READERS GUIDE

A Conversation with Maria Smilios about
THE BLACK ANGELS


How did you first come across the story of the Black Angels and what made you decide to tell it?

In August of 2015, I was working as a developmental editor in the biomedical sciences for Springer Science & Business Media, where I spent my days poring over manuscripts about pediatric cancer, gastrointestinal illness, heart conditions, and uncommon diseases affecting the brain, eyes, and lungs. One day, I was working on a book about rare, often incurable, lung diseases when I came across the line “The cure for tuberculosis was found at Sea View hospital in Staten Island.”
 
Curiosity and a love of New York history compelled me to stop what I was doing and begin Googling. An article about the cure for tuberculosis at Sea View hospital in 1952 appeared and tucked within it were a few sentences about an African American woman, Virginia Allen, who belonged to a group of nurses called the Black Angels. For three days, I rummaged the Internet hoping to find anything substantial on the Black Angels or Virginia Allen, and when the search turned up nothing except immense frustration, I dialed the Staten Island Museum. This was on a Thursday. The woman who answered the phone told me that there would be a grand reopening of the museum that same weekend, and Virginia would be there talking about the Black Angels. Three days later, I took the Staten Island Ferry with my daughter and found my way to the museum.
 
I found Virginia standing beside a small exhibit. She was tall, serious, her presence commanding but inviting, and she wore a long, boldly colored dress. (I would later learn that Virginia embraced color in every aspect of her life—“What good is a life without color?” she told me.) But that day, she spoke only about the Black Angels, these nurses who boarded Jim Crow buses for New York and helped the city avert a looming public health crisis, who fought racism and redlining alongside tuberculosis.
 
Two weeks later, Virginia and I met in a café in Harlem Hospital, where she told me bits of her story. Every Wednesday for six weeks, we met in the back booth of the café and she told me more and more about her aunt, Edna Sutton, and the other Black nurses who came up from the Jim Crow South to work at Sea View and fill the labor shortage left behind by white nurses who had quit en masse. One day, she invited me to visit her home in Staten Island, the restored nurses’ residences, and Sea View, and asked me if I could tell their story.
 
There was no doubt I wanted to tell it.

The Black Angels’ story has survived in the oral histories of the Staten Island’s tight-knit Black community, but your book will be the first definitive, recorded account of their heroism. Why do you think a story this big and with such impact has yet to be told?

To start, this is a story about Black female nurses working in a New York City municipal hospital and caring for patients comprising the city’s poorest and most marginalized classes: the poor, the underhoused, the working class, the elderly, immigrants, and Black and brown communities. All these groups were—and in many ways, still are—seen as second-class citizens, pushed to the fringes of society. When they became sick with an incurable disease, the perception of them only worsened. Now, they were regarded as “morally bereft,” “sinners,” “filthy,” “incredulous consumptives”—only adding to their status as expendable burdens who didn’t matter to society. It would be years before our society saw their lives as valuable, even longer until we realized their stories were worth saving.
 
Another reason is that, historically speaking, our society has been conditioned to structure narratives about medical discoveries around male doctors and scientists; anyone else involved, most of the time, remains a silent bystander, either barely mentioned or never mentioned at all. But many more people are integral to the infrastructure of almost all medical breakthroughs, including assistants, students, lab technicians and, yes, nurses. Any discovery that focuses on a new vaccine or new medical procedure relies on patient information, and nurses are the ones who gather that information daily. Nurses know their patients better than anyone because they work at patients’ bedsides every day, treating them and contending with their families. But they never get the credit they deserve. The fact that the women in this story are Black women adds another layer: In the same way we are accustomed to reading medical discovery narratives that are male-centered, we are also predisposed to seeing Black women as part of the background—the silent laborers who always kept and still keep this country running.
 
