Who Bleeds American Blood?

My mom says giving blood is the most patriotic thing she does. Less than a hundred years ago, she would have been banned from the blood bank. (An excerpt from Mitchell S. Jackson's Survival Math.)

Here’s rough copy of a call between Mom and me:

“Hey, Mom? What’s good?” I said.

“Oh, it’s goin,” she said.

“Goin not so great by how you sound,” I said.

“Well, I’m tired,” she said. “Just came from donating, and oh Lord, it takes a lot out of you.”

“Donating,” I said. “You still donating. What for?”

“Why else, Mitchell? Because I need it,” she said.

“No, you don’t,” I said. “How much do they pay you anyway? Matter fact, never mind. Whatever it is, I’ll give it to you not to go.”

“But that’s not your place, Son,” she said. “This is where I put myself, so I do what I have to, till I don’t have to. You know what I say, we can do for a day what we can’t do for forever.”

As it turns out, my mama had been donating plasma for much more than a day. We’re talking selling pints of her blood parts for near on decades. For those years, twice a week she’d catch a ride or take the bus or the light rail to a for-profit plasma center, a space built to resemble a hospital ward or medical clinic — cool walls, tiled floor, medical posters, workers in lab coats. She’d check in and submit to a process that consumed a couple of hours. Staff would query her about her health, check her vitals, send her to a room full of vinyl beds, clean her venipuncture site, tell her to pump her fist to help the extraction along, jab a sterilized needle in her median cubital vein, and suck a pint or so of whole blood out of her with a plasmapheresis machine. That machine would separate her plasma by centrifuge and return her red blood cells, white blood cells, and platelets to her. Up until a few years ago, the extraction was followed by the benevolence of pumping a saline solution back into her to help her recover, but in recent times, they’d have her drink water or Gatorade and wait ten or fifteen minutes, while meantime, they loaded her recompense (50 or 60 bucks is the current market rate) on a prepaid debit card. After all that, Mom would slug off to destination X, which was often home, wherever home was that season, month, week since Uncle George, her middle brother, got her — or should I say us, cause we all felt it — kicked off Section 8.

Our proud nation stockpiles so much plasma, industry folks have taken to calling us the OPEC of the plasma business.

It’s wishful to claim my mama was duped, that she shuffled into that first center with the single virtuous intent that her blood was a gift to a person in need, that she expected no more in return than a Samaritan’s joy. But I got to be straight with myself if no one else, and the real is, my mama ain’t no Mother Teresa. Safe bet she wouldn’t see heroics involved in losing her plassing innocence. Mom lost that riding the bus from her gig in the boonies to the downtown bus depot. Rides during which she kept seeing a billboard advertising the money to be made from anteing plasma. Let Mom tell it, this was around the time she was lightweight scheming on a way to make some extra loot without getting a second job. She says day after day after day after day she’d see the billboard and then one day decided to stop in and see what was what. Those first umpteen times she plassed for extra income, but at points — truth be told, more points than my racked mind can stand — her plassing has been her lone source of income. These days, Mom says she can’t recall the name of the place she first plassed, claims that she ain’t set foot in a center in months. She says her last time was at an outpost of an outfit named CSL Plasma.

Give my mama credit, please, for not getting down with a slouch business. CSL is, depending on whose word you take, either the first or second biggest player in the plasma protein therapies business. And best believe it’s BIG business. I’m talking an annual $4B in 2008 (capital B as in billion) growing to $11B in 2014. CSL Plasma of Boca Raton, Florida, is a division of CSL Behring, a plasma protein biotherapies company out of King of Prussia, Pennsylvania. CSL Behring is a member of CSL Limited of Melbourne, Australia. The other major player is Baxter International, out of Deerfield, Illinois. The rest of the industry’s big four, or what the FTC has called a “tight oligopoly,” include Grifols of Spain, and Octapharma of Switzerland.

