty, many of whom are led by single mothers. And as we know, poverty poses one of the greatest threats to the health and well-being of children in the United States, making it also one of the greatest threats to the health of adults, as most children grow up to be adults.

Taken together, it is clear that our ability to succeed as a nation will be defined by our willingness to support single mothers and their families. Be it through their economic contribution to their community or their role in raising the future leaders of this country, these women are fearlessly facing the adversity in their lives, daring to raise children without Rand Paul’s approval, and working towards a better future for themselves and their families. They are not entitled, they are in need of our utmost regard for enduring despite the odds and we should invest in them. Period.

This post is also being featured on Kevin.MD! Check it out here!

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Dying While Black

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Each year, as our nation reflects on the life and legacy of Dr. Martin Luther King Jr., I look for contemporary signs of change, examples of how we as a society have evolved in our understanding of race and how and where African-Americans have folded deeper into the American story and been embraced by the country they’ve called home for centuries.

This year, I didn’t have to look any further than my own backyard. Last week, the Sun Reporter, a Bay Area weekly that runs local and national news involving African-Americans, featured a story on Jahi McMath. Jahi was a 13-year-old African-American girl whose untimely death, following a tonsillectomy, lead to weeks of contentious debate between her family, her medical providers, and the national media regarding her diagnosis of brain death. Being a local pediatrician* I was well-aware of the story. But what struck me when reading this particular piece, was the way the periodical characterized the family’s mistrust of the medical system.

Historically, there has been “bad blood” between some African-Americans and the US health care system. In many cases, that tension can be directly linked to documented cases of exploitation and deceit. Like, for example, when the US Public Health Service purposely withheld treatment from African-American men infected with syphilis, allowing them to suffer and sometimes die, to study the effects of untreated disease from 1932-1972.

Or take the case of the Henrietta Lacks, the African-American woman from whom the world’s oldest and most commonly used line of human cells (HeLa cells) were obtained in 1951. Despite being the substrate for some of the greatest advances in medical research, biological science, and pharmaceutical development, neither she nor her family received any financial compensation or recognition. Her cells were obtained without her consent, manipulated and sold without her family’s knowledge, and her genome and her family’s medical records were made public without their approval. In August of 2013, less than a year ago, the National Institutes of Health finally publicly acknowledged Henrietta Lacks’ contribution to science, agreed to protect her family’s private medical information, and allowed her family to be privy to future research utilizing her cells.

Given these egregious missteps in US history, you might not be surprised to know that some African-Americans actually believe the US government introduced crack into their neighborhoods or created AIDS to kill them. The woefully unsuccessful, and I would argue, recklessly enforced, War on Drugs aside, some black folks just don’t trust the core institutions that are created to serve the public good, and chief among them may be our health care system.

In the case of Jahi McMath, I have to wonder if feelings of distrust ran deep and strained the relationship between Jahi’s family and her medical providers, as they sought to find a common ground to discuss an incredibly difficult and distressing reality – a young girl is dead. Add to that discussion the general public’s confusion regarding the medical definition of death and the media-bolstered accusations that everyone, from the family and their lawyer to the hospital and its personnel, mismanaged the situation, and it is easy to see how the private bond between the medical system and the community it serves can fray and break.

Underlying this all has been the hurtful allegation that the hospital wanted to discontinue Jahi’s life support to save money or that the family’s limited resources affected their ability to advocate for her care. The obvious comparison here is the Terri Schiavo case, in which a 26-year-old woman was kept on life support at the insistence (and in part through the financial support) of her parents for 15 years. Although, I must say, that case was very different because the ultimate diagnosis was a coma-like condition called persistent vegetative state where the brain continues to function, albeit at a significant deficit, and in Jahi’s case her brain was determined to no longer be functioning at all.

Ultimately, it seems, despite being cared for at a hospital that local doctors like myself revere as a leader in practicing in and for, communities of color, a disconnect remained. To me, it suggests that perhaps it was the family’s distrust of the system to adequately care for Jahi and the complicated medical language surrounding the diagnosis of death that created an impasse. That impasse gave way to an unnecessarily long period of suffering for Jahi and her family and it must be prevented in the future.

But how? And why is this so important? There are two lessons here.

First, it is just as important now as it has ever been, to elevate the national dialogue about race as we continue to seek to understand each other as human beings.

Second, and most importantly, part of that understanding is rooted in communication and in every area where we miss an opportunity to effectively communicate with each other, we risk alienating people from the very institutions on which our communities rely, including medicine, education, and justice.

It is on this note that the media completely missed the point. Part of our national evolution to understand race involves recognizing and acknowledging the nuanced ways it remains relevant in our lives. One of those ways is in the way we communicate across cultures.

Effective cross-cultural communication (and one can argue that any communication outside one’s area of expertise is cross-cultural), requires identifying the contextual clues – the values, knowledge, and historical roots that contribute to how individuals interpret information and make important decisions. This is key to understanding any human behavior from basic lifestyle choices to the painstaking and charged decisions involved in end of life care.

