Book 31:
Legacy: A Black Physician Reckons with Racism in Medicine by Uché Blackstock
Rough Review:
4 stars. I have so many thoughts about this one, but they’re all over the place and I’m afraid I won’t remember them all, but I’ll try to put them in some sort of order.
This is the third book read for my genetic counselling book club in 2025, which is a book club I found through linked in when I was still researching and applying for GC master’s programs, and it was also on the list for continuing education credits for NSGC and CBGC, which threw me a bit because so far all our books have been very genetics-based, focusing on the cell, specific genetic mutations and syndromes, and scientific research. But after reading it, I completely understand why it’s on the list and appreciate that it was put on my radar.
This book is a loving tribute to Dr. Uché Blackstock’s mother, a memoir of her journey though the American education and health system, an examination of the history of racism in healthcare and the ways it continues to manifest today, and a call to action to do better, now. I think it succeeds at the first and last items best. The memoir portion was somewhat surface level, and the history portion more of an overview/summary, but the ways she related those to the American healthcare system today, and how it continues to fail Black people and people of colour, was wonderfully laid out, and I really appreciate the itemized lists of tangible ways to make change. I also felt she honoured her mother beautifully, and I was not expecting to cry on the subway while reading this, but I did.
Genetic counselling may not be primary medicine (yet?) but it is provided within the framework of a healthcare institution that has abused, taken advantage of, excluded, minimized, and dismissed Black people and the repercussions of that history are still being felt today, along with continued discrimination and lack of understanding. The ways of addressing this injustice so far have been anemic, lazy, and unfocused, with the proliferation of DEI initiatives often used as a form of lip service, a way to check a box and move on from having to do any real work, and of putting the onus of change on Black people when they were not the people who built the system in the first place.
I’m going to be studying in the US, and the genetic counselling program I’ve matched with made a strong point of highlighting the importance of diversity, equity, and inclusion in our studies, even as the current presidential administration wages its own loud and obnoxious war against the very concept. I hope SLC will do a good job of providing an education that celebrates and embraces diverse backgrounds and the richness of cultural experiences and contexts that make up the US and North America as a whole. I don’t know where I’ll end up working after school, but I’m not so naive as to think that Canada has no issues with systemic racism in healthcare and education, so I hope I’ll be able to use the awareness and knowledge base gained from reading this book to ensure that any work I do within the system is sensitive, and to do what I can to call out and address unfairness when I see it, and to support racialized patients and colleagues.
I read this on Libby, so I’ve copied out some quotes that stood out since I wasn’t able to do the Kindle highlight thing I’ve gotten so used to:
“…people like my father, coming to the US from the African diaspora, can have excellent health outcomes when they arrive in this country, but for the second generation of their families those outcomes decline, becoming comparable to Black Americans whose enslaved ancestors were brought here in chains” – This shocked me. This is insane.
“Recent studies point to the continued overrepresentation of white patients in clinical oncology trials, which may be another reason for the unfavorable outcomes we see for Black cancer patients. For decades, Black patients have been disproportionately underrepresented in cancer studies, the results of which are generally assumed to be applicable to everyone. But how can we be certain of universal applicability if Black people are excluded from trials in the first place?” – Similar to excluding women from clinical trials and then acting shocked when drugs affect them differently, which I know is why intersectional feminism is so important. It also makes me wonder, though, about how we phrase things like “there’s no biological difference between men/women/white/Black people” because I understand this to be true in terms of our humanity and how we all deserve to be valued and respected and given equal opportunities, but clearly isn’t medically true if drugs affect us all differently; are there nuances to the way “biological” is used that I’m missing? is it what ASPECTS of the biology is different? and since different people react differently to different drugs, does that mean that we need to divide the categories into people with x, y, and z genes rather than male/female/race/height/weight? but if we’re zooming in that far, how do you even run clinical trials? and this is what I mean when I say my thoughts are all over the place…
“My professors were overwhelmingly white men; I could count the number of Black faculty members on one hand. From our instructors, we learned to see the world through what was considered an entirely “scientific, objective, and evidence-based” lens. These men were immensely confident, seemingly competent authorities on their subjects. It was not our job to doubt them, it was our job to absorb everything they told us.”
“The information imparted to us in the classrooms and on the wards was presented as “factual data” and “research-driven” without any sociopolitical context. I now realize that this so-called objectivity was anything but.”
