Upward Mortality

She has no idea how much he hates her. And as I watch the perky blond nurse wipe drool from my father's face, I hate her too. He spits up more mucus when she adjusts the giant caterpillar of a tube that pumps oxygen into his lungs, and I wince. I don't feel sadness or fear; I'm not even grossed out. I'm just angry. That's what the old man would want. He'd want me to resent this white girl's innocence with him, if his brain were still alive.

My father came a long way to arrive at his deathbed at the age of 57. Fifteen years ago, he ranked among Indianapolis' premier physicians, treating a largely working-class black clientele in this same hospital. But the way he griped about it, you would think he spent the day sweeping floors instead of doing surgery. He'd come home tired and frustrated, complaining about the indignities he'd suffered: The white nurses who snuck behind his back to change a patient's care. The principal at my all-white elementary school who wanted to put me in special ed because of my "temper problem." The white lady next door who had made some remark about the length of our grass, or otherwise policed our property.

He developed a real attitude about the whole thing; Chris Rock had nothing on Dad's angry-black-man routine.

My father excelled in life. He was off to college at 16 and went on to get a medical degree from the nation's most prestigious black university. His legion of one-time patients and proud former schoolmates would corner me in drugstores and gas stations all over town, "Hey, little doc!" I could go nowhere without bumping into his achievements.

Yet, here we are, both rendered dependent upon this indefatigable young nurse. "How you doing today, Dr. Wright?" she beams as she pokes around the edges of his mouth with one of those loud spit vacuums that dentists use. "I bet you helped soooo many people," she softly recognizes. Everybody but himself, I snort under my breath.

As disabling diseases go, diabetes is among the most insidious. If it runs its course, as it did with my father, it will shut down most bodily functions: mobility, sight, kidney, and finally the heart. More than 2.5 million African Americans have it, which is 80 percent higher than the disease's prevalence among whites. More than 9 out of 10 black diabetics have type 2, the version that develops in adulthood. Why some people get it and others don't is still subject to considerable medical debate, but most opinions fall into two camps: genes versus lifestyle.

The genetics theory is driven by the commonsense observation that adult-onset diabetes runs in the family--if your parents had it, you are more likely to as well--and researchers are frantically searching for a guilty gene. The lifestyle, or "conditioning," argument blames obesity and inactivity, both of which happen to be more prevalent among African Americans.

This same genes-versus-lifestyle debate applies to a range of deadly illnesses that disproportionately plague black America--and middle-class black America in particular. From heart disease to AIDS, African Americans are dying from preventable illnesses in disturbing numbers. The diabetes mortality rate is 20 percent higher for black men than white men, and 40 percent higher for black women.

Progressive convention says the problem lies in poverty: too many black people uninsured, too few with access to routine care. And there's certainly clear enough evidence of a link between disease and poverty. But what no one can figure out is why the problem is getting worse even as socioeconomic conditions are improving. How does a successful, educated, and well-insured man like my father die before the age of 60 at the hands of a disease that is totally preventable?

Here's where the debate turns political. If genes are decisive, then no one is to blame for the racial imbalance in Americans' health. If it's lifestyle that divides the sick from the well, then the problem is a matter of personal choice.