Mama Might Be Better Off Dead: The Failure of Health Care in Urban America

Jackie Banes is the mother of the Banes household, whom Abraham describes as “the guiding light for the book, just as she is for her family” (xv). As the only healthy adult in her family, Jackie serves as a caretaker for everyone else in the household, including her three children, her husband, and her grandmother. As such, she takes on a herculean role within the book, and more importantly, within real life, juggling an impossible number of responsibilities and emotional burdens at the same time.

Resentment forms between Jackie, Robert, and Cora as she feels increasingly suffocated by her obligations to them. This resentment gives way to an even more complex web of emotions:

Jackie frequently talked about feeling guilty for all manner of supposed sins: for wanting time away from the old woman, for not taking her to the doctor, for considering putting her grandmother in a nursing home, for not putting her in a nursing home, for using part of Mrs. Jackson’s Social Security check for household expenses, for not visiting her enough at the hospital (162).

In this way, even though Jackie is not ill herself, the failures of the healthcare system still directly affect her wellbeing. The emotional toll that being a mother of three and caretaker to two adults takes on her is evident in her darkest confidences with Abraham. Indeed, the camaraderie between Jackie and Abraham shines through in many parts of the text because of the reverent way Abraham writes about her. In Chapter 10, she fiercely defends Jackie against critics who might be quick to judge her as a lazy mother for not having her children immunized: “Her strong sense of responsibility for her children shows just how far-reaching are the failures of the health system for poor children” (177). Depicted in this light, Jackie is the chief protagonist of Mama, a beleaguered yet resilient mother who finds time to bare her soul to the author for the greater cause of combatting healthcare inequity.

Robert is Jackie’s husband and the father of her two youngest children, DeMarest and Brianna. He was diagnosed with glomerulosclerosis at the age of 27 and subsequently underwent one kidney transplant. When the kidney transplant failed after several years, Robert was placed on dialysis treatment in the mornings three times a week. Against all odds, Robert is able to keep the treatment up at the same time that he holds a job, but as Abraham explains, “[o]nly one-third of all patients who dialyze at a clinic return to work once their treatments begin” (39), so his position in the workforce is undoubtedly tenuous. The delicate balance that allows Robert to maintain his familial obligations at the same time that he undergoes treatment is threatened by several key factors: the unsteady function of his private transportation to the clinic, his inconsistent standing at work, and not least of all, his drug use.

Robert’s dependency on cocaine places a strain on his marriage and a strain on his chances of receiving a second kidney transplant. He is aware of this and tries to hide the drugs from both his doctor and Abraham. He is, for this reason, the least accessible member of the Banes family to both author and readers: “Robert refuses to discuss drugs with anyone but Jackie and then only if she pushes the issue” (26-27). The boundaries placed around information regarding his drug use are, in effect, boundaries to getting a fully clear picture of Robert’s circumstances, although hints suggest the extent of the problem. Jackie’s indignation when Robert asks if she would give him one of her kidneys reveals the amount of faith she places in his ability to retain it: “Will you mess up my kidney? [...] I should spare my kidney for you?” (190). Just as doctors have eroded Jackie’s trust over time with their unreliability, Robert has done the same, and despite being in immense need, he cannot seem to garner charity even from his wife.

Cora Jackson is Jackie’s elderly grandmother (aged 69 at the start of the book), who raised her and now lives with the family. The course of her illness, a form of diabetes that results in the amputation of both her legs, is followed the most closely throughout the book. According to Jackie, Cora has two distinct personalities: the Cora before her illness and the Cora afterward. Abraham finds hints of this original personality sprinkled throughout the Banes family’s apartment, including in an old photograph: “Her burgundy-shaded lips are pressed together in a smile that is more cryptic, a bit flirtatious, perhaps. Cora Jackson looked like a woman who played her cards close to the vest” (54). This vibrant personality is also evident during her funeral service at the book’s conclusion, when large portions of the community show up to pay their respects.

Throughout her illness, however, Cora is grouchy, curt, and melancholic (as the title of Chapter 5 suggests). Her severely and suddenly limited mobility as a result of her amputations drastically diminishes her mental health, suppressing her previously vivacious spirit. As Abraham observes, “[T[he longer Mrs. Jackson was confined to bed, with nothing to do but think, the more a lifetime’s worth of hardships began to weigh heavy on her heart” (80). While doctors are concerned by her deteriorating mood, no concerted effort is made to alleviate the suffering that plagues her. Later on, in the days leading up to her death, she is reduced to utter silence, as Jackie looks on helplessly: “The only way Jackie could tell her grandmother was alive was by the sound of her breathing” (235). Thus, the gradual dampening of Cora’s spirit culminates in her final period of unconscious nothingness and constitutes the book narrative throughline. In the book’s final chapter, Cora is restored to dignity, dressed beautifully in her coffin, but only after she has died.