Synopsis:
Inspired by true events, Take My Hand is the story of a Black nurse in post-segregation Alabama who blows the whistle on a terrible wrong done to her patients.
Montgomery, Alabama, 1973. Fresh out of nursing school, Civil Townsend has big plans to make a difference, especially in her African American community. At the Montgomery Family Planning Clinic, she intends to help women make choices about their lives and bodies.
But when her first week on the job takes her down a dusty country road to a worn-down one-room cabin, she’s shocked to learn that her new patients, Erica and India, are just thirteen and eleven years old. Neither of the Williams sisters has even kissed a boy, but they are poor and Black, and for the officials handling the family’s welfare benefits, that’s reason enough to have the girls on birth control.
As Civil grapples with her role as their nurse, she takes India, Erica, as well as their father and grandmother, into her heart. But one day she learns the unthinkable has happened . . . and nothing will ever be the same for any of them.
Decades later, with her daughter grown and a long career in medicine in her wake, Dr. Civil Townsend is ready to retire, find peace, and leave the past behind. But there are people and stories that refuse to be forgotten. That must not be forgotten.
Because history repeats what we don’t remember.
Review:
Author Dolen Perkins-Valdez holds a Bachelors of Arts degree from Harvard College and earned her PhD at George Washington University. She serves as an Associate Professor in the Literature Department at American University and is Chair of the Board of the PEN/Faulkner Foundation. In that capacity, she visits public high schools in the District of Columbia to talk about the importance of reading and writing. Her first novel, Wench, examined the moral complexities of slavery through the stories of four enslaved Black women in the years preceding the Civil War. She followed that bestseller with Balm, set in the days following the Civil War, an exploration of the lingering trauma of the War and the end of slavery as the citizens of a bitterly divided nation worked to heal and reunite. Her short fiction has appeared in numerous publications.
Take My Hand is a fictional work based on actual events. In 1973, Mary Alice Relf, age fourteen, and her sister, twelve-year-old Minnie Lee, both mentally disabled, were surgically sterilized after their illiterate mother signed with an “X,” mistakenly believing she was authorizing the provision to her daughters of birth control shots. It was not an isolated incident. In the 1970’s, many poor women who received government assistance, particularly women of color, were coerced into agreeing to sterilization when threatened with a loss of benefits. The U.S. Congress established the Community Action Programs (CAPs) in 1964 to assist low-income households become self-sufficient. It was Alabama officials affiliated with that federal program who took the impoverished Relf girls to a doctor for Depo-Provera injections. But the drug had been banned, pending FDA approval. Nurses told the girls’ mother they would be given “some shots” and convinced her to sign a consent form that she could neither read nor understand. When the truth came to light, a social worker took the girls to the Southern Poverty Law Center, which filed a complaint on their behalf. The ensuing litigation brought to national prominence the issue of involuntary sterilization and Senator Ted Kennedy held hearings that led to guidelines being promulgated. Ultimately, those guidelines were ruled insufficient to prevent involuntary sterilization and the federal court condemned the practice, holding that federal funds cannot be used for involuntary sterilizations and enjoining the practice of threatening women with the loss of benefits if they refused to accede. Eventually, the Department of Health and Welfare issued acceptable regulations outlining when sterilization in federally funded programs is medically appropriate and authorized. “The case is considered a pivotal moment in the history of reproductive injustice, as it brought to light the thousands of poor women of color across the country who had been sterilized under federally funded programs.” In the wake of Relf v. Weinberger, the concept of reproductive freedom expanded to encompass both the right to have children and the right to be free from unwanted pregnancy.
Perkins-Valdez says that when she first heard the Relf girls’ story and became aware of the case, her reaction was “outrage. I couldn’t believe it and wondered why more people don’t know the story.” Her inspiration for Take My Hand was envisioning and wondering how the spirits of the Relf girls might want her to frame their story. She commenced three years of research and “everything” that she learned surprised her. The Relf girls were sterilized just one year after the shameful, four decades-long experimentation on Black Tuskegee men with syphilis came to light and marked the culmination of decades of eugenic policy — egregious and racist — including a push by Margaret Sanger to control the reproductive lives of Black women. She also discovered that reproductive justice has not been achieved in post-Roe v. Wade America. For example, in 2013, it was revealed that between 2006 and 2010, approximately 150 women were involuntarily sterilized in California prisons. In Tennessee, it came to light in 2014 that prosecutors were incorporating stipulated agreements for permanent birth control into plea bargains, and a whistleblower reported in 2020 that immigrant women in Immigrations and Customs Enforcement facilities were sterilized without consent.