But it don’t much matter which country the company calls home. If they do business in my mama’s home country, they collect up to twice a week, more than any other first-world nation allows. Our proud nation stockpiles so much plasma, industry folks have taken to calling us the OPEC of the plasma business. But before the US was the OPEC of world plasma, before the industry amounted to capital-B billion-dollar big gross, the business of blood transfusion wasn’t enterprise at all.

Blood banks didn’t exist in the early part of the last century. Doctors instead transfused blood straight from the donor to the donee. Since the donor had to travel or hoof to that donee, the British began calling the program Donors on the Hoof, AKA Blood on the Hoof. In 1921, a man named Percy Lane Oliver of the London Red Cross organized the London Blood Transfusion Service — the first citywide panel of health-screened blood-doning volunteers. Five years later, Oliver’s service received the backing of the British Red Cross Society and developed into the British Red Cross Transfusion Service, an organization that serviced the whole country.

In the US, researchers were studying blood in an attempt to comprehend how it changed under different conditions and how those changes affected its efficacy when used. In 1929, prominent New York hematologists founded the BTBA (Blood Transfusion Betterment Association) to supply reliable, tested donors on demand as well as funding to researchers. A decade later, September 1, 1939, Hitler’s Third Reich invaded Poland and provoked World War II. The ensuing need for plasma in treating wounded Allied soldiers for shock, as morbid as it sounds, was a boon for blood bank research. The next year, 1940, the president of the burgeoning BTBA called a meeting of medical professionals, military leaders, and businesspersons. That collective agreed that, despite plasma collection being in the experimental stage, enough was known to justify an effort to amass large amounts, and also that testing America’s competence in supplying plasma to the armed forces of our allies would be of service to the country’s national defense.

Those wartime benefactors were fueled by a love of country, by the belief that responding to the Red Cross’s pitch to aid wounded soldiers was a lofty form of patriotism.

That same year, Dr. Charles Richard Drew (the first black to earn a doctor of medical science degree from Columbia University) helped set up the first blood collection bank while working as a young resident at New York’s Presbyterian Hospital. Dr. Drew, who would become known as the “Father of the Blood Bank,” and his mentor went on to help launch the pilot program that became the first Red Cross Blood Donor Center of the World War II blood plasma program.

The initial centers in that program were, by and large, concerned with gathering and sending dried or liquid plasma, rather than whole blood, to Allied soldiers. From the get-go, the centers had trouble fulfilling demand, trouble, that is, until Japanese fighter planes sneak-attacked a US naval base and forced us into the war. The spike in donors post–Pearl Harbor makes perfect sense. Those wartime benefactors were fueled by a love of country, by the belief that responding to the Red Cross’s pitch to aid wounded soldiers was a lofty form of patriotism. Unlike my mama, who acted over fears of finite ducats, the early donors gave of themselves with no prospect of pay. Or rather, their profit was the patriot’s joy of supplying what might’ve been the most precious substance to soldiers fighting to preserve and propagate American ideals.

Facts: Me and my mama ain’t rapped one bit about American ideals nor patriotism; neither can I recall a single serious debate on politics. But since I’d goaded her into dialogues on her blood donating, I figured this was the chance — said, if not now, then when?

Another time, another call:

“So tell me, what’s your idea of a patriot?” I said.

“Hmm. I’d say a patriot is someone who believes in their country, who’s loyal to their country,” Mom said. “A patriot is someone who, whether America is right or wrong, they ride with them. Someone who’d rather live in America than anywhere else. Come to think about it, a patriot is almost like being a mom.”

“Almost like being a mom?” I said. “Okay, let me hear you explain this one.”

“Because as a mom, sometimes you know your child is wrong, but you still stand by them. You stand with your child through the good and the bad until the final outcome,” she said. “Some people see America as a mother. But what if it’s the other way around? What if America is the child the patriot must protect?”

“Then I guess that means you’re a patriot?” I said.

“Well, I wouldn’t say that,” Mom said. “But I will say donating is about the most patriotic thing I do. Cause even though I do it because I need the money, I’ve got to believe that what I give will be put to good use. Shoot, they can’t pay you enough for no body fluids. That’s priceless.”