“Such experiments and interventions that were carried out on Black Americans have gone on to create what has often been described as “institutional distrust”—in which Black people are perceived to be reluctant to interact with a medical system that has historically perpetrated abuses upon them. However, this term pathologizes and places the blame on Black people. Instead, this phenomenon is better described as “institutional untrustworthiness,” whereby institutions have shown themselves to be untrustworthy to our communities thanks to a litany of abuses and mistreatment enacted against Black Americans by the health-care system.” – I like this. I want to underline “institutional untrustworthiness” about five times.
“‘stereotype threat’—a psychological phenomenon in which an individual feels at risk of confirming a negative stereotype about a group they identify with.”
“But in the end, all the self-care in the world couldn’t make up for the long hours and intense stress of the job.”
“Midwives in general began to be sidelined, regarded as old-fashioned and unsafe, even though these perceptions were far from accurate. In fact, a New York Academy of Medicine study in 1932 found that home births attended by midwives had the lowest maternal mortality rates of any setting. Despite this, ob-gyns and the medicalized model of managing pregnancy and childbirth became the norm.” – I hate that, growing up, I thought midwifery was quackery on par with essential oils and crystals. I don’t know where I picked that up, but it was years before I understood that just because midwives and doulas don’t necessarily have medical degrees, that doesn’t mean their knowledge isn’t valuable and evidence-based.
“Yet, I found it ironic and infuriating that we, Black faculty members, were being given the complex and overwhelming task of remedying the outcomes of centuries of institutionalized racism—problems we did not create in the first place. […] I was never told, “Uché, this is your role, and we are going to invest in you and make sure you get the training and support that you need to be successful in your role.” In some ways, that’s the nature of academic medicine—you get thrown into positions and you either sink or swim, or you learn by doing. At the same time, it’s hard to do substantive work or even have a positive outlook when you don’t have the people, the resources, or the institutional support to effect real change.”
“Every newsletter that the office published had to be vetted by the senior deans (older white men) for inflammatory content.” – FFS. We want to be celebrated for our efforts without ever actually doing a damned thing or ever having to feel even a little bit bad!
“The pandemic rolled on, leaving hundreds of thousands of lives in its wake.” – It’s beside the point, so I didn’t mention it in my main review, but odd sentences like this happen quite a bit in the book and I’m not sure if it’s because I read a digital copy and there were words missing, or if it’s another entry in the “HIRE ME TO BE AN EDITOR” log, because shouldn’t this be “thousands of lives devastated in its wake” or “crushed” or “destroyed” or something? It didn’t just leave lives in its wake.
“In 2018 alone, health-care companies spent nearly $568 million on lobbying, more than any other industry. Imagine what could be done with that money if it were directed toward actually caring for patients in need.” – Insert rage gif from Inside Out here.
“The maternal mortality rate is now higher than it was twenty-five years ago. Black infants are more than twice as likely to die in their first year of life as white infants, a wider inequity now than fifteen years before the end of slavery (although it’s important to note that enslavers had a financial interest in keeping Black babies alive because they possessed monetary value).” – Again, this is insane.
“What my mother wrote in 1996 remains true, appallingly so. Not only has the percentage of Black physicians failed to increase but numerous racial health inequities have actually worsened since the 1990s.” – ARGH.
Final Review: I mean, it’s enough words.
Book 32:
Missoula: Rape and the Justice System in a College Town by Jon Krakauer
Rough Review:
Short, non-specific, sardonic review:
It’s hard to know what to say about this book. If ever I was under the impression that I had developed control over my temper as I’ve grown older, I am no longer. My Garmin informed me after every reading period that I had experienced a period of “high stress”. I don’t even want to rate it because that seems besides the point. Like, what, 5 stars for the victims’ determination, thoughtfulness, and level-headed and consistent testimony, 0 stars for some of the prosecutors and townspeople and college students, 2.5 stars for the second half of the book which is more transcripts than actual writing and reporting, 4.5 stars for the rest of the book because it’s gripping and informative and mostly very fair and even handed, but also he CLEARLY does not like Kirsten Pabst one tiny bit, which I personally enjoy because I am spiteful, but is also not necessarily helpful, and a giant eldritch scribble for the justice system?
Actual review:
The first half of the book is an overview of the college town of Missoula and their football team (the Grizzlies), and the rape scandal that engulfed it from around 2010-2013.
The second half covers two court cases stemming from that period, one of which resulted in a conviction for the accused, the other exoneration.
From these two lenses, Krakauer examines sexual assault and rape (in particular, acquaintance rape – as opposed to rape by a stranger) in society in general, how it manifests on college campuses, the culture that allows it to proliferate, the avenues for reporting the crime and holding people accountable (or not), the realities of police and legal work, the social effects of a rape accusation on the victim and the accused, and the politically charged debates over whether false accusations or unjust exonerations are more common.