Despite her extensive research, Perkins-Valdez could not find any accounts from the nurses who worked at the clinic in Montgomery, Alabama, where the Relf girls were sterilized. So she created Civil Townsend, a nurse, to serve as the lead character and narrator of the book. Perkins-Valdez wanted to understand what it would be like to be a nurse working at a clinic where such atrocities were taking place — how they could make sense of what was happening there and would react to such an incident occurring “on their watch.” The book opens in Memphis in 2016, with a sixty-six-year-old Civil addressing her daughter, Anne, who has just graduated from college. She says she must tell the story of India and Erica as a “reminder to never forget” and to lay “ghosts to rest.” Civil has learned that India is very ill and she is going to go visit her, but first wants Anne to understand how her “story is tied up with those sisters.”
The story then moves back to March 1973. Civil is only twenty-two years old, and has just graduated from nursing school and begun working at the Montgomery Family Planning Clinic along with two other young, new nurses, supervised by Linda Seager, a stern “white woman working in a clinic serving poor Black women.” Civil is the daughter of a local doctor who wanted her to go to medical school and join his practice. But Civil is idealistic and chose to be a nurse because in the medical hierarchy they “were closer to the ground. I was going to help uplift the race, and this clinic job would be the perfect platform for it.”
Early in the book, Civil reveals that she had an abortion in the spring of 1972 — before Roe v. Wade legalized abortion. Perkins-Valdez says including that event in Civil’s history frightened her because she had never included such a story in any of her prior work and she was scared about readers’ reactions. She had to research how Civil would locate an abortionist, where she would have the procedure, whether she would be provided with after-care, including pain medication, etc. The location she uses in the book is the site where abortions were provided illegally. But she concluded that Civil takes the job at the clinic in order to give women more reproductive freedom than she herself enjoyed. “It made sense that she would have been through that, because that part of the motivation for working at that clinic is so important to her,” Perkins-Valdez notes. “She doesn’t want the women to go through what she went through.” The decision to include that aspect of Civil’s history was the correct one because it enhances Civil’s motivations. It also provides context, dimension, and emotional depth to Civil’s story and, regardless of the reader’s stance on abortion, makes Civil more sympathetic because she thinks about her choice, the procedure, and what might have been. She is not yet at peace with her decision or her relationship with the father, even though she tells her daughter, “There is no greater right for a woman than having a choice, Anne. I exercised that right. Fully and consciously.”
Civil quickly discovers that birth control is an instrument of oppression of Black women. Clinic staff aggressively pressure them to use birth control and Depo-Provera, then an experimental drug, is being routinely given to clinic patients. At first, Civil assumes it is safe but is troubled to find out that it has not received FDA approval.
There is an outreach component to Civil’s duties and early in her tenure at the clinic she is assigned an off-site case. She dreads the journey out into the country to the Williams’ home. “Now when I say the country, I’m talking the country country. No running water. Outhouses. Unpaved roads,” she recalls. “Up close the structure was more of a wooden shanty than a cabin” with no telephone so Civil isn’t sure her patients are expecting her visit. But she meets Erica, age thirteen, and her sister, India, who is mute. They live in unimaginable squalor with their widowed father, Mace, who is just thirty-three years old, and his mother, Patricia, age sixty-two. “Walking into that house changed my life,” Civil relates. “And yes, it changed theirs, too. I walked right up in there with my file and bag of medicine, ready to save somebody. Little old me. Five foot five inches of know-it-all.” She discovers that India is being given birth control even though she is a mere eleven years old, is not sexually active, and has not even begun menstruating. And Erica, just two years older, insists that she has never even kissed a boy and admits that she bleeds all the time, a side effect of Depo-Provera. Civil is enraged. And resolved.
From that first meeting, Take My Hand focuses on Civil’s efforts to help the Williams family. She is young, naive, and ignores the medical protocols she was taught in nursing school, her involvement and relationship with the family members growing increasingly personal. She is determined to help them find better housing, unabashedly using resources available to her to do so, even as she recognizes that she is jeopardizing her career by not maintaining the requisite professional distance from the family. Her clinical practices are also risky. And she feels that her efforts are making a difference, but Ms. Seager will not be deterred, making the Williams sisters pawns in a dangerous game of power in which Seager asserts her will. What happens to the Williams sisters becomes “the greatest hurt of” Civil’s life — a watershed moment that impacts her, as well as the entire Williams family, and alters the trajectory of their lives and relationships.
