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    Small Great Things

    by

    Picoult, Jodi

    Jodi Picoult’s Small Great Things (2016) explores themes of race, privilege, and justice through the story of Ruth Jefferson, an African American labor and delivery nurse accused of causing the death of a white supremacist couple’s newborn. The novel alternates perspectives between Ruth, the infant’s father Turk Bauer, and Ruth’s public defender Kennedy McQuarrie, revealing systemic racism and personal biases. Inspired by Dr. Martin Luther King Jr.’s quote about doing “small things in a great way,” the narrative examines moral dilemmas and societal structures. The book has been praised for its thought-provoking examination of contemporary racial tensions and is being adapted into a film.

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    Small Great Things

    Stage One: Active Labor — Ruth 2

    by

    Picoult, Jodi

    The chap­ter opens with Ruth, an expe­ri­enced labor and deliv­ery nurse, reflect­ing on her career and recall­ing only one instance where a patient tem­porar­i­ly dis­missed her—a sit­u­a­tion resolved when Ruth brought pain med­ica­tion. The nar­ra­tive shifts to a cur­rent con­flict involv­ing Turk Bauer, a racist patient who dis­plays a Con­fed­er­ate flag tat­too and objects to Ruth, an African Amer­i­can woman, car­ing for his new­born. Ruth’s col­league, Corinne, tries to light­en the mood with humor, but Ruth is unset­tled by the overt prej­u­dice, con­trast­ing it with the more sub­tle bias­es she typ­i­cal­ly encoun­ters in her pre­dom­i­nant­ly white com­mu­ni­ty.

    While tak­ing a break in the cafe­te­ria, Ruth notices an elder­ly woman instinc­tive­ly clutch­ing her purse when Ruth approach­es, a microag­gres­sion that stings despite the woman’s obliv­i­ous­ness. This moment under­scores the per­va­sive nature of racial bias, even in mun­dane inter­ac­tions. Return­ing to the ward, Ruth dis­cov­ers a shock­ing Post-it note on the baby’s chart explic­it­ly bar­ring African Amer­i­can per­son­nel from pro­vid­ing care. The note, sanc­tioned by her super­vi­sor Marie, is framed as a prag­mat­ic solu­tion to pla­cate the racist father, but Ruth rec­og­nizes it as insti­tu­tion­al com­plic­i­ty in dis­crim­i­na­tion.

    Con­fronting Marie, Ruth chal­lenges the jus­ti­fi­ca­tion that the request is akin to accom­mo­dat­ing reli­gious pref­er­ences, point­ing out the hypocrisy and the lack of oth­er African Amer­i­can staff on the ward. Marie’s dis­missal of Ruth’s con­cerns as “not about her” only ampli­fies the injus­tice. Ruth’s anger cul­mi­nates in a dra­mat­ic exit, slam­ming the door behind her. The chap­ter then jux­ta­pos­es this inci­dent with a past exam­ple of cul­tur­al sen­si­tiv­i­ty, where Ruth accom­mo­dat­ed a Mus­lim father’s request to be the first to speak to his new­born, high­light­ing the stark con­trast between respect­ful accom­mo­da­tion and out­right exclu­sion.

    The chap­ter clos­es with Ruth observ­ing the Mus­lim father’s awe over his new­born, a uni­ver­sal moment of pater­nal bond­ing that tran­scends race and cul­ture. This poignant scene under­scores the dig­ni­ty and pro­fes­sion­al­ism Ruth brings to her work, mak­ing the ear­li­er dis­crim­i­na­tion even more jar­ring. The chap­ter effec­tive­ly con­trasts moments of human­i­ty and prej­u­dice, empha­siz­ing the emo­tion­al toll of sys­temic racism on indi­vid­u­als like Ruth, who nav­i­gate both per­son­al and pro­fes­sion­al chal­lenges with resilience.

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    FAQs

    • 1. How does Ruth’s experience with the Muslim couple contrast with her treatment by Turk Bauer, and what does this reveal about different forms of discrimination?

      Answer:
      The Muslim couple represents a cultural/religious request that Ruth accommodates with professionalism and mutual respect. She explains medical necessities, allows for discussion, and honors their wishes when possible (the father whispering to his newborn first). In contrast, Turk Bauer’s demand that no African American personnel care for his child is overt racism, enforced via a dehumanizing Post-it note. The contrast reveals how discrimination can manifest differently: one involves respectful negotiation of cultural practices, while the other is an exclusionary mandate rooted in prejudice. Ruth’s reaction—anger and refusal to comply—highlights her recognition of this fundamental difference (pages 44–45 vs. 42–44).

      2. Analyze the significance of the elderly woman moving her purse when Ruth approaches in the cafeteria. How does this incident contribute to the chapter’s themes?

      Answer:
      This subtle act exemplifies unconscious bias, contrasting with Turk Bauer’s explicit racism. The woman’s instinct to protect her purse assumes Ruth might steal, reinforcing harmful stereotypes about Black individuals. Ruth notices but dismisses it, showing how microaggressions accumulate in her daily life. The scene underscores the chapter’s exploration of prejudice’s spectrum: from overt (Bauer’s tattoo and demand) to covert (the woman’s gesture). It also highlights Ruth’s resilience—she chooses not to confront it, but the incident clearly lingers, adding to the emotional toll of systemic racism (page 43).

      3. How does Marie’s justification for accommodating Turk Bauer’s request (“religious preferences”) fail as an analogy, and what does this reveal about institutional complicity in racism?

