Medical Racism and the Legacy of Tuskegee in Take My Hand
The Thematic Claim
In Take My Hand, Dolen Perkins-Valdez argues that medical racism is not a closed chapter of American history but a living system that repeats itself whenever institutions treat poor Black bodies as expendable research material. The novel makes this case by placing the 1973 sterilization of the Williams sisters in direct conversation with the Tuskegee syphilis study, which had been exposed to the public only a year earlier. Through nurse Civil Townsend, the narrative shows that the same logic that allowed the federal government to leave hundreds of Black men untreated for four decades also allowed a federally funded clinic to sterilize two young girls without their consent. The thematic claim is precise: when medical authority is combined with racial hierarchy and poverty, "care" becomes a cover for experimentation, and the only defense is the kind of vigilance that Civil learns to practice.
Tracing the Theme Through the Plot
Part One: The Clinic and the First Suspicion
The theme first emerges in the early 1970s sections, when Civil begins working at the Montgomery Family Planning Clinic. She is assigned to visit the Williams sisters, India and Erica, who are receiving Depo-Provera injections. Civil initially trusts the system. She believes the clinic is doing community work, saving poor families from "more dire choices." But when she learns that India has not even had her first menstrual cycle, and when she discovers that the drug is not FDA-approved and has caused uterine cancer in laboratory animals, her confidence cracks.
The turning point comes when Civil, Tyrell Ralsey, and Alicia visit Miss Pope, a Tuskegee librarian who has collected materials on the syphilis study. Miss Pope explains that the men were told they had "bad blood" and were given free meals and transportation to participate, believing they were receiving first-class medical care. She reveals that penicillin was available after the war but withheld because researchers wanted to study what happened when the disease was left untreated. Most devastating for Civil is the revelation that a Black Tuskegee graduate, Eunice Rivers, helped recruit the men, likely believing she was doing good. Miss Pope's words land directly on Civil: "Now, you know how some white folks feel about Black bodies." Civil immediately draws the parallel, thinking, "The federal government could not possibly be doing the same thing with Depo and Black women"—a hope she cannot sustain.
Part Two: The Investigation and the Trial
The theme deepens as Civil acts on her suspicion. She breaks into Mrs. Seager's locked file cabinet and finds records of young patients—Mary, age thirteen; Patsy, age sixteen; Yolanda, age fourteen—all receiving Depo-Provera. She reads notes describing patients as "unfit" and "poor candidates for oral contraceptives." She overhears Mrs. Seager pressuring a mother of six to have a tubal ligation, dismissing the woman's religious objections. Civil realizes she may be "wading in the same harmful waters Eunice Rivers had," and the fear that she is complicit becomes the engine of her investigation.
The trial sections make the Tuskegee parallel explicit. When Civil argues to Lou that the sterilization policies are "not that different than what happened at Tuskegee," Lou pushes back, noting that forty of the eighty-two sterilized patients in Alabama were white, and that no white men were infected in the Tuskegee study. Civil counters with a structural argument: half of Alabama's population is not Black, so the numbers are not proportionate, and the family planning clinics are located in Black neighborhoods. The exchange captures the difficulty of proving intent in cases of systemic racism—a difficulty the novel refuses to smooth over.
Part Three: The 2016 Frame and the Enduring Legacy
The frame narrative set in 2016 shows that the theme is not confined to the past. Civil, now approaching sixty-seven, still thinks of India and Erica every year and has stitched their names inside every white coat she has worn. The act of stitching is a refusal to let the sisters be forgotten, the way the Tuskegee men were forgotten for forty years. When Civil learns that India is very sick, she takes it as a sign to head south and finally tell her daughter, Anne, the full story. The novel's structure—a confession delivered decades later—suggests that the wounds of medical racism do not heal on their own; they require acknowledgment and testimony.
The Author's Note extends the theme into the present. Perkins-Valdez cites sterilization abuses in California prisons (2006–2010), Nashville plea deals (2014), and ICE detainee facilities (2020), and notes that compulsory sterilization of "unfit" inmates remains federally protected by the 1927 Buck v. Bell ruling. She closes with statistics on Black maternal mortality and reproductive justice, making clear that the novel is not a historical curiosity but a warning about a pattern that continues.
Character Connections
The theme operates through a web of characters who embody different positions within the medical system. Civil is the conscience of the novel, moving from trust to suspicion to action. Her arc mirrors the reader's own education: she must unlearn the assumption that medical professionals are benevolent. Her father, a doctor, taught her to navigate Alabama carefully, and his caution initially makes Civil hesitate to investigate. But her mother's impulsiveness balances his conservatism, and Civil ultimately acts.
Mrs. Seager represents the institutional face of medical racism. She is not a cartoon villain; she genuinely believes she is helping. She tells Civil they are "God's guiding hand" for their patients. Yet she pressures women into sterilization, dismisses their objections, and withholds information about Depo-Provera's risks. The novel's refusal to make her purely evil is part of its complexity—it suggests that harm can be committed by people who believe they are doing good.
The Williams family—Mace and Patricia and their daughters—represents the human cost. India and Erica are not abstract case studies; they are girls who enjoy listening to Civil's records and marvel at the needle on the vinyl. Their vulnerability—young, poor, Black, rural—is precisely what makes them targets. The novel insists that we see them as individuals before we see them as victims.
Ty functions as the catalyst who pushes Civil to confront the Tuskegee parallel. His research on Depo-Provera and his blunt statement—"You can't have a baby if you dead"—force Civil to take the risk seriously. Miss Pope, the librarian, is the keeper of historical memory, the one who connects the dots between the syphilis study and the clinic's practices.