Priceless — every damn part of my mama’s blood — and don’t no one forget it. For fact, it’s both priceless and equal in biology to everybody else’s on earth. But for some her blood was not, could not, and will never be equal to the 20th-century compatriots who marched into those first Red Cross hubs during WWII.

For a great many those donors bestowed more than human blood.

They gave American blood.

American blood was born on March 5, 1770, on colonial Boston’s State Street. American blood is made of what George Mason declared as man’s natural rights: “enjoyment of life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety.” American blood is part of Thomas Jefferson et al.’s self-evident truths: “all [white] men were created equal” and owners of “inalienable rights.” American blood is Walt Whitman’s America: “Centre of equal daughters, equal sons, / All, all alike endear’d, grown, ungrown, young or old, / Strong, ample, fair, enduring, capable, rich, / Perennial with the Earth, with Freedom, Law and Love.” It’s John O’Sullivan defining the country’s predestined quest for land. American blood is made of those beloved two-crusted apple pies invented by the Pennsylvania Dutch and ratted blankets stitched to quilts to keep out the cold. It’s James Truslow Adams’s defining a “dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.” It’s old and glorious and star-spangled. There are atoms of McCarthyism in American blood, as well as FDR professing, “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have little.” American blood, as JFK once did, asks “what you can do for your country.”

But American blood seldom, if ever, asks, as writer Amy Hempel once did, “Aren’t we all ... somebody’s harvest?”

For all her years as America’s harvest, my mama, one of the Americans with little, ain’t never supplied one drop of American blood. She could not. To do so she would have to believe in the principles and guarantees of those Dunlap Broadsides, trust that her home is the center of equal sons and daughters. In order for Mom to bleed American blood, she would have to convince herself that what she calls “priceless” is valued in this great homeland of free and brave.

But most of all, to bleed true American blood, my mama would have to be white.

In what’s a cold-blooded fact of our great nation’s history, there was a point in time when my mama’s mama and the adult Negroes of her era were banned from blood bank contributions. And check this: Though he was a catalyst for blood donating and given prime opportunities by powerful white folks, not even the fair-skinned Dr. Drew was allowed to break that ban. The policy, of course, didn’t sit well with the black press, the NAACP, and Negro sympathizers (tell me why, please, we seldom if ever call them empathizers?), so they took to protesting. Then in 1941 the Red Cross announced they’d accept black blood.

Accept it and segregate it.

I’ll call that apartheid blood.

The era of apartheid blood collection aligned with the dying days of Jim Crow, which means pre–civil rights, which how I see it, ain’t that long ago. But on the other hand, apartheid blood is based on ideals that form the bedrock of American patriotism. Patriotism, American patriotism, was the not-long-deferred dream of the Loyal Nine and Sons of Liberty, dreams that, we could argue, became, as my homeboys say, “official tissue,” when those 56 men signed the Declaration of Independence. They risked, by virtue of that vow, beheading as punishment for dishonoring the crown, their financial health, their physical health, and the safety of their loved ones — outcomes that attest to their passionate commitment. But as historian Sarah J. Purcell points out in her book Sealed with Blood, American patriotism took hold in the revolution that ensued from that declaration.

Dr. Joseph Warren was a surgeon, Harvard grad, and husband of an heiress, president of the Provincial Congress of Massachusetts, leader of the Sons of Liberty, a Masonic Grand Master, and a popular political speaker. Purcell argues that when Warren was shot in the face at the Battle of Bunker Hill, he became the first national war hero and great patriot.

Apartheid blood is based on ideals that form the bedrock of American patriotism.

Warren’s death was commemorated and memorialized again and again with speeches, almanac entries, poems. And those tactics, while setting precedent for the kind of mythologizing men of means would receive, helped a newborn country define its vision of its most esteemed citizens: not only men who were willing to pay the highest price for the ideals of America but pedigreed white men who were willing sacrifice their lives.

