Dawn Turnage had been dizzy and exhausted all week. Her vision was blurry, but she wrote it off. Maybe she needed new glasses, she thought. Or, maybe a day off of work. Either way, she kept it moving.

Then, one day after work, she woke up on the bathroom floor after chugging Pepsi to muster up enough energy to work out, and didn’t remember how she got there. In hindsight, she thinks that was the first mini stroke. On the drive home, she remembers being at a streetlight with a lot of horns blowing around her. She wonders if she fell asleep or blacked out.

Soon after, on FaceTime, her 2-year-old niece asked why she was making faces.

When her sister came to the phone, she could see the signs of a stroke. Slurred speech and a drooping face. When she finally got to the hospital, Turnage learned a blood clot had been traveling to her brain.

“If I would have laid down and taken a nap that night, that would have been the end,” she said, behind tears.

Her story is similar to those of many Black women, who wrestle with the pressures of feeling like they have to be superhuman. The weight of navigating what it means to be a Black woman in America is part of what is driving poor health outcomes.

All the stress, on top of instances of racism, creates a perfect storm for health complications, doctors say. A study released last month from Boston University shows that, for Black women, perceived experiences of racism are linked specifically to increased risk for strokes.

Those who perceive having experienced racism in employment, housing, and interactions with police had about a 40% greater chance of suffering from some form of stroke later in life compared to those who didn’t, researchers found. The study adds to the idea that racism weathers down Black Americans bodies over time, breaking them down by raising their stress hormones to unhealthy levels.

It’s like 1,001 paper cuts, said Yvette Cozier, one of the study’s authors.

“By the end, there’s a lot of blood.”

Turnage, 53, sees how stress may have impacted her health. She recalls racism from the divorce attorney she tried to hire, who quoted her double the amount for a deposit compared to a white friend and ultimately suggested she seek out a public defender. Then, the apartment complexes telling her there were no units available.

It was 2015 and she was working two jobs. The divorce was newly final, and her dad had recently passed away unexpectedly in an accident. So, she moved as close as she could to her mom in Columbus, Ohio. The oldest daughter with no kids, a lot of responsibilities often fell to her.

“Even if I couldn’t,” she said, “I always made a way.”

Education is not a protective factor

When the doctors asked how much pain she was in, Leslie Jordan said the headache was beyond a 10 on the scale. The physicians responded by saying that was normal.

She had just given birth to her first child. Now, she was exhausted and her head was so heavy it was as if it was a bowling ball. The muscles in her neck felt weak.

“The intensity was beyond painful,” she said.

In the 48th hour, she said, her angel arrived. A nurse she hadn’t seen before came in and went over her medication list.

“You’re still having a headache beyond 10?” she asked.

After Jordan confirmed, the nurse went into the hall, yelling loudly then came back with another doctor.

“This is the neurologist,” the nurse said. Within seconds, Jordan’s body started to feel like it was burning. Her speech was deteriorating. She yelled as loud as she could.

“I’m having a stroke,” she said.

Black folks are 50% more likely to suffer a stroke compared to white adults, and Black women are twice as likely to have a stroke compared to white women, according to federal data. The median age for having a stroke tends to be around people’s 60s and 70s, said Dr. Shanshan Sheehy, one of the study’s co-authors, but Black women, are having them closer to 50.

The research was part of the Black Women’s Health Study, which followed more than 48,000 Black women from 1997 to 2019. Over those two decades, there were about 1,660 cases of strokes. The researchers followed up with participants every two years, and asked questions about everything from experiences at restaurants, to whether participants felt like others perceived them as less smart, or were discriminated against in hiring and promotion, when interacting with police and buying a house.

When these instances happen, often a stress response occurs in the body, which looks like the heart rate going up, blood vessels constricting, and blood pressure rising, said Dr. B.J. Hicks. It’s good for promoting an automatic flight or flight response in a flash during an emergency, but over time, it causes damage.

Blood pressure remains high. The heart can enlarge and then fail. Blood vessels harden.

Racism, and how people experience it, is very complex. This study by Boston University focuses specifically on folks’ perceptions of it.

“Racism is more than insults,” Cozier said. It can be subtle.

Women with a higher level of education tend to report more racism than those of a lower socioeconomic class. They might have a deeper understanding of what it means to be the only one in the room, as they enter predominantly white spaces, Cozier said. Education is not a protective factor for Black women the same way it is for white women.

One outcome can be higher risk for strokes, which is a sudden loss of blood flow to the brain. It often creates a sudden change in behavior.

The symptoms can often be recognized using the acronym F.A.S.T., which stands for face drooping, arm weakness, speech difficulty, and time to call 911. The more time that passes during a stroke before treatment by emergency physicians, the more brain cells die, causing more severe complications. Even if it comes and goes within minutes, during what some call a “mini stroke,” it’s still considered an emergency, doctors say.

Black folks’ increased exposure to discrimination could be part of their high risk, experts say.

Pregnancy complications could increase risk

Jordan woke up weeks later in the hospital’s intensive care unit.

“As far as I’m concerned, I wasn’t here, if you know what I mean,” she said. “I’m not able to say the word.”

Everyone was so wound up about her stroke, they’d forgotten all her body had gone through to deliver her baby, including preeclampsia. She told everyone she was fine so she’d be released, and when she was, a seizure sent her back.

Her long term memory was gone. She didn’t recognize the car or the house. It was hard to care for her son.

Now, Jordan, who’s 39, is in her fifth year of recovery. Still going to rehab and doing therapy. Still taking breaks, monitoring her swallowing, speech and motor skills.

“It’s really a lifelong journey for me,” she said. “I thought it would be a Band-Aid.”

When asked if she feels like racism affected her health, she said absolutely.

“Racism happens to me every day,” she said. It’s not so much if it happens, but rather how she chooses to respond. She picks and chooses her battles.

For Black women who’ve had preeclampsia, they have a higher risk of stroke, even 20 years later, said Sheehy. “Pregnancy is a window to look at your future cardiovascular health,” she said. It may be an early indicator to try new healthy habits grounded in stress management and heart and brain health, but the exact mechanisms behind risk are complicated and a bit mysterious.

“There’s still a lot to be answered,” Sheehy said.

There’s a lot affecting Black women’s health outcomes, from battling racist interactions to the baseline stress of life and added pressure of feeling like they have to do and accomplish it all.

“Prevention is the way out of a persistent cycle of health disparities in our people,” said Hicks, who works in Ohio. He suggests incorporating mindfulness practices into the day, getting adequate sleep, and exercise that gets the heart rate up. Even 20- and 30-year-olds should know their blood pressure and cholesterol numbers and have a good relationship with a primary care physician.

Turnage has short-term memory loss, and relies a lot on note-taking. She did speech therapy but didn’t have to do much physical therapy. After her own stroke eight years ago, she learned her grandmother died of a massive one.

It was incredibly hot outside that day, and her grandmother’s ride didn’t make it. So, she was pissed off, and she was stressed. She was two blocks into her walk to her sister’s house when the stroke struck, ending her life.

Turnage now volunteers with the American Heart Association along with Jordan, and wants Black women to understand how important it is to put themselves first.

These days, she makes sure to get massages twice a month. Often, she said, Black women think they have to give, give, give, but it’s impossible to do it all. 

She wants more people to use “no” as a complete sentence to ease the burden of stress, she said: “Be fierce with your voice.”

Margo Snipe is a health reporter at Worldacad. Twitter @margoasnipe