Perkins-Valdez knew that Civil and the girls had to hail from different socio-economic classes. Indeed, college-educated Civil explains that she and her family “managed to live dignified in undignified times,” and she had advantages that the Williams girls did not, even though they still fought to survive “the humiliations of the Jim Crow life.” Perkins-Valdez recognized early on that she was writing a book about Black class dynamics and wanted to explore what it would be like for the two families to encounter each other. She does so skillfully, describing in detail the day-to-day details about the families’ lives and letting the images of their disparate living conditions illustrate how different their experiences of living in the same small area of Alabama has been. She also expertly allows their voices to effectively make the point that the two families are living in two different Americas, neither of which is a land of freedom or equality for persons of color or the poor.
Perkins-Valdez’s extensive research lends validity and depth to the powerful story, and her characters are fully developed. Perkin-Valdez relates their engrossing story with compassion and insight. Erica and India are clever, believable young women, as well as heartbreakingly sympathetic, and Mace, their father, is fascinating. He’s a man searching for a way to create a better life for himself and his family who has been beaten down by a system rigged against him, the death of his beloved wife, and his own flaws. Patricia, the girls’ grandmother, is wise and appropriately skeptical, but also loving and appreciative.
Civil is a woman looking back over a period of forty-four years, evaluating her life and her choices as she stands on the cusp of retirement. She has enjoyed a successful career and flourished as a mother, but news of India’s illness, along with contemplating the next phase of her life, compels her into something of an “apology tour” during which she meets with her baby’s father for the first time in many years and is reunited with the Williams sisters. Civil is as objective as anyone can be about her decisions and actions all those years ago, admitting her own faults and acknowledging that her life can be divided into two parts — before she met and after her involvement with the Williams sisters. “Now I know why I came on this trip. I needed to make my peace. Ain’t nothing like peace of mind, Anne.” Indeed. Perkins-Valdez’s treatment of the story is evenly paced, vividly credible, and utterly heart-wrenching, inviting readers to become deeply invested in Civil’s richly emotional narrative to see where she is finally able to reconcile the past.
Valdez-Perkins says she hopes that Take My Hand “will provoke discussions about culpability in a society that still deems poor, Black, and disabled as categories unfit for motherhood.” The book is both timeless and eerily contemporary given that the right to reproductive freedom is far from assured in the United State with the U.S. Supreme Court on the brink of overturning Roe v. Wade and many states are enacting laws that restrict or completely annihilate reproductive choice. Thus, in addition to being a beautifully crafted, absorbing, and thought-provoking tale that will surely be on lists of the best historical fiction published in 2022, it is also an important book that belongs in every history classroom. Because Perkins-Valdez correctly believes that “the power of the novel (and its readers!) to raise the alarm, influence hearts, and impact lives” is tangible.
Excerpt from Take My Hand
ONE
Memphis
2016
A year never passes without me thinking of them. India. Erica. Their names are stitched inside every white coat I have ever worn. I tell this story to stitch their names inside your clothes, too. A reminder to never forget. Medicine has taught me, really taught me, to accept the things I cannot change. A difficult-to-swallow serenity prayer. I’m not trying to change the past. I’m telling it in order to lay these ghosts to rest.
You paint feverishly, like Mama. Yet you got the steadfastness of Daddy. Your talents surely defy the notion of a gene pool. I watch you now, home from college, that time after graduation when y’all young people either find your way or slide down the slope of uncertainty. You’re sitting on the porch nuzzling the dog, a gray mutt of a pit bull who was once sent to die after snapping at a man’s face. In the six years we’ve had him, he has been more skittish than fierce, as if aware that one wrong look will spell his doom. What I now know is that kind of certainty, dire as it may be, is a gift.
The dog groans as you seek the right place to scratch. I wish someone would scratch me like that. Such exhaustion in my bones. I will be sixty-seven this year, but it is time. I’m ready to work in my yard, feel the damp earth between my fingers, sit with my memories like one of those long-tailed magpies whose wings don’t flap like they used to. These days, I wake up and want to roll right over and go back to sleep for another hour. Yes, it is time.
Two weeks ago, I heard the news that India is very sick. I’m not sure what ails her, but I take this as a sign that it’s time to head south. I know what it looks like. No, I am not going to save her. No, I don’t harbor some fanciful notion that she’ll be the first and last patient of my career. I have prayed about that. Please, Lord, reveal my heart to me.
I call your name, and you look back through the screen into the kitchen. You’re used to my hovering, though each year you need me less and less, and I mourn the slipping. Soon it will be just me and the dog, an old lady muttering in that rambling, crazy way owners talk to their pets when no one is around.
But before we both head into that next chapter, we need to talk. You and I always have been open with each other. As soon as you were old enough to wonder, I told you everything I knew about your birth parents. I told how you came into my life, about the gift of our family.