Those men, over the ages, have proven themselves idealists who desire to build America’s ethos. Those men have been moved to action on behalf of their homeland. They are territorial and proud to the point of hubris. The patriot, ripe for indoctrination, places high value on regarding the state over the self and believes one can die a myth if death occurs in service of country. Perfect countryman that he is, he hopes he’ll bleed thick ichor from a war wound suffered defending his mighty flag. This nationalism has proliferated by symbols, photographs, speeches, news, fine art, fiction, subjective-ass history, et cetera, and since early cinema, via Hollywood’s beloved war films.

Mom’s quick to profess her hate of war flicks, to argue they glamorize blood and violence and suffering and for no worthwhile end that she can suss. Though I’m no blue blood and would never claim myself a dream-believing apple pie–eating quilt-making flag-waving “Star-Spangled Banner”–singing American, I will admit to indulging in a few World War II flicks and can imagine a scene like the one below — it of a sort I’ve never witnessed on-screen — about the madness of apartheid blood:

One proud member of the Old Breed, a Mississippian named Skip, is lying in a field hospital somewhere in the jungles of Guadalcanal with his fatigues cut open and a corpsman working to stanch his gushing gut. Outside the tent flying insects big as mammals, incessant rain, and cracks of lightning. Outside the tent, a gun-storm of Arisaka rifles and Brownings and M1 carbines and Springfields and grenades. Inside the tent, the sacred moans of one of Mississippi Skip’s wounded comrades. A flustered doc checks Skip’s systolic pressure, notes it’s 100 and dropping, and sends a corpsman rushing for a bag of dried plasma. In what could be called a miracle, Mississippi Skip (Is there a home state more apt as a namesake?) musters the strength to ask if that package of dried plasma comes from nigger blood. The corpsman eyes the label and nods affirmative. Then, guts still hemorrhaging, Skip says, “Don’t put that nigger blood in me. I’d rather die!” The doc attends Skip some more while the soldier blinks and gasps and cries for his mama. The moment before Mississippi Skip’s eyes fall shut eternal, he murmurs, “God bless America.”

One day in the late 1980s Mom got a call from Uncle George. He called frantic after returning from work to find his crib emptied, by his woman and her mother, he assumed, of almost every single thing of value. Mom drove the Interstate Bridge into Vancouver, with my infant brother Adrian, the youngest of her three sons, strapped in the backseat of her brown-and-tan Mercury Montego MX Brougham. Mom motored to her brother’s assistance carrying on her person the $1,700 paycheck she’d earned from her job as a nurse’s aide. Mom met her discomfited middle brother (Uncle George was an emotional sort) at his looted apartment and, when she couldn’t console him, offered to help him locate his woman and the belongings he believed she pawned. They checked the nearest pawnshop first and found a couple of his things, a discovery that inspired hours more of hunting for sign-the-second of a possession and-or sight-the-first of his woman. Meanwhile Mom, who was against lugging her infant boy in and out of a car, trailed Uncle George in her Montego, and in time began urging him to abandon his search. Unc wasn’t hearing none of that, though, so Mom, in the end, had to leave him.

She arrived in Portland belated for bank hours but not mall hours, and since Mom’s motto has been shop as soon as bucks touch her palm, she cruised to the check-cashing store and huffed inside with my baby brother wedged on her hip. The second she got inside, she peeped a pair of suspect dudes stealing glances at her. Mom, ever vigilant, requested the teller hand her the bills minus the custom of counting them aloud. Mom carried my toddler brother and her uncounted bucks out of the check-cashing store and into her car — head swiveling the whole time to see if the furtive twosome or anyone else followed. She strapped my brother in his seat and stuffed the bills in her bra and socks and would’ve drove straight to the mall if she hadn’t promised my great-uncle John, the last of Mama Edie and Bubba’s adopted children, that she’d pick him up from a friend’s place. That friend’s place (major side-eye to this) was the infamous Mallory Court apartments. Mom pulled up to the complex, and given this was that prehistoric epoch before cell phones, she honked her horn and waited for my great-uncle to come jittering out of a building. He didn’t. In the meanwhile, my baby brother fell asleep. Mom idled with no sign of Great-Uncle John. She tarried until she was at risk of the mall closing, and since she wasn’t about to forfeit a chance to blow a paycheck, she climbed out, locked my snoozing brother inside in his car seat, and hustled into the complex to find the address Great-Uncle John had given her.