Symbol Connections
The white coat with stitched names is the novel's most powerful symbol of the theme. In 2016, Civil has stitched India's and Erica's names into every coat she has worn, transforming a symbol of medical authority into a memorial. The coat that once represented the institution's power over Black bodies becomes a record of the bodies the institution harmed. It is Civil's way of ensuring that the sisters are never reduced to the kind of anonymous subjects the Tuskegee men became.
The hymn "Take My Hand, Precious Lord" connects the theme to the civil rights movement. The epigraph records Martin Luther King Jr.'s reported final words, asking that the hymn be played at the meeting scheduled for the evening of April 4, 1968—the day he was assassinated. The hymn becomes a thread linking the struggle for civil rights to the struggle for reproductive justice, suggesting that both are fights for the dignity of Black life.
The Dodge Colt, Civil's graduation gift from her father, symbolizes the class privilege that separates her from her patients. She hides it a block and a half away and trades cars with her mother to avoid drawing attention. The car is a reminder that Civil can move between worlds—the world of the clinic and the world of the Williams family—and that this mobility gives her a responsibility the other nurses do not share.
The lipstick Civil buys in 2016 as she drives toward Birmingham is a quieter symbol. It suggests the persistence of ordinary life, of femininity and self-presentation, even in the face of painful memory. It also connects to the novel's interest in how Black women assert agency in small ways when larger systems deny it to them.
Complexity and Contradiction
The novel is careful not to present medical racism as a simple conspiracy. Several complications complicate the theme. First, the Tuskegee study itself involved a Black nurse, Eunice Rivers, who likely believed she was helping. Civil's fear that she is repeating Rivers's mistake gives the theme a personal, moral weight—it is not just about evil institutions but about well-meaning individuals who fail to ask hard questions.
Second, the legal case is genuinely difficult. Lou's point about the white patients complicates any claim of intentional targeting. The defense can point to numbers and claim the policies were not racially motivated. Civil's counterargument—that the location of clinics and the disproportionate impact prove structural racism—is persuasive but not airtight. The novel refuses to offer easy legal victory, suggesting that the harm is real even when intent is hard to prove.
Third, the clinic's work is not purely harmful. Birth control genuinely helps some women avoid unwanted pregnancies. Alicia argues that pregnancy is a more pressing concern than the distant risk of cancer. The novel acknowledges this tension: the same institution that harms the Williams sisters may help other patients. The problem is not birth control itself but the withholding of information, the targeting of the poor, and the absence of meaningful consent.
Finally, the theme extends beyond the 1970s. The Author's Note shows that sterilization abuses continued into the twenty-first century, and that Buck v. Bell still protects compulsory sterilization. This is not a story about a past that has been overcome; it is a story about a pattern that persists.
Study Questions and Answers
1. How does the novel use the Tuskegee syphilis study to frame the sterilization of the Williams sisters?
The novel draws a direct parallel between the two events. Miss Pope explains that the Tuskegee men were told they had "bad blood" and were left untreated even after penicillin became available, because researchers wanted to study the disease's progression. Civil recognizes that the clinic's use of unapproved Depo-Provera on young Black patients follows the same logic: the federal government is using patients as subjects in a live clinical trial. Both cases involve federally funded institutions, Black victims, and the withholding of information. The novel argues that the sterilization case is not an isolated abuse but a continuation of the same pattern of medical experimentation on Black bodies.
2. What role does Eunice Rivers play in the novel's exploration of complicity?
Eunice Rivers, the Black Tuskegee graduate who helped recruit men for the syphilis study, serves as a warning to Civil. Miss Pope reveals that Rivers likely believed she was doing good, trusting the federal government to find a cure. Civil immediately worries that she is "wading in the same harmful waters" as Rivers. The parallel forces Civil to examine her own role: she is a Black nurse administering a dangerous drug to Black patients, trusting her supervisor's assurances. Rivers represents the danger of good intentions without critical scrutiny, and Civil's arc is defined by her refusal to repeat that mistake.
3. How does the novel complicate the idea that medical racism is a conspiracy?
The novel resists a simple conspiracy narrative in several ways. Mrs. Seager genuinely believes she is helping, describing the nurses as "God's guiding hand." The legal case is complicated by the fact that forty of the eighty-two sterilized patients in Alabama were white, giving the defense a statistical argument. Even the clinic's work has genuine benefits for some patients. The novel suggests that medical racism operates through a combination of individual bias, institutional incentives, and structural inequality—not through a single villainous plot. This makes the harm harder to identify and harder to remedy, which is part of the point.
4. What does the white coat with stitched names symbolize, and how does it connect to the theme?
In the 2016 frame narrative, Civil reveals that she has stitched India's and Erica's names into every white coat she has worn. The coat is the uniform of medical authority, the symbol of the institution that harmed the sisters. By stitching their names into it, Civil transforms the symbol: the coat becomes a memorial, a record of the bodies the institution failed. It is also an act of witness—Civil refuses to let the sisters be forgotten the way the Tuskegee men were forgotten for forty years. The coat represents the possibility of accountability within the medical profession.
5. How does the Author's Note extend the theme beyond the novel's historical setting?
The Author's Note connects the 1973 sterilization case to contemporary abuses: nearly 150 women sterilized in California prisons between 2006 and 2010, prosecutors in Nashville offering permanent birth control as part of plea deals in 2014, and allegations of forced sterilization of ICE detainees in 2020. Perkins-Valdez also notes that Buck v. Bell (1927) still protects compulsory sterilization of "unfit" inmates, and she cites statistics on Black maternal mortality and reproductive justice. The effect is to argue that the novel's theme is not historical but ongoing—that the same assumptions about poor Black women's fitness for motherhood continue to shape medical practice today.