In America, there is a history there that makes dying while black a particularly contentious issue, one fraught with fear of mistreatment and maligned intention, and one that must be addressed openly, honestly, and with compassion. Whenever we are able, those of us in positions of institutional power, must acknowledge and uphold the dignity of all human life as we practice across centuries of experience and knowledge. If we can do this for the most marginalized, then we have some hope of healing the scars of our past and addressing the ongoing struggles of our present.

I write this post in loving memory of Jahi McMath and Dr. Martin Luther King Jr, beloved members of the African-American community who died challenging all of us to learn to understand each other better.

*Disclaimer: Although I am a pediatrician in the Bay Area I was never involved in Jahi McMath’s medical care and this piece is not intended to discuss any details of her clinical course or treatment. In addition, this post is not meant to speculate on the feelings of the McMath family or the intentions of the medical providers who rendered her care but rather to stimulate a larger discussion about the ways race may remain relevant in each of our lives and how we can confront that reality in a meaningful way.

Update: Thank you to everyone who read, commented on, and shared this post. Given the significant interest it garnered, it was published in the San Francisco Chronicle on Sunday, February 2nd! Check it out here!

Black Art

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Warning: This is not your typical physician blogger post. But, as you’ve hopefully figured out by now, I’m not your typical physician blogger.

There have been but few times in my life when the power of the written word has changed me.

When words, so delicately crafted, approximate both the splendor and the obscenity of human experience, and the light can overcome the shadows. When I was liberated because they spoke it so.

Those are sacred moments between me and Langston Hughes, W.E.B. DuBois, Zora Neale Hurston, James Baldwin, Maya Angelou, and Amiri Baraka.

When I read Amiri Baraka’s Black Art I was a sophomore in college and about 19 years old. I was living in a world dominated by the images, opinions, and interests of white people and trying to figure out what it meant to be a brown girl like me. He said:

Poems are bullshit unless they are teeth…

We want “poems that kill.” Assassin poems,

Poems that shoot guns…

Clean out the world for virtue and love,

Let there be no love poems written

until love can exist freely and

cleanly. Let Black People understand

that they are the lovers and the sons

of lovers and warriors and sons

of warriors Are poems & poets &

all the loveliness here in the world.

We want a black poem. And a

Black World.

Let the world be a Black Poem

And Let All Black People Speak This Poem

Silently

or LOUD

What a thought.

What if blackness was the perspective from which all other experiences are compared?

What does it mean to conceptualize blackness beyond a race card or a problem or a conversation about affirmative action, inner city violence, or health disparities?

Is it possible that black people could be “all the loveliness here in the world?”

If it is possible, then how can I embody that pride effortlessly or “say it loud?” Both, of course, being equally acceptable.

Historically, this poem framed a time of anger and unrest at the centuries of injustice suffered by black people in America. It was the 60s. It was the beginning of the movement for civil rights. It was the birth of the Black Arts Movement, the contribution of black artists, writers, philosophers, and activists to not only chronicle the emotion and the intentionality of the movement, but take the greatest weapon at their disposal – the written word – and BE the movement.

Amiri Baraka was the movement. He was bold. He was fiery. He was unabashedly committed to re-claiming blackness and the beauty it embodies. As a young black woman who found my passion for social justice in medicine through the ethnic pride I discovered in college, I can only hope my writing will do justice to the beauty of the people I seek to serve. For the overlooked, vulnerable, and marginalized among us, thank you Amiri Baraka for fiercely embracing our power and showing us how to live in the beauty in us all.

RIP.

New Tomorrows

Every day carries the promise of tomorrow. But the start of a new year stands out as a collective moment to prepare for “the future,” the new tomorrow.

What does that even mean?

We never really live in the future. Each moment offers us now. Having recently completed 23 long years of higher education, I have no idea what it means to live in the now. I have spent my entire career thus far, planning (and applying) for what is ahead. At the end of that established path is now. And the greatest lesson I learned in 2013 was to feel, experience, enjoy, mourn, grow, learn, play, think, question, now.

The truth is, my life is not on a 10 year plan. I’m going moment to moment, shift to shift, idea to idea, opportunity to opportunity, each now touching the next now until it comes into being. Any other way of living simply makes me feel overwhelmed and inadequate and doesn’t honor the power I hold in the moment, to make choices, rightly or wrongly, learn, grow, feel, and take that step to the next now.

What are you doing with your right now? (besides reading this post, thank you!)

Are you at peace or do you feel stressed? What are the choices that you control to create the life you dream of? If tomorrow was new and you could be whoever you want to be, what would you do, who would you be?

What if, instead of wishing onto the days, weeks, and months of the unforeseen, we felt, experienced, enjoyed, considered, the new year as a new moment, a new day, a new promise that we may have tomorrow. At the end of every day, be it good or bad, we can lie down and if we are so lucky, get up again. Isn’t that what tomorrow is all about? Getting up, in the moment, and choosing to live in the joy, mystery, and wonder of it all.

Hello, 2014 you stranger, you.

I accept that I have no idea what this year has to bring.

I am excited about new opportunities to share love, life, and creation and thankful to be a part of it all.

I hope each of you will continue to join me on the journey.

To new tomorrows!