Thick: And Other Essays

The dream of striding with purpose while wearing high heels signified different things to McMillan Cottom at different times in her life. It could be tied to the high earning potential of someone carrying a briefcase, it could also mean she would struggle in love because succeeding in work meant being less soft. However, ultimately, she realizes that competence is her dream. Structural incompetence is the reality of people who cannot control their lives: people who get assigned last minute shifts, who have to work around other people’s schedules, and who cannot plan for the future. Black women are particularly affected by structural incompetence, which is rooted in racism, sexism, and classism, and the “the competency trap is a cumulative multifold iron cage of network effects in oppressive regimes” (81). She uses healthcare as her case study because it’s a bureaucracy based on standardized rules and experiences. It cannot be reduced down to individuals, but rather reflects larger patterns.

Black women receive worse medical care than other people. When McMillan Cottom is pregnant and experiences painful bleeding, she does not receive adequate treatment. She chose the clinic because it was in a wealthy area, and she presumed she would get better care. Her care is good until something goes wrong. The doctor dismisses her concerns, and she has to go through labor pains for a week. Once she is giving birth, she has to beg for painkillers. When the nurse is leaving the room after McMillan Cottom has given birth, she tells McMillan Cottom that the hospital couldn’t do anything to save the child because McMillan Cottom didn’t tell them she was in labor. McMillan Cottom is thus blamed for the death of her child. When she tells people repeatedly something is wrong, she is not heard because she is not presumed to be competent. For the medical professionals to take her seriously, they have to hear there is a problem from someone perceived as being competent. She links her experience to a broader pattern of denying proper care, writing, “Like millions of women of color, especially black women, I was churned through a healthcare machine that neglected and ignored me until I was incompetent” (85). McMillan Cottom is educated, married, and has insurance, all factors that point to competence. But her earned competence is undermined by her Blackness. She emphasizes this point by pointing to the experience of Serena Williams, one of the most famous Black women in the world. Williams has to use all of her celebrity and authority to convince a nurse that she needs treatment while pregnant. Black women without these resources have little recourse. To demonstrate this, McMillan Cottom turns to statistics:

In the wealthiest nation in the world, black women are dying in childbirth at rates comparable to those in poorer, colonized nations. The World Health Organization estimates that black expectant and new mothers in the United States die at about the same rate as women in countries such as Mexico and Uzbekistan. The high mortality rate of black women in the United States has been documented by the CDC, which says that black women are 243 percent more likely to die from pregnancy- or childbirth-related causes than are white women (87).

This is an example of McMillan Cottom’s methodology of thick description. She uses her personal experience as an entry point to a larger, structural critique. Her evidence includes both statistics and anecdotal evidence.