There’s a lot going on here, and Krakauer’s writing and organization are such that the information never feels confusing or unfocused. The EMOTIONAL effects of that information may be another story.
The women Krakauer spoke to while writing this are remarkable in what they have endured and in how they have responded to it. Numerous times while reading this I would unconsciously clench my fists or slam the book down, and my dad would ask, “Why are you reading something that makes you so angry?” Why? Because these women deserve to be heard, that’s why. And moreover –
I think that every single person needs to read Missoula, with the obvious and extreme caveat that this does not apply to anyone who has ever been sexually assaulted or would be trigged by reading graphic descriptions of rape and assault.
The reasons I think everyone should read it are not because it is well written or particularly compassionate and fair minded towards both the unjustly accused and the unjustly ignored accuser, although it is both those things, but because I think it does an incredible job of showing the reader what sexual assault and rape (especially acquaintance rape) can look like, what the process of reporting the assault to police and campus officials in America entails, what forensic examination can involve, what prosecution and defense of a rape or sexual assault case can involve, how the system is set up, and how it fails the people it’s meant to protect.
For example:
“After a victim has reported a crime to the police, many people believe that the decision whether or not to charge the suspect with a crime, and then prosecute the suspect, is the prerogative of the victim. News media often contribute to this misconception in stories about rape victims by reporting that a victim “declined to press charges.” In fact, the criminal justice system gives victims no direct say in the matter. It’s the police, for the most part, who decide whether a suspect should be arrested, and prosecutors who ultimately determine whether a conviction should be pursued.”
I did not know this.
“When defense counsel David Paoli cross-examined Detective Brueckner, he asserted that when Cecilia Washburn was on the witness stand nine days earlier, Washburn had testified that “she assisted [Jordan Johnson] in changing positions.” Brueckner countered that Paoli was misrepresenting Washburn’s words. Washburn had in fact testified that Johnson said, “Turn over, or I’ll make you,” and then she’d said, “And then at that point he grabbed my hips and flipped me over….I just knew I was going to get raped….I did assist him, but it was because I gave up.””
This is the sort of thing that’s allowed in a courtroom. People should read this book to know that, it nothing else.
“Seemingly by design, the American legal system encourages defense counsel to be as mendacious as possible. […] It’s an essential component of our adversarial system of justice, based on the theory that justice is best achieved not through a third-party investigation directed by an impartial judge but, instead, through vigorous disputation by the interested parties: trial by verbal combat. […] In reality, the system promotes chicanery, outright deceit, and other egregious misconduct by trial lawyers.”
In plainly laying out the facts, Krakauer allows the reader to see how rape cases are handled from beginning to end, not just the publicized spin and the final verdict. As a result, despite being published in 2015, it’s one of the most important books I read this year.
Some other thoughts:
I think when people who are inclined not to believe rape victims picture the whole situation, many of them envision a hysterical, confused woman overwhelming and guilting police officers into action, or a calculating, malevolent woman marching into a police station and demanding charges be filed immediately. Many of them assume that when one is being assaulted, the obvious, indeed only sensible way to react is to try to beat off the assailant and run away. But when someone chooses to rape you, they have shown unequivocally that your psychological wants and needs, as well as your bodily autonomy and safety, are not important to them. Knowing that this is the case, why is it a surprise that people may not fight back because they are afraid of escalating the violence? A rape eventually ends, but a murder is final.
I think these people also fail to realize or remember that women are adult human people perfectly capable of identifying bad or regretted sex as just that, and warning friends off of a bad lay. Whole comedy specials and TV shows have revolved around the concept. These people may not have thought about or fully understood what “consent” actually means and involves. Rape can involve strangers, assaults at gunpoint, vicious beatings, deliberate overpowering of victims, but it can also involve people the victim knows taking advantage of a baseline of trust, ignored or dismissed verbal and physical signals, treating sexual conquest as a “game” where “prey” is hunted, deliberately or unintentionally using substances like drugs or alcohol to reduce the victim’s ability to communicate verbally and physically. So many people do this. So many people see others doing this. So many think it is acceptable. People who believe themselves (or their friends, or family members, or idols) to be genuinely good people could find it difficult to square this belief with the possibility that they might have unintentionally or thoughtlessly severely injured someone. This may even be true, but it does not mean that there should be no consequences for the injurious action. It doesn’t matter how much of an upstanding, kind, remarkable citizen with a promising future ahead of them someone is, if they accidentally run over a person, they are punished. The same should be true of a rapist.