Last, I imagine that part of the reason the Black Angels’ story has remained mostly confined to the Staten Island community is that it has survived primarily as an oral history. It’s easy to accept a historical narrative when no substantial archival material on the nurses exists and many accounts of Robitzek’s role in the cure do. For the Black Angels, their stories have lived on exclusively in the memories of their families, a few surviving trial patients, and Virginia Allen. It’s actually quite astonishing that we have nothing else because, the day that news of the cure broke, hundreds of photographers and journalists swarmed Sea View, though not a single one stopped to ask the Black nurses a question. In one iconic image from that day, a group of once incurable women can be seen jitterbugging in the hallway and behind them stand a row of Black nurses. The Black Angels’ story is a powerful testament to the ways oral history can challenge long-standing societal narratives.

Writing The Black Angels involved a grueling, eight-year research process. Describe what that research entailed for you. Did you learn anything that surprised you?

It was startling to learn that an entire class of professionally trained Black women within the Great Migration had been written out of history. These women helped desegregate the NYC hospital system, anchored the middle class in Staten Island, and played a vital role in curing tuberculosis, which ultimately changed the course of global history. And yet no one had ever written about them. That was astounding.
 
The research itself was all-consuming. Because this is an oral story, my exploration involved hours of conversation—on the phone, over email, and in person, on visits to New York City and around the country—with people who were connected to the nurses or patients in this story. Sometimes, someone would give me a name, and I would cold-call another person, then find myself sitting in their living room talking about Missouria or Edna or what it was like to live as a Black person in South Carolina in the early twentieth century.
 
The oral history aspect also required meticulous, arduous work in corroborating the stories that I was being told. I never wanted to negate what someone might have felt or remembered, but we all know that memory is fallible. Over time, it changes and fades, and this is a nonfiction book, so things needed to be verified. Through long conversations with my editor and agent, I concluded that I could verify dates, salaries, statistics, working conditions, and locations, but would not disavow anyone’s personal experience. Where I could, I corroborated their stories with historical fact. If, for example, Edna’s family told me that she enjoyed sitting by the window as she rode the elevated train from Harlem, city lists allowed me to see where she lived at the time, subway maps allowed to see which train she took, and archival photos and documents confirmed the route of the train, which neighborhoods it passed over, how much time it took to reach the ferry, what the interior looked like. And from this historical information, I could then place Edna on a seat by the window in the elevated train traveling down Ninth Avenue where she saw signs for ’mulsified beauty products and heard the din from Radio Row on Cortlandt Street when the doors opened.

You, of course, began writing The Black Angels long before COVID-19 brought epidemic disease back into the public consciousness. How did the current pandemic change the way you approached the Angels’ story?
             
I’m not sure if the advent of COVID-19 changed my approach to the book as much as it enhanced relevant themes, such as health disparities; failing and overcrowded municipal hospitals; patient populations comprised of immigrants and the poor; inequality in labor, especially with brown and Black women; and of course, living with a fatal disease. But what I’m certain about is that COVID gave me a palpable sense of what it was like to live with a deadly airborne virus. COVID haunted us, turned us anxious, and stirred our most potent fears in the same way tuberculosis had done for centuries.
 
In the end, living through the COVID-19 pandemic helped me to gain a deeper understanding of the nuances and challenges posed by health care inequalities. In America, inequity in health care has always existed, but, for the most part, it remains hidden unless you live it. COVID pulled back the curtain and exposed the reality of a health-care system that had been long broken, one designed to care for some but not others, and one kept together largely by underpaid brown and Black nurses. It’s no wonder, then, that the demographics most affected by COVID so closely reflected Sea View’s patient population. These groups received the least resources and medical care, then and now.
 
Beyond the parallels to the coronavirus pandemic, the Angels’ story also bears an unfortunate prescience in its treatment of pressing societal problems, from public health inequities to pseudoscience to systemic racism. What is it about such public health crises that occasion such seismic social reckonings, and what can we learn from the Angels’ story as we continue to pick up the pieces from the past few years?

First, I don’t know that America has ever really reckoned with any of its societal problems, be it public health inequities, systemic racism, and resources or safety nets for the poor and most vulnerable populations. Doing so would require us to reach way back to our nation’s origins and repair the lasting damage that slavery has wreaked on us all—which some in this country are still reluctant to do.
 
