Joe Roper

Thoughts on Medicine, Diversity and a Happy Accident

I first met Joe Roper after he had turned 65 and joined Medicare. He had chosen a managed Medicare organization, Tufts Medicare Preferred. They randomly chose him a new primary care physician, me, though I was 24 miles and about an hour’s drive through Boston and out to the far northern suburbs.

His first visit with me, a standard physical, went well. I did the usual history and exam: reviewed his medical history, present concerns, cancer and cardiovascular screenings, immunizations, mental health, nutrition and exercise. I told him that he likely had essential hypertension and that we would need to keep blood pressure log and follow up in 2 weeks and probably start medication. We did an EKG. I ordered labs. But mostly we just talked. From the outset he was just very engaging and likable. I was late for my next patient.

I told him that he should probably find a doctor closer to his home. He insisted that he wanted to follow up with me. He did. He kept coming for the next 23 years.

Mr. Roper eventually developed issues including hypertension, hyperlipidemia, and prostate cancer. He was grateful that I had pushed him to get a prostate biopsy when his PSA had first accelerated. His most bothersome ailment was degenerative arthritis of his shoulders (probably prior seronegative rheumatoid arthritis). He was an avid golfer and he kept playing as long as he could despite losing most of the range of motion in his right shoulder. He had a knob put on his steering wheel when it became impossible for him to raise his arm high enough to drive otherwise. Despite his ailments, he really didn’t complain much. He always maintained his sense of humor and his characteristic poise and grace. I spoke recently with his daughter, Vanessa. I found out later that she was neither his biologic or adoptive daughter and that she had known him since she was 3. She always referred to him as Daddy-Joe. She told me that he was always the consummate gentleman. She said he was always calm and always kind. She said he was very generous and that he liked to give to family and community. She said that he had had a big impact on many of the tenants whose properties he managed. She also told me something that I was unaware of: he liked to gamble and had done so much of his life: betting the numbers and then at the Connecticut casinos.

When he became unable to make the drive all the way to Tewksbury, I started doing home visits with him in Dorchester. I figured that since he had come all that way to me, the least I could do was go the distance to him. Although he continued to live alone, Vanessa, who is a social worker, became his effective caretaker and our go between with his permission. Joe had always been independent and resented any attempts to diminish his autonomy. He especially wanted to be able to take walks by himself, although he was a high fall risk. Most contentiously, he wanted to continue to drive.

He had lived in the house in Dorchester since he bought it from Vanessa’s mother and uncle in the late 70’s. It was a classic large, old New England triple decker. Vanessa walked me through some of the now unused rooms in the home. Since as he had become more immobile, Mr. Roper was more or less confined to his bedroom. As we walked through the house I saw a lot of golfing tournament trophies as well as a poster of a young Tiger Woods. Vanessa told me that there is still a tournament plaque with Mr. Roper’s name on it at the Golf Course at Franklin Park (the second oldest public golf course in the country).

Mr. Roper had developed more edema, recurrent wounds and heart failure with preserved left ventricular function, and a peripheral neuropathy. He had progressive dysphagia, worsened by the severe arthritis in his neck. He had gradually lost a significant amount of weight and had trouble maintaining adequate caloric input. None the less, he still strived to keep some semblance of activity.

At my last visit with him, he was recovering post- hospitalization , after a fall. He had recovered from acute renal failure but he had fractured ribs, dislocated his shoulder and had a new slowly healing wound. I met with him, Vanessa, his good friend, George, and a long-term friend who was a lawyer. Mr. Roper had decided that he wanted to move to South Carolina where he would live near his nephew in an assisted living facility. I think they were hoping that I could talk him out of it. I couldn’t, nor could anyone else. He ended up moving in August, 2022. He died there about a year later at age 89.

When I began my career in family medicine in Tewksbury, MA in 1988, I was concerned that I would miss the diversity I had found training in Philadelphia and Cincinnati. The predominant ethnic group in my area were Irish Americans whose families had immigrated to the US in the 1840’s and Italian Americans who came in waves in the 1890’s and again in the 1920’s. None of the Irish or Italians had an easy time when they first arrived to the Boston area. They initially lived in poverty and were often met with much prejudice and resentment. Many of my Irish and Italian patients and their families had moved out of the city and to the more affordable blue-collar suburbs in the 1960’s and 1970’s. What I found over time was that there was broad diversity not in race, but in the economics, education levels, age ranges and personalities in these patients who I came to care for and to care so much about.

The demographics changed over the decades. I had plenty of patients from Brazil, Haiti, The Dominican Republic, India, China, Vietnam, Lebanon, Kenya, Jamaica, South Korea, and Cambodia. Most of them were first and second-generation Americans.

Mr. Roper’s ancestors had been in the United States much longer. I don’t know the actual story of his family of origin, but I would imagine that it involved being forced into the hold of a trans-Atlantic ship, chattel slavery, sharecropping poverty and then 20^th century life in the Jim Crow south. Mr. Roper was born in Georgia in 1934. After a spending about 3-4 years in The US Coast Guard, he moved to Boston in the 1950’s. Evidently, he moved to Boston because a few of his shipmates and some of his cousins lived there. He had gained engineering skills in the Coast Guard and became a successful property manager in Boston.

Boston had only a small black population before 1950- maybe only 3%. By 1970 it was about 16%. Today it is about 25%. (Boston itself has been majority non-white since 2000). The post WWII migration of African Americans from the south has been well documented in Isabel Wilkerson’s 2010 Pulitzer Prize winning book, “The Warmth of Other Suns”. She describes how many of the 6 million Black Americans who left the south felt more like more like immigrants then citizens after arriving in the Northeast and Midwest. This despite their ancestors having been on the continent for up to 300 years and having being US citizens since the passage of the 14^th amendment in 1868.

