46 pages • 1 hour read
Laurie Kaye AbrahamMama Might Be Better Off Dead: The Failure of Health Care in Urban America
Nonfiction | Book | Adult | Published in 1993A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapters 1-2Chapter Summaries & Analyses
Chapter 1 Summary: “‘Where Crowded Humanity Suffers and Sickens:’ The Banes Family and Their Neighborhood”
Robert Banes sits in a patient room at the University of Illinois Medical Center, west of Chicago’s Loop. His chronic kidney failure, the result of glomerulosclerosis, requires dialysis treatment multiple times a week in order for him to survive. Even so, in the past week or so, there has consistently been blood in his urine, and doctors are concerned that he might require surgery. After a passing interaction with a nurse, during which he reveals that he has not had anything to eat for dinner, Robert’s wife Jackie arrives for their visit. Jackie brings a light meal for Robert, including a slice of cake from their youngest daughter, Brianna’s, first birthday party. Robert was forced to miss the celebrations due to his hospitalization. Jackie hopes that Robert will be able to stay at the hospital over the weekend, since his temporary absence gives her more bandwidth to take care of the other family members, including her ailing grandmother, Cora.
After visiting Robert in the hospital, Jackie rides the bus home to the family’s apartment in North Lawndale, one of the city’s most impoverished neighborhoods. The year is 1989, and Abraham uses Jackie’s bus route along Ogden Avenue as a vehicle for describing the state of the city at that particular moment. As the bus leaves the University of Illinois Medical Center near downtown and heads for North Lawndale, Jackie passes Mt. Sinai Hospital, where the family receives most of its care, and then Douglas Park, which divides the neighborhood in two. As Abraham goes on to explain, North Lawndale is racially divided along this same line: The Black population lives on the north side of the park, and the Hispanic population lives to the south. The grandeur of the park’s design hints at glory days past, but nowadays, the neighborhood is falling into disrepair as poverty tightens its chokehold on the community. When Jackie arrives home, Cora and the children are introduced, along with the issue of Cora’s debilitating diabetes.
Chapter 2 Summary: “The Rigors of Kidney Dialysis for Robert Banes”
Chapter 2 examines the intricacies of Robert’s dialysis treatment. Three times a week (on Mondays, Wednesdays, and Fridays), Robert wakes up at 5:30 am to catch a six o’clock private ride to the dialysis clinic, chartered by the Chicago Transit Authority. This ride is essential because it saves him 40 minutes of travel time each way (a bus ride would take an hour, but the car ride only takes 20 minutes). Even with this time saved, however, Abraham likens dialysis treatment to a part-time job, noting that it can take eight hours or more each day, preventing Robert from working during those daytime hours. In addition to undergoing this rigorous treatment, Robert works night shifts as a security guard. This overpacked schedule leaves him feeling consistently exhausted. He also frequently uses cocaine, something that he refuses to discuss with Abraham and rarely discusses with Jackie.
Also introduced in this chapter is Jackie’s father, Tommy, who was absent for most of her childhood. An intimidating, muscular man, he was charged with armed robbery in the mid-1960s, and many of Jackie’s fondest memories of him were visiting him in prison. Tommy’s hypertension caused him to have a stroke at the age of 48, leaving him paralyzed on the left side of his body. Though he had known before the stroke that his blood pressure was dangerously high, he did not understand that there might be serious consequences for leaving it untreated. This story mirrors Robert’s, who left his failing kidneys untreated until it was too late to save them and he needed a transplant urgently.
Chapters 1-2 Analysis
In Chapter 1, a combination of historical, medical, and geographic analysis sets the tone for the book’s broader exploration of Intersections Between Medicine and Sociology. In particular, Abraham’s tracking of demographic changes in the North Lawndale community over space and time indicates that her focus in the book will not be on raw medical science but instead on key social factors like race. “Chicago’s poor neighborhoods have always been its sickest” (18), she writes, affirming her own thesis that health cannot, and should not, be reduced to a matter of biology. Such historical findings serve as evidence that the sociological dynamics she explores throughout the book are longstanding issues, even if social scientists have only just begun to identify and name them.
Furthermore, by using Jackie’s bus route as the vehicle for her sociological exposition, Abraham emphasizes that the histories of racism and poverty that influence the health of the Banes family are woven into the cityscape itself. Through Jackie’s eyes, the highway is an “escape route” for the wealthy who do not want to be bothered by the poverty of neighborhoods like North Lawndale, and a random vacant lot is where her aunt used to live. Riding the bus home with Jackie is a way for Abraham to acquaint readers, especially those unfamiliar with Chicago, with the city and to place them in the shoes of its poorest residents. This is just one of the many strategies Abraham employs throughout the book to establish an empathetic connection between the reader and the subject.
At times, Jackie speaks about the area with disdain, as though she herself is not a resident: “That’s a hangout for IV-drug users […]. When I saw that, I told the man I’d skip the change” (16-17). Just as readers are encouraged to imagine themselves in the position of the residents, Jackie seems to look upon the goings on in her neighborhood with the same judgment that outsiders might. Pieces of dialogue such as this one reveal the limitations of Jackie’s own perspective; despite having loved ones who experience drug addiction, she feels removed from other users due to her socioeconomic circumstances.
The issue of drug use within North Lawndale’s community is one that Abraham tries to address, but it is always just out of reach for her to incorporate fully into the text. This barrier exists largely because Robert, whose cocaine use causes significant problems for his family, is unwilling to discuss the subject with Abraham. “Robert refuses to discuss drugs with anyone but Jackie,” she remarks, “and then only if she pushes the issue” (26-27). The fact that Robert is hesitant to open up even to his spouse speaks to the extreme shame associated with his drug use. There is also an implicit connection in the text between Jackie’s disdain for users and Robert’s reticence regarding his use. As a journalist, Abraham observes preexisting family dynamics that determine, to some extent, the scope and trajectory of her book. The boundaries having been set, Abraham can only acknowledge Robert’s cocaine addiction in shadowy terms; the details of his use remain a mystery to both her and Jackie. While limiting in regard to the subject matter, however, this commonality between Abraham and Jackie is productive in forging a camaraderie between the two women. More than any other figure, Jackie’s willingness to confide in Abraham defines the shape and structure of the book.