I told you the story of your parentage, but what I didn’t reveal was the story of your lineage. How you came to be. How you came out of a long line of history that defies biology. What I am trying to say is that your story is tied up with those sisters. The story of my welcoming you into my life, of my decision not to marry or bear children, is complicated. I have tried not to burden you, but I’m beginning to believe that not telling you the whole truth, letting you walk this earth without truly understanding this history, has done you a disservice.
I reach into the pocket of my dress and pull out the paper. Without opening it, I know what it says because I have memorized the address, mapped out the directions on my cell phone, and I know the route I will take. The car is gassed up, the snacks tucked into a backpack. The last of my carefully packed wardrobe capsules are squared off in a suitcase that sits behind the door. The only thing I have not done is tell you where I am going or why. You know a little about the sisters, about the case that engulfed the country, but you don’t know the whole story. And it is time for me to tell you.
“Anne?” I call your name again. This time, I wave you inside.
TWO
Montgomery
1973
There were eight of us. When I think back to the time I spent at the clinic, I cannot help but stumble over that number. What might have been. What could have passed. None of us will ever know. I suppose I will still be asking the same question when I’m standing over my own grave. But back then, all we knew was that we had a job to do. Ease the burdens of poverty. Stamp it with both feet. Push in the pain before it exploded. What we didn’t know was that there would be skin left on the playground after it was all over and done with.
In March 1973, nine months after graduation, I landed my first job at the Montgomery Family Planning Clinic. On the day I started, two other newly hired nurses, Val and Alicia, began with me, the three of us like soldiers showing up for duty. Hair straightened. Uniforms starched. Shoes polished. Caps squared. Child, you couldn’t tell us nothing.
Our supervisor was a tall woman by the name of Linda Seager. I swear that woman had three eyes. Nothing escaped her notice. Despite her stone face, a part of me couldn’t help but admire her. After all, she was a white woman working in a clinic serving poor Black women. Trying to do the right thing. And doing that kind of work required a certain level of commitment.
“Congratulations. You are now official employees of the Montgomery Family Planning Clinic.”
And with that, the training was over. One week. A fifty-page orientation manual, half of which concerned cleaning the rooms and the toilet, and keeping the supply closet organized. We had spent three days just going over that part. Long enough to question if we’d been hired as maids or nurses. On day four, we finally covered charting patients and protocol. When the more experienced nurses noticed our downcast expressions in the break room, they promised to help us in our first few weeks. We were in this together.
As we dispersed, Mrs. Seager pointed a finger at me. “Civil.”
“Yes, Mrs. Seager?”
She pointed to my fingernails with a frown, then retreated to her office. I held up a hand. They did need a clipping. I hid my hands in my pockets.
The three of us new hires squeezed into the break room and removed our purses from the shelf. One of the nurses nudged me gently with an elbow. She’d introduced herself earlier in the week as Alicia Downs. She was about my age, born and raised in a small town up near Huntsville. I’d known girls like her at Tuskegee, pie-faced country girls whose wide-eyed innocence contrasted my more citified self.
“I don’t think it’s real,” she said.
“What?”
She pointed to her own head. “That red helmet she call hair. It ain’t moved an inch in five days.”
“Look like a spaceship,” I whispered. Alicia covered her mouth with a hand, and I caught a glimpse of something. She’d been putting on an act all week in front of Mrs. Seager. Alicia might have been country, but she was far from timid.
“I bet if you poked a finger in it, you’d draw back a nub,” she said.
The other nurse glanced at us, and I rearranged my face. Val Brinson was older than me and Alicia by at least a decade.
“You crazy, Alicia Downs,” I told her as we walked outside. “She might have heard you.”
“You look at your file yet?”
I took a yellow envelope from my bag. I had been assigned one off-site case: two young girls. Nothing in the case jumped out at me other than wondering what on earth an eleven-year-old would need with birth control. According to the file, she and her sister had received their first shot three months ago and were due for the next one.
“You got anybody interesting?” she asked.
I wanted to tell her that was a dumb question. This wasn’t a talent search. Alicia had been trained as a nurse at Good Samaritan in Selma. She was pretty in a plain way, and there was a ready smile beneath her features. At one point, Mrs. Seager had asked, What do you find so funny, Miss Downs? and Alicia had answered, Nothing, ma’am. I just felt a sneeze coming on. Then her face had gone dull and blank. Mrs. Seager glared at her for a moment before continuing with her instructions on how to properly clean a bathroom toilet in a medical facility.
“Not really.” I didn’t know how much I was allowed to reveal about my cases. Mrs. Seager hadn’t said much of anything about privacy. “Two school-age girls on birth control shots.”
“Well, I’ve got a woman with six kids.”