In the tug of war between fairness to victims and fairness to the accused, there’s a tendency for agitators on both sides to lean towards extremes. A stoning for every rapist! (My emotions feel very kindly towards this possibility!) Public shunning, harassment, and incarceration for every false accuser!
The result, as Krakauer says, is that “the procedures for adjudicating sexual-assault cases bring to mind a goat rodeo and are fair neither to victims nor those accused of assaulting them.” Which, I think, is how you get people sentenced to jail time for assault reports with some of the flimsiest evidence you can imagine, while other reports with ACTUAL VIDEO OF DRUGS BEING PUT INTO DRINKS results in no charges. Justice for victims and justice for the accused is a crap shoot, and when actual justice does occur, it’s because it slipped in through the cracks in the system, not simply because of any better or worse conduct on the part of professionals. We need to be able to talk about this, but the rage and fear surrounding rape accusations makes it pretty much impossible for each “side” to not just be screeching to the choir. (I include myself here, because 90% of the quotes and comments I made on my Kindle edition of this book are me screeching in incoherent rage.)
I would like to end this gigantic semi-review with a couple more quotes:
“As the scope of my research expanded, I was stunned to discover that many of my acquaintances, and even several women in my own family, had been sexually assaulted by men they trusted. The more I listened to these women’s accounts, the more disturbed I became. I’d had no idea that rape was so prevalent, or could cause such deep and intractable pain. My ignorance was inexcusable, and it made me ashamed.”
But when people are encouraged to keep silent and ashamed, his ignorance is understandable. And so:
“As more and more survivors emerge from the shadows and reveal the pervasiveness of sexual assault, they draw strength from their numbers. This collective fortitude touches all victims, even those too fearful to speak for themselves, by eradicating the undeserved sense of shame that is so often borne in isolation.”
Final Review: Possibly too many words.
Book 33:
How to Age Disgracefully by Clare Pooley
Rough Review:
This was lovely. A breath of fresh air after some heavy reading. I’d say it was a bit Man Called Ove, a bit Thursday Murder Club, a bit 100-Year Old Man Out of Window Etc, but despite the cover, it wasn’t as cutesy or patronizing as that might lead you to believe (patronizing mostly applies to the latter book). It had some bite, it was well-plotted, and it was genuinely funny. I wish I’d been able to savour it a little longer, but my 7-day skip the line loan from Libby was almost due when I started reading it.
Final Review: Not as many words but please let the others make up for it, I’ve got 33 minutes left and 20 more books.
Book 34:
Here After by Amy Lin
Rough Review:
5 stars. “Yes.”
That’s what I felt after reading this book, which wrecked me, and I don’t want to talk about it.
It’s barely over 200 pages. I didn’t realize I’d made so many highlights.
I’m glad to have gotten the opportunity to get to know Kurtis through Lin’s eyes.
Kurtis died in August of 2020 at the age of 32 while running a virtual half-marathon in Calgary. The autopsy did not reveal a cause of death – his heart just stopped beating.
So Lin is about as removed from the wrecking ball of a sudden “out of order” death as I am. J and D died within months of each other in 2020. Neither was my husband, but D was a partner.
Lin turned the experience into a fucking raw, brutal, beautiful, bare depiction of grief and a testament to her love for and relationship with Kurtis, and his love for her. “We grieve with what we have” said one of her grief counsellors, and Lin had writing. I don’t know what I have. I still don’t want to write about it.
A lot of memoirs about grief are written in a similar style. The intensity of the experience erases embellishment. Sentences are short, the writing is stark. The best writers can almost make poetry out of it, and I think Lin does that here.
“Despite this total dark, the earth still holds sun.”
Final Review: No words.
Book 35:
Vera Wong’s Unsolicited Advice for Murderers by Jesse Q. Sutanto
Rough Review:
2.75 stars, rounded up. FULL OF SPOILERS, NO TIME TO REDACT, READ AT OWN RISK, I DID NOT ENJOY THIS BOOK.
I really wanted to like this. It started out pretty good, too. Vera is a lot of fun, the food descriptions were great, I chuckled out loud at some moments. But for a mystery book, the mystery aspect was INCREDIBLY lacking. It was obvious immediately (like so obvious you might as well have made it a meta knowing nod to the reader, even if the characters wouldn’t know until later), and you could solve the mystery . And of course, I realize this is a “cozy mystery” and it’s more about the characters than the plot, but not a single character except Vera herself felt real, or even particularly interesting to me. Honestly, they had about as much depth as the paper they were printed on, . Maybe some of this is a normal, expected part of the cozy mystery genre? I feel like I’m being incredibly harsh on this book, but it just didn’t do it for me at all.
Final Review: What it says on the tin.
