Lee revisits his father Leroy’s final moments in the hospital, and tries to parse out what really led up to his father’s death. Later in the episode, Lee talks with Natalie Slopen, an assistant professor at Harvard University, about ACES (Adverse Childhood Experiences) and how they can contribute to shortened life expectancy. Lee also speaks with Dr. Nathaniel Harnett, a neuroscientist and the director of Neurobiology of Affective and Traumatic Experiences Laboratory at McClean Hospital, about childhood trauma and how it disproportionately affects Black children.

TRANSCRIPT

My name is Lee Hawkins and this is What Happened in Alabama.

This episode is very emotional for me because we’ll be revisiting the details of my dad’s death. My sister, Tiffany, recorded some of our exchanges with the intensive care doctor and nurse in our father’s final hours. It’s difficult to listen to some of it, so sensitive listeners, please take care. I want to understand how the stressful experiences my father had growing up as a child under Jim Crow apartheid affected his health as an adult, and the role I believe racism-related stress played in his death, first in Alabama, but later in Minnesota. The conversations in this episode connect the dots between the Adverse Childhood Experiences of three groups: the twelve generations of enslaved Black people in the US, the five generations of Black people who, like my father, lived through Jim Crow, and the millions of Black American descendants of both who are alive today.

But, if you’re joining us for the first time, you’ll get a whole lot more out of this episode if you go back and listen to the prologue first - that’ll give you some context for putting the whole series in perspective. Do that, and then join us back here. Thank you so much.

Lee: Don't put our father through any pain with restarting his heart. We know you wanted that and we agreed to that. So now this is where we are…

Roberta: We just want our time with him

It’s 3:30 in the morning on February 28th 2019. My entire family - my mom, two sisters and me, are in my dad’s hospital room. I had been sleeping in my hotel room down the street when my sister Tiffany woke me up to tell me that the night shift doctor wanted to meet with all of us. Four days earlier, he was rushed to the hospital by helicopter after his heart had stopped at the Buddy Guy concert he’d gone to with my mom. It was a date night. They were celebrating their 50th anniversary. Though they were able to restart his heart a few times, his condition wasn’t improving.

The ICU room was slightly smaller than a college dorm room. It had a curtain instead of a door and a window that faced the hospital entrance. Every day, I could see Dad as I approached the room, with a bunch of tubes connected to his upper body. An intubation tube protruded from his mouth, and a breathing tube came out of his nose. An electronic panel behind his head monitored every sign of progress and every setback. Those four days were an emotional whirlwind. My dad still looked youthful with his hair parted on the side as always, and that gave me a little hope. But his kidneys were another story. A dialysis machine had been moved into his room. He wasn’t talking, but there was a good chance that he could hear all the conversations happening in the room.

Eventually, the doctor walked in to give an update. “Your father is a very sick man,” he began. “We see cases like this, and the survival rate is very low. There are so many possibilities with this. His lungs aren’t clearing up, and we’re worried he could develop sepsis at some point. He’s on dialysis now, but if we take him off, he’ll stop functioning within two hours. His organs are shutting down.”

I thanked him for the information and then gave him our position. Knowing that our father was a God-fearing man who would want us to exhaust every option before pulling the plug, we were standing by our consistent position that we were going to keep praying for a miracle and that we wouldn’t be stopping dialysis at any point. I told him that we appreciated the work they were doing to keep him as comfortable as possible and that we wanted to continue until his situation improved or his heart or organs shut down naturally. We made it clear, once again, that the only way we would allow them to discontinue treatment was if my father’s heart was to stop again. Using a defibrillator at that point would have been brutal.

The doctor’s position was that we should just trust him and the medical staff and that every person–including my father–would want his or her family to stop dialysis at this stage. I felt resentment towards them. They were culturally clueless, just blindly assuming that Black patients and their families trust medical institutions. Our decisions to embrace our faith and our father’s faith, and exercise our father’s wishes and our legal rights were paramount.