Mom wasn’t more than a few steps into the apartment’s courtyard when somebody pushed her down and snatched at her purse. Feisty, she fought back. And that’s when the dude started whooping on her something vicious. “HELP! HE’S ROBBING ME! HE’S ROBBING ME! SOMEBODY PLEASE HELP!” she wailed to the dozen or so witnesses, not one of whom intervened. The man beat and stomped and kicked Mom until she believed she would die, until she felt the lone way to stay alive was to play dead. So, dead she feigned until he stopped, until the crowd dispersed, until all she could hear was the thrum of her heart. She waited longer still before she got up and hobble-winced back to the car, with blood leaking from her head, face, and who knows where else. Thank God, Great-Uncle John was leaning against the Montego, a guardian of sorts over my slumbering baby brother.

The next time I saw my mother, which was either that night or the next morning, she was limping like she might need a bionic knee, painted with scrapes and bruises, and had a raw gash beneath her eye that should’ve been stitched but never was.

There are countless ways to be bloodletted in this republic, and I pray it doesn’t happen again to Mom in the street, hope too that she’s sold the last parts of her blood to a megacorp. But who knows, maybe one of Mom’s pints spared a soldier in Iraq or Afghanistan, will aid a wounded Mississippi Skip in Syria. If Mom submits to plasmapheresis again, perhaps her blood parts will treat a burn victim or hemophiliac or kid with HIV. Maybe when it’s time to give account in her church, our church, there will at least be that.

Another one of our calls:

“What else can you tell me about donating? I want to make sure I didn’t miss nothin,” I said.

“Oh, I don’t know, Mitchell,” she said. “I think I’ve pretty much covered it. But if you really want to know, you’ll go see for yourself.”

“Me, donate? No way. I can’t do that. I can’t let them folks stick me. You know I’m scared to death of needles.”

“So was I,” Mom said. “But I guess that means you don’t want to know that bad.”

“That’s not true,” I said.

“Well,” she said.

“Where’s the best place for a CSL Plasma center?” is the question I ask myself. Is it Lake Oswego, the richest neighborhood in my city? Or is it the Pearl District, in a renovated warehouse that costs the adjusted net worth of a founding father? Should it be in West Linn, where the median household income is near six figures? It makes sense to me to open a branch in one of those wonderlands, out where there’s unassailable evidence of America the Beautiful, the virtues of American patriotism, out where reside the favored citizens who could bleed American blood. It seems sensible to put it right smack in a neighborhood where an appreciative congregant of The Church could wake up on a Saturday, don a flip-collared polo shirt and khakis, drive his weekend ride mere blocks, and ante a pint of plasma for dogma’s sake.

Now there’s a win-win-win if there ever was one.

Truth: The CSL my mama once frequented ain’t nowhere near suburban life. It’s located out on 162nd Avenue and Glisan — The Numbers.

One morning, I wheeled a rental car out there from Northeast. The first thing I peeped when I pulled into the lot was a cigarette outpost the size of a shack. The roof was decaled with cartooned cigarette packs and the words “SMOKE 4 LESS” in leviathan. Its walls were plastered with tobacco posters and price specials. The rest of the lot was near full with cars. A dented Jeep Cherokee. An old Chevy pickup with a U of O sticker in its back window. And more Saturns than I’d ever seen in a parking lot that didn’t sell them. I circuited the lot, spied a man sitting against the building with his face pressed into his knees. Saw a pair of twenty-somethings strapped with backpacks skulking near the entrance of CSL — the guy tugging a mangy German shepherd; the woman dragging one of those dogs that don’t never look grown — and keep right on past it. A dude I recognized from high school rolled through the lot in an old-school Oldsmobile with his trunk BOOM-BLAPPING!

Damn near everybody looked as if surviving to next week wasn’t foregone, a vision that made me wonder if Mom had ever slogged through the doors wearing her desperation in plain view.