It’s through that context that we can consider the ways public health crises like COVID and TB disproportionately affect our society’s most disenfranchised citizens. At the same time, both crises revealed how we depend on the very same vulnerable population to survive via “essential labor”—largely low-wage, high-risk jobs. That is economic inequality, absolutely, but in a pandemic, that is public health inequity, too.
 
That convergence of economics and health rears its ugly head when we think about how public health crises reveal the literal cost that our lawmakers put on human life. In 1903, Dr. Hermann Biggs, New York City’s then-general medical officer, made the case for city health officials to build Sea View by claiming that it cost the city tens of thousands of dollars to keep the “incredulous consumptives” alive for one year. His appeal was approved six weeks later, and the city eventually staffed the hospital with underpaid and overworked Black nurses.
 
It is this intersection between economics and systemic racism that essentially strings my book together. There would be no story if in 1929, white nurses—who had the opportunity for advancement and mobility within the municipal hospital system—began quitting Sea View, leaving behind a gaping void in Sea View’s workforce. To fill that void, the city shifted down to the next level of qualified medical professionals: Black nurses from the Jim Crow South. But, after they were hired, they were never given the opportunities to advance within the system or the profession; they were paid less, denied promotions, and outright barred from joining the American Nurses Association until 1950. Evidently, city officials and health-care leaders didn’t care that these women were risking their lives to fight a deadly disease; for them, that was the whole point.
 
As far as the public’s rejection of actual science in favor of pseudoscience—well, what a fascinating and rich subject. Truthfully, I was confounded by how much quackery and chicanery was directed at tuberculosis: among the remedies touted were mice boiled in salt and oil; drinks of petroleum and turpentine; slices of dog fat; ground up human eyeballs; leeches and tanner’s oil (the runoff from slaughterhouses). While we register these “treatments” now as dangerous and frankly absurd, people flocked to them because they wanted to live, and most important, the remedies were cheap. It’s no wonder, then, that when former President Trump recommended bleach or horse tranquilizers as viable treatments for COVID, people believed him. When facing mortality, even the most enlightened person runs the risk of becoming desperate and scared, willing to make a Faustian bargain with any charlatan that promises life. But, in the end, the bigger question isn’t why people believe these charlatans, but why we don’t have a robust health care system to undermine such falsehoods.

As a non-BIPOC author, can you speak to how you approached topics of race and identity in the Black Angels’ story? How were you able to gain the trust of living Angels and their families, and what measures did you take to ensure your book honored their experience as well as those of Black Americans?

To ensure I honored the experience and legacy of their ancestors, I worked closely with the families of the Angels, conducting hundreds of hours of interviews wherein I asked their opinions on which stories might best represent a particular moment. I also shared what I wrote with them, not only for their input, but because I wanted them to be part of the greater process. This book is a collection voices, their voices, and without them the story could not have been told. I also worked closely with African American experts in medicine and history to ensure that the events and issues I was representing were as accurate as possible.
 
Part of earning the trust and confidence of the surviving Angels and their families stemmed from acknowledging my privilege as a white writer and just listening, without judgment or preconceived notions, to their stories. It wasn’t my job to alter or whitewash the profound injustices experienced by their community and by other Black Americans, but to tell it exactly as it was experienced. This is a major reason the book contextualizes the Black Angels’ story within the larger narrative of systemic racism and the struggle for civil rights, underscoring the obstacles these women faced while on the front lines fighting against a deadly disease. That the nurses prevailed in spite of these conditions makes their already remarkable story that much more extraordinary.

To read The Black Angels is to understand the brutal irony of this story: that the opportunity for these women to save lives at Sea View was only made possible by a fundamental disregard for Black lives. How does the Black Angels’ story serve as both a challenge to and a representation of the fraught relationship between Black Americans and a health-care system that has not always valued their lives or treated them as essential?
 
The Black Angels’ story of course fits into a much larger historical narrative wherein the American health-care system has historically disregarded Black Americans as secondary or expendable—or worse, not seen them at all. There are a confounding number of examples highlighting a medical system that has physically and psychologically harmed, and in many instances maimed or killed Black people in the name of “science.”
 