      Answer:
      Marie equates the racist demand to religious accommodations, arguing both are about “patient preferences.” However, religion involves neutral practices (e.g., dietary restrictions, prayer), while Bauer’s demand actively excludes a racial group, perpetuating harm. Ruth’s rebuttal—“How many other African American personnel are on this ward?”—exposes the hypocrisy: the policy only affects her, revealing its discriminatory intent. Marie’s dismissal (“this isn’t about you”) reflects institutional complicity—prioritizing a white patient’s comfort over an employee’s dignity. The hospital’s compliance normalizes racism under the guise of “smooth operations” (page 44).

      4. Critical Thinking: Evaluate Ruth’s decision to slam the door after her confrontation with Marie. Is this an effective response? Why or why why not?

      Answer:
      Ruth’s door slam is emotionally justified but strategically limited. It expresses her fury at Marie’s gaslighting and the hospital’s racism, asserting her refusal to accept the injustice. However, it’s a solitary act that doesn’t challenge the systemic issue. A more effective response might involve documenting the incident or escalating to HR, though the text implies such actions could be futile in a biased system. The slam’s power lies in its rawness—it communicates the emotional impact of racism, forcing Marie to witness Ruth’s pain, even if it doesn’t change policy (page 44).

      5. Application: How might Ruth’s approach to the Muslim father’s request inform strategies for addressing discriminatory patient demands in healthcare settings?

      Answer:
      Ruth’s handling of the Muslim couple demonstrates balancing cultural sensitivity with medical ethics: she listens, explains constraints (e.g., emergencies), and collaborates on solutions. This model could be applied to discriminatory demands by (1) acknowledging the patient’s concern without endorsing prejudice, (2) explaining why blanket bans violate anti-discrimination policies, and (3) offering alternatives (e.g., assigning a different nurse if feasible). Unlike Marie’s capitulation, this approach upholds professionalism while rejecting racism. However, the chapter also shows limits—when patients like Bauer refuse dialogue, institutions must prioritize equity over “customer service” (pages 44–45).

    Quotes

    • 1. “But Turk Bauer is not silly and selfish; based on the way he brandished that Confederate flag tattoo, I’m guessing he is not too fond of people of color.”

      This quote introduces the central conflict of the chapter, revealing the overt racism Ruth faces from a patient’s father. The Confederate flag tattoo serves as a visceral symbol of prejudice that contrasts sharply with Ruth’s professional demeanor.

      2. “I’m sure she doesn’t even realize she moved her purse when I got closer. But I did.”

      This subtle yet powerful moment captures the microaggressions Black people face daily. The elderly woman’s unconscious action speaks volumes about ingrained biases, even as she smiles politely at Ruth.

      3. “NO AFRICAN AMERICAN PERSONNEL TO CARE FOR THIS PATIENT.”

      The shocking Post-it note represents the chapter’s climax and institutional complicity with racism. This blatant discrimination, formally documented, forces Ruth to confront systemic prejudice in her workplace.

      4. “Honestly, this isn’t about you, Ruth.”

      Marie’s dismissive comment highlights how racism is often minimized as “not personal.” The quote underscores the gaslighting marginalized people experience when institutions prioritize comfort over justice.

      5. “The man bent close to the tiny head of his son, and whispered to him in Arabic.”

      This contrasting positive example of cultural sensitivity in healthcare shows Ruth’s professionalism and the beauty of honoring diverse traditions - making the Bauer family’s racism even more jarring by comparison.

    Quotes

    1. “But Turk Bauer is not silly and selfish; based on the way he brandished that Confederate flag tattoo, I’m guessing he is not too fond of people of color.”

    This quote introduces the central conflict of the chapter, revealing the overt racism Ruth faces from a patient’s father. The Confederate flag tattoo serves as a visceral symbol of prejudice that contrasts sharply with Ruth’s professional demeanor.

    2. “I’m sure she doesn’t even realize she moved her purse when I got closer. But I did.”

    This subtle yet powerful moment captures the microaggressions Black people face daily. The elderly woman’s unconscious action speaks volumes about ingrained biases, even as she smiles politely at Ruth.

    3. “NO AFRICAN AMERICAN PERSONNEL TO CARE FOR THIS PATIENT.”

    The shocking Post-it note represents the chapter’s climax and institutional complicity with racism. This blatant discrimination, formally documented, forces Ruth to confront systemic prejudice in her workplace.

    4. “Honestly, this isn’t about you, Ruth.”

    Marie’s dismissive comment highlights how racism is often minimized as “not personal.” The quote underscores the gaslighting marginalized people experience when institutions prioritize comfort over justice.

    5. “The man bent close to the tiny head of his son, and whispered to him in Arabic.”

    This contrasting positive example of cultural sensitivity in healthcare shows Ruth’s professionalism and the beauty of honoring diverse traditions - making the Bauer family’s racism even more jarring by comparison.

    FAQs

    1. How does Ruth’s experience with the Muslim couple contrast with her treatment by Turk Bauer, and what does this reveal about different forms of discrimination?

    Answer:
    The Muslim couple represents a cultural/religious request that Ruth accommodates with professionalism and mutual respect. She explains medical necessities, allows for discussion, and honors their wishes when possible (the father whispering to his newborn first). In contrast, Turk Bauer’s demand that no African American personnel care for his child is overt racism, enforced via a dehumanizing Post-it note. The contrast reveals how discrimination can manifest differently: one involves respectful negotiation of cultural practices, while the other is an exclusionary mandate rooted in prejudice. Ruth’s reaction—anger and refusal to comply—highlights her recognition of this fundamental difference (pages 44–45 vs. 42–44).

    2. Analyze the significance of the elderly woman moving her purse when Ruth approaches in the cafeteria. How does this incident contribute to the chapter’s themes?

    Answer:
    This subtle act exemplifies unconscious bias, contrasting with Turk Bauer’s explicit racism. The woman’s instinct to protect her purse assumes Ruth might steal, reinforcing harmful stereotypes about Black individuals. Ruth notices but dismisses it