The Fly
In describing her own experiences in school, the author writes, "What I would later understand as high-effort coping never prevented me from feeling like a fly in the buttermilk, but it did allow me to find a place." The reference to the fly and buttermilk is a metaphor that describes the experience of being the only African American surrounded predominantly by whites. Her school experience recalls being the first Black student at a white elementary school in which she excelled in accomplishments.
The War
"Heather learned from her immigrant parents not to complain, not to look back, not to blame others, not to be weighed down by regret, but instead to put her head down, work relentlessly, and soldier ahead." The metaphorical imagery of carrying a heavy weight and being a good soldier refers to the upbringing of Heather as the daughter of a middle-class parents. Despite being raised with greater advantages than many other children of immigrants, however, Heather delivered a baby prematurely and significantly underweight just as she was herself. The implication is that were Heather the daughter of white middle class parents, her situation would be different because race does play a role in sub-standard health care. The metaphors subtly intimate that this racial division becomes a war for survival.
Hostages
Specifically referencing her school experience, but more generally observing the state of the racial relationships, the author engages a very specific and suggestive metaphor. "Fitting in demanded a kind of Stockholm syndrome trade-off; it meant absorbing the stereotype about Black people and communities, pervasive in every corner of American culture, that most white people accept as truth." The term "Stockholm syndrome" refers to the tendency of many long-term kidnap victims and hostages to develop a psychological bond with their abductors. The comparison here is to racism being a form of abduction.
Emergency C-Section
One really horrific case study examined in the book concerns a young woman whose prenatal treatment involved magnesium to which she turned out to be allergic. The road to natural childbirth took a left turn to an emergency C-section. "It felt like a Mack truck, maybe several of them, had had a complete accident on my uterus...And then like a chain saw came and shredded my stomach and yanked my baby out." The metaphorical imagery is as gruesome as it the severity of bad healthcare decisions by the doctors treating the young mother.
Weathering Stress
Arline Geronimus, Univ. of Michigan professor, was inspired by an ironic paradox within the healthcare situation among African Americans. "Geronimus, who coined the term `weathering,' chose this metaphor leaning into its double meaning. To weather means to wear down, but it also means to withstand, as in weathering a storm." The specific circumstances leading to the creation of this metaphor is that the very process of fighting against the racism which contributes to poor health can itself increase levels of the stress which leads to poor health which is likely to receive sub-standard treatment.