The abuse of Black bodies of course began on slave ships, where enslaved people were whipped or thrown overboard if they didn’t take medication or food they were offered. After they were sold, their bodies became property, and their fates were handed over to enslavers who often ignored their illnesses or, many times, forced them take medicine for entertainment. (In one account, an enslaved woman was forced to consume castor oil, a purgative, until she became sick. After that, her enslaver placed her into a wooden box covered with stones and left her overnight, effectively burying her alive in her own vomit and excrement.) Slaves also became subjects of medical experimentation: in the 1840s, a South Carolinian physician, Dr. J. Marion Sims, operated on dozens of enslaved women without their consent in the hope of finding a cure for vesicovaginal fistula, a condition usually resulting from complications of childbirth.
 
The legacy of slavery, as with much of our country’s institutional framework, set the precedent for the mistreatment of Black bodies in the centuries to follow. Perhaps the most egregious cases of medical racism and abuse in our country’s history came a century later with the infamous Tuskegee Syphilis Study. Originally called the Tuskegee Study of Untreated Syphilis in the Negro Male, the experiment spanned the years from 1932 to 1972, and was sanctioned by the United States Public Health Service and the Centers for Disease Control and Prevention. During those forty years, more than four hundred Black men were recruited and used as test subjects for “bad blood,” a term that referred to a variety of ailments; in reality, the government wanted to “observe the natural history of untreated syphilis” in Black men. The study violated the bioethical principles of respect for autonomy, given that participants were not asked for their consent; and of nonmaleficence, given that antibiotic treatment was withheld from participants even after it had become readily available.
 
Whereas Tuskegee withheld treatment from Black patients, other scandals involved issuing treatment to Black communities, with untested and unsafe medications. In 1937, Dr. Samuel Massengill—best known for the Massengill douche—created Elixir Sulfanilamide, from sulfa, to treat strep and other infections. While sulfa had been used in pill form, no one had managed to make it into a liquid because it was undissolvable. Massengill had his chemist add diethylene glycol (DEG), a poisonous agent used in antifreeze, to create a liquid form the antibiotic. Then, without testing it to determine its efficacy or safety, they distributed it across the country, where it was prescribed in rural and poor communities to catastrophic effects: Elixir Sulfanilamide elixir sulfanilamide killed over one hundred people, more than half being children and people of color.
 
It’s no wonder, then, that mistrust of the health-care system persists in many communities of color. A recent example lies in reticence of Black Americans to take the COVID-19 vaccine, despite being one of the demographics most affected by the disease. Likewise, the fact that so many of Sea View’s patients in the 1930s, ’40s, and ’50s were Black men and women reflects tuberculosis rates, which were three times higher amongst Black New Yorkers than white ones—both situations, again, being the result of intersectional, systemic inequality. We have only to look to history—in stories like the Black Angels’—to understand why these conditions persist. I hope that my book will help provide a lens through which we can look at the present and consider how we can ensure all Americans have access to ethical, equitable, and affordable health care.
 
You are also a former Biomedical Sciences editor. How did your experience prepare you to write a book like this? In what ways did the writing process differ?

My years of working in the biomedical sciences were helpful in that, by the time I began writing this book, I was already comfortable talking to doctors, familiar with many medical journals, and literate in medical language. It was easy for me to break things down in layman’s terms for a general audience, because I wanted all of it, including the science, to read like a novel. When writing, I recalled all the manuscripts I had read that used easy language to describe hard scientific concepts.
 
Beyond working as an editor for the biomedical sciences, I spent three years volunteering at Boston Children’s Hospital on the pediatric bone marrow transplant unit. It was there, through being and talking with families and nurses, that I got a deeper insight into what it means to work as a nurse on a ward with a disease that many times isn’t curable.

Were there any books, movies, or other media that informed the writing process of your book?
 
Yes, way too many to list! Some of the top authors that I read and reread: Isabel Wilkerson, Thomas Mann, Virginia Woolf, Langston Hughes, Zora Neale Hurston, Countee Cullen, Jean Toomer, W. E. B Du Bois (especially The Souls of Black Folks), Octavia Butler, and Wallace Thurman. When describing Sea View’s vast complex of buildings, I read Shirley Jackson’s The Haunting of Hill House and Ann Patchett’s The Dutch House, both of which do an extraordinary job of rendering the building as a living, breathing entity. I drew inspiration from Samuel Beckett’s structure of a closed space narrative when writing about Sea View and its wards, and from Toni Morrison, that ever-present ghost whose writing informed how I wrote about Edna’s father.
 
Sadly, there are not many patient narratives about tuberculosis aside from Betty MacDonald’s The Plague and I, and so I turned to other medical narratives, memoirs, and fiction: Audre Lorde’s The Cancer Journals; Suleika Jaouad’s Between Two Kingdoms; Paul Kalanithi’s When Breath Becomes Air; poet Marie Howe’s What the Living Do; and even Maggie O’Farrell’s Hamnet. I read many newspapers from that time period, which were golden for capturing both the way people talked about the disease and how they described everything from cars to coats to parks.
 
Moviewise, I watched The Shining repeatedly for the visuals, especially the beginning. I wanted Sea View to emerge with same kind of looming, terrifying, and awe-inspiring grandiosity as the Overlook Hotel, and similarly I wanted it to become a character whose walls hold history and secrets.
 
In terms of music, I listened to a lot of Radiohead, not only because I love them, but because Thom York has a way of singing about the brokenness of society in a way that sounds melodic and hopeful. Writing about such heavy topics needed language, a rhythm, a cadence that sounded poetic and hopeful. I also listened to the whole of U2’s The Joshua Tree, which tells this haunting story of America in a beautifully strung together-series of songs.

What’s next for you?

Writing another book. I came across some fantastic stories in my research and so I’m hoping one pans out.
 
But I also hope to keep talking about the Angels and their incredible story. With publication now around the corner, I anticipate more nurses, families, and patients will come forward and fill out the story in greater ways. I also want to use the book and the lessons from the nurses to add to the larger, much needed conversations about health inequities, systemic racism, communicable illnesses, and front-line labor, especially in nursing.
 
 
Discussion Questions
 
1.      How much did you know about tuberculosis before reading The Black Angels? Were you surprised to learn that it’s still the number-one global infectious disease killer in the world?
2.      Although the tuberculosis epidemic occurred in the United States almost a hundred years ago, the world has faced another disease-related threat since then—COVID-19. Discuss the similarities and differences in how society and the medical field responded to these pandemics. How did people treat “essential workers” then versus now? How do you think the Black Angels would have been treated if the tuberculosis epidemic occurred in America today?
3.      What do you think makes the Black Angels’ story so powerful? Was there a fact you learned about these courageous women that particularly resonated with you? Without the Black Angels, what do you think the health-care system, and world, would look like today?
4.      Maria Smilios crafted the story of the Black Angels and their experiences using a narrative, almost novelistic approach. How do you think this style of writing aided in painting the picture of these women’s lives, this time in history, and life at Sea View Hospital?
5.      What was your favorite chapter in The Black Angels and why?
6.      Although this is a book about the Black Angels’ fight to help cure tuberculosis, this is also very much a story about the racism and segregation that plagued the nation. Were you surprised to learn how integral the Black Angels were in the fight for equality in health care, given that their stories were hidden until now? How did the unjust political and social climate shape each of these women’s lives day to day, and in their ongoing fight for a cure?
7.      If you could cast each of the Black Angels in a movie, who would you choose to play each person and why?
8.      In what ways do you think society has progressed in the fight for equality in the workplace, and in what ways do you think we still have a long way to go? If you were one of the Black Angels during their time, how do you think you would have handled the obstacles they faced?
9.      If you could take away one life lesson from the Black Angels and their journeys, what would it be and why?
10.   Upon establishing the National Association of Colored Graduate Nurses, the fifty-two nurses who formed the national organization to ensure equality in health care came up with a motto: “Not for ourselves, but for humanity.” What does this saying mean to you, and how do you think each of the Black Angels embodied this idea?