African Americans have had a long, rich, and complicated history in Boston. I will not attempt any in depth examination here but will point out some highlights in a brief time-line:

--1638-first Africans arrive in Boston from the Bahamas in the slave ship Desire’

--1720- about 2200 African Americans live in Boston, most of them slaves

--1770- The Boston Massacre- Crispus Attucks shot and killed by British soldiers

--1779- Many slaves were freed in gratitude for their bravery and service in fighting in the Revolutionary War- many settle at the base of Cobbs Hill, now known as Beacon Hill)

--1781- Slavery essentially abolished in Massachusetts by a judge’s ruling in a state court case

--19^th Century- New England continues to benefit economically from Slavery indirectly by their part in the triangular trade system – initially where sugar harvested by slaves in the Caribbean was shipped to New England – and rum and molasses made in New England was shipped and sold in Europe

--1831- William Lloyd Garrison begins publication of The Liberator

--1832- The New England Anti-Slavery Society was founded by freed slaves and white abolitionists at The African Meeting House

-- 1830-1860- Boston is a key hub on the Underground Railway (Harriett Tubman instrumental in Boston in the 1850’s)

-- 1841-1847- Frederick Douglass lives in Lynn, MA where he writes his autobiography. In Boston, he gives many speeches important to the abolitionist movement

--1850- Boston Vigilance Company forms in response to passage of the Fugitive Slave Law (many of the leaders are black women)

--1863- 54^th Mass Infantry Unit formed after the Emancipation Proclamation – fights heroically in multiple Civil War battles

--Early 1900’s- Black writers, artists, activists – part of an educated and influential Black elite or Black Brahmins in Boston

--1911- first chartered branch of the NAACP founded in Boston

--1964- Celtics field the first all-black starting 5

--1965- Martin Luther King, Jr. leads a march from Roxbury to the Boston Common to protest school desegregation – soon thereafter Governor Volpe orders school desegregation

--1966- Bill Russell becomes the first black NBA coach

--1974-1978—peak of the Boston busing crisis sparking violence due to court ordered busing and demonstrating to the world the racist side of Boston

--1989- Charles Stuart murders his pregnant wife and accuses a black man- reigniting racial tensions in Boston

--1980-2020- African American population grows with immigration from the Caribbean and from Africa (particularly Cape Verde)

Readers may be wondering why I included this easily obtainable information in an essay about my patient and our relationship. I guess I’m hoping this outline gives some sense of the messiness, the complexity and the nuance of the forces that shape people, this region and our nation. I think though, that the primary reason I included it is that I’m pissed off. I’m angry that the Trump administration has pulled funding for the Museum of African American History in Boston I’m worried that fears about indoctrination may result in real indoctrination.

I may not agree with all of the post-BLM educational initiatives: for example, the need to put a disclaimer on a portrait of George Washington. I would like people to connect dots and think for themselves. But removing educational funding for The Museum of African American History in Boston is not an isolated event. It is a nationwide attempt to target ideology that the administration worries may be too “woke” or be giving its audience anti-American feelings. It is part of the strategy to simply use the key word diversity as an entry point to seek and destroy. Clearly, it is part of a larger strategy to further a narrative that allows the destruction of so many of our institutions and potentially, of our democracy.

Diversity is clearly a good thing. America has been built on a melding of cultures unlike any nation in the world. Diversity can enlarge our perspectives on ourselves and our outlooks on the world. In medicine here are multiple high-quality studies that demonstrate having a more diverse medical work force improves patient outcomes and that black residents living in a county where there are more black doctors have lower morbidity and mortality rates. American medicine would collapse if not for the work force that has come from all over the world to study, do research, create health tech and medicine related businesses and to care for every community in the US. Removing incentives, opportunities and a sense of welcome for these men and women to come to the US is a crazy self – inflicted wound for the US.

But diversity is not holy. Making it part of a pledge or part of required sensitivity training has tarnished and not furthered a good intent. Corporatizing and homogenizing messy ideas into a recited passage or a click the right answer evaluation only diminished the value of celebrating diversity. And some of the excesses of progressivism have led to less diversity of opinion and of critical thinking. It has instead helped to provide ammunition for a full-frontal cultural backlash.

But make no mistake. The reactionary right-wing backlash that we are now seeing is a thousand times more dangerous. And the attack on anything “DEI-related” is often simply used as a canard to justify upending progress in research, medicine, science, environmental initiatives, coherent foreign policy leadership and logical and humane immigration reform and border control.

It is not unusual for regimes in power to rewrite history to further their goals and ideology. In the 20^th century, Stalin and Hitler were great examples of this approach. Dismantling the US Department of Education, banning students from reading certain books that are not aligned with right-wing ideology, attacking anybody who disagrees with the regime and limiting funding for institutions like The Smithsonian and the Museum of African American History in Boston are all part of the playbook.

Getting to know people of diverse backgrounds can be enriching, as it was for me in my medical practice. The fact that I got to care for Joe Roper was a happy accident. Mr. Roper was a man of kindness and decency and that was apparent the day we met. Over the years we talked a lot more about his health care (and sports) then we did about his background or history. But I feel strongly that without knowledge of history and respect towards the cultures that Americans have come from, we will be unable to combat the present assault on true American values. Recognizing both the good and bad in the important details of our history is essential if we want to counter a false narrative and move forwards again in America and not backwards as our current administration would have it.