The second I ducked inside the center, I was struck by the dread of being outed as an intruder, by the feeling that someone I knew would spy me and spread news of it on a neighborhood wire, and that that news would birth the rumor I’d fallen on hard times, or worse, dog me as a mandate to explain my motive. The room, in a stroke of good luck, was peopled with strangers: A frowning girl with her shirt hiked up over her belly. A slim guy wearing an oversized T-shirt, jeans from another era, and his socked feet crammed in slippers. An older dude donning a neon T-shirt and checkered shorts with his hair blown every-which-way. And damn near everybody looked as if surviving to next week wasn’t foregone, a vision that made me wonder if Mom had ever slogged through the doors wearing her desperation in plain view. From what I hoped was an inconspicuous distance, I read posters and small placards hanging from the textured cream-colored walls. From behind a counter, worker bees in lab coats and rubber gloves dropped what resembled needles into metal trash cans lined with plastic. One of the workers nodded, what’s up, and in an instant, I singled him out as someone who might assist.

That dude rambled up to the counter. He wore a white shirt with rolled sleeves and slicked dark hair, was about the only one of them not dressed like a chemist. “Can I help you?” he asked. “Yes,” I said. “I was thinkin about donatin, but wanted to get some info first.” Dude smiled, plucked a card from a counter display, handed it to me. The card read, “Giving has its rewards. Donate plasma. Save lives. Earn up to $200/mo.*”

Dude (why I failed to ask his name, who knows) suggested I read over a pamphlet. He also offered to explain.

“Sure,” I said. “That’d be great.”

“Well, first you’ll need a valid ID,” he said, and explained that I’d also need to bring a Social Security card or some other official doc with my SSN. He clarified that if my address wasn’t current, I’d need to prove where I lived, with maybe a recent gas or light bill. Dude lectured: Plasma is in essence the water portion of my blood, and the other parts would be put back in me. “The water part gets extracted through a process called centrifugal, which whips it around at like sixty thousand times per second,” he said. “Then after that happens, they ship it to one of their many warehouses, where the plasma sits for a year to make sure it’s safe to use.” He reported that with parts of the safe plasma, the company makes lifesaving medicines for hemophiliacs and burn victims and all kinds of other victims. “We aren’t just a donor center,” he bragged. “We’re also a pharmaceutical company too.” He informed me that I could donate twice a week, assured me the threshold was deemed safe by the FDA.

“What’s cool is that, after you donate, we put the money on a debit card,” he said. “So, you can get it on the spot.” He followed his pitch with an anecdote about a time, while working at a post in Denver, he helped a twice-aweek donor check his balance and discovered it was over $3000! Dude claimed the donor announced he wouldn’t be seeing him for a while because he was using his balance for a trip. Dude went on to brag that he’d been donating for years, even showed me an old needle scar near a vein in his bicep, bore the pock the way a proud vet might flaunt a combat wound.

Straight-faced, he claimed there’re seldom side effects from plassing, that he could go hiking or backpacking right afterward. “But,” he cautioned. “You might want to test it out a few times to see how you feel.” He handed me another legal-sized foldout. It read, “Donating Plasma Saves and Improves Lives.” The foldout showed a cheerful white boy, a smiling black woman who appears close in age to Mom, and an older white man — smart glasses, straight teeth, light scruff — of a sort who bleeds patriotic and pays his tithes. ●

Copyright © 2019 by Mitchell S. Jackson. From Survival Math: Notes on an All-American Family by Mitchell S. Jackson (Scribner, March 5, 2019)

Mitchell S. Jackson’s debut novel won a Whiting Award and the Ernest J. Gaines Award for Literary Excellence. His honors include fellowships from TED, the Lannan Foundation, the Ford Foundation, PEN, NYFA (New York Foundation for the Arts), and the Center for Fiction. His writing has appeared in the New York Times Book Review, the Paris Review, the Guardian, Tin House, and elsewhere. He is a Clinical Associate Professor of Writing at New York University. Survival Math: Notes on an All-American Family is available now.

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