“Six?”
“You heard right.”
“Well, you better make it over there quick before it’s seven.”
“You got that right. Well, I’ll be seeing you.” Alicia waved to me and I waved back.
I’ll be honest and tell you there was a time I was uppity. I’m not going to lie about that. My daddy raised me with a certain kind of pride. We lived on Centennial Hill, down the road from Alabama State, and all my life I’d been surrounded by educated people. Our arrogance was a shield against the kind of disdain that did not have the capacity to even conceive of Black intellect. We discussed Fanon and Baldwin at dinner, debated Du Bois and Washington, spoke admiringly of Angela Davis. When somebody Black like Sammy Davis Jr. came on TV, it was cause for a family gathering.
But from the very first day I met Alicia, she ignored my airs and opened up to me. As I watched her walk away, I knew we would be fast friends.
I’d parked a block and a half away on Holcombe Street to hide my car. Daddy had given me a brand-new Dodge Colt as a graduation gift, and I was shy about anyone at the clinic seeing it. Most of the nurses took the bus. Mrs. Seager had assigned me two sisters way out in the sticks because she knew I had a reliable set of wheels.
“Civil?”
Oh Lord, what did she want now? I turned to face Mrs. Seager.
“Might I have a word?”
“Yes, ma’am.”
She went back inside the building and let the screen door slam shut behind her. A gust of warm air swirled around me. I could swear that woman surged fire when she spoke. There had been scary professors at Tuskegee, so she wasn’t the first dragon I’d met. Professor Boyd had told us if we were so much as two minutes late, he would mark down our grades. Professor McKinney divided the class between women and men and dared us to even think about glancing over to the other side. That kind of meanness I could handle. The thing that bothered me about Mrs. Seager was that I always had the sense I could mess up without knowing how.
Inside the building, the reception desk was empty. I positioned my cap and smoothed the front of my dress before knocking on her door. She had taken the trouble to not only go back into her office but to close the door behind her.
“Come in,” she called.
The clinic had formerly been a three-bedroom house. She’d converted the smallest bedroom into her office. The other two were examination rooms. The old kitchen was now a break room for staff, the living and dining spaces served as a reception and waiting area. From the back of the building we could hear the roar of the new highway behind us.
Bookshelves lined one side of Mrs. Seager’s office, file cabinets the other. On the wall behind her desk hung at least a dozen community awards. Rotary Club Woman of the Year. Junior League Lifetime Member. The surfaces were clutter-free. On top of the desk sat a cup of pencils, the sharpened points turned up. She cradled a file in her hands.
“Sit down.”
“Yes, Mrs. Seager.” I took a seat. The window was open and a sparrow was chirping insistently.
“I understand your father is a doctor in town.”
I could now see that she was holding my employment file. When I tried to speak, I coughed instead.
“Are you sick?”
“No, ma’am.”
“Because in our profession we have to maintain our own health in order to help other people. You must rest and eat properly at all times.”
“Yes, ma’am.”
“Very well. So your father is a doctor.” She said this as a matter of fact.
I knew what she was about to say. The same thing my professors at Tuskegee had lectured when they discovered my father and grandfather were doctors. Your marks are impressive. Of course, as a woman, you have other issues to consider. Starting a family, for instance. You have wisely chosen the nursing profession, Miss Townsend. I never knew what to say when they sounded off like that. The beginnings of a compliment always ended up stinging like an insult. Usually, I mumbled something incoherent and wondered if I was just being too sensitive.
“Yes, ma’am.”
“We have been sanctioned by the federal government to execute our duties. We must take our mission very seriously. A wheel cannot work without its spokes. We are the spokes of that wheel.”
Alicia was right. The woman’s hair didn’t budge.
“What I’m saying to you, Civil, is that you are a smart girl. It’s why I hired you. I have high expectations of you because I think you’ll make a fine nurse someday. I don’t want you to go getting ideas.”
She had just paid me a compliment, but it sounded strange in my ears. “Ideas about what, ma’am?”
She frowned and, for a moment, I worried that my tone had slipped into insolence. “About your place in all this. You have to work together with your fellow nurses. Our mission is to help poor people who cannot help themselves.”
“Yes, ma’am.” I sat quietly, digesting her words. My daddy had made sure that I was educated not only in my books but also, as he had once described it, in the code that dictated our lives in Alabama. Knowing when to keep your mouth shut. Picking your battles. Letting them think what they wanted because you weren’t going to change their minds about certain things. It was a tough lesson, but I’d heeded it well enough to get some of the things I wanted out of life. Like this job, for instance. The woman is just trying to pay you a compliment, Civil. Show her you can gracefully accept it.
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