We felt that the doctors weren’t listening to us.

Our mother, who had been a nurse herself for decades of her career, knew my dad was likely in his final hours. But as we sat there, we knew she needed a little time and that she’d probably never forgive herself if she stopped dialysis at this stage. She was grieving the likely loss of that handsome boy she met at the beach when they were just fourteen. She’d known and loved this man for nearly sixty years, had children and grandchildren with him, and was squeezing his hand as they loaded him on the helicopter. She just needed to sit with her family, and pray, and think.

Lee Hawkins: I know that in the industry there's a lot of concern about that and how families, particularly in our community, you know, are treated. And we appreciate your concern. You know, our position as a religious family and you've dealt with religious families before here. So that's the situation and we really appreciate you.

Tiffany: Know it's human nature. It's my heart. My father. I didn't expect to wake up today and get this pain. And so this is why.

Lee: And if my father didn't explicitly say.

crosstalk: Anything, he wanted to go. He didn't.

Lee: Measure that. He didn't if he didn't explicitly say that he didn't want you to do anything, you know, he said he wants.

Roberta: And he told us.

A doctor ran up to us and told us that, as a last attempt at saving our father, he was going to do something he’d never done in his career before: Put my father on two kidney dialysis machines and run them, simultaneously. He ordered everyone out of the room and commanded his staff to hook the other machine up.

Only minutes after they did that, the code blue rang out, and my father was gone.

If you check the records, my father’s cause of death was cardiac arrest. He was 70 years old and had survived prostate cancer and Type-2 diabetes for years. But in the end, his heart wasn’t strong enough to withstand his weight, his stress level, and his three decade battle with obesity.

In the years since he passed, I’ve realized that it’s much deeper than what was written on his death certificate. This podcast was inspired by my research for a forthcoming book -– I Am Nobody’s Slave: How Uncovering My Family’s History Set Me Free, which set the stage for me to interview my dad for four years about his time in Jim Crow Alabama, and to do extensive research about everything that’s been covered in this podcast. Through all of that work, especially the books I read, the related journalism fellowships I completed, and the discussions I had with experts in psychology and neurobiology, I realized that my father’s fate might’ve been determined much earlier than that one day in 2019.

As part of my research, I came across a 2014 study from Harvard, published in the journal Epidemiology, that examined the health effects of Jim Crow laws on Black and white populations in the U.S. from 1960 to 2009. Researchers looked at data from all U.S. counties, focusing on people born between 1901 and 2009, and assessed the racial differences in premature mortality, defined as death before age 65. The study found that in 1960 36% of the U.S. population lived under Jim Crow laws, with 63% of Black Americans affected.

1960 was just one year before my father’s mother, my grandmother Opie, died of kidney failure at 56. Her death is why my father moved from Alabama to Minnesota, to live with his older sisters up north.

Black folks born between 1921 and 1945 in Jim Crow areas were 20% more likely to die prematurely compared to those outside these areas. Throughout the study period, Black people were about twice as likely to experience premature death compared to whites, regardless of Jim Crow laws. The highest risks were for Black people born between 1901 and 1945, while there was no clear pattern for whites. The study concludes that Jim Crow laws have had a lasting impact on premature mortality among Black Americans, and their abolition has not eliminated the racial disparities in premature death rates over the past 50 years.

Born in 1948, my father lived five years longer than age 65, so compared to many other Jim Crow survivors, he was fortunate. But compared to Black men as a whole, my father’s death at 70 fell short of the average life expectancy for a Black man, which, according to the CDC, was 71 1/2 years. In comparison, the life expectancy for a white man was about 76 years. I would have given my life savings for my father to have been given that extra year and a half , and my right arm for an extra 6 years. I believe Jim Crow – for all the chronic stress it caused my father from the moment he opened his eyes in Alabama– took that from me. I can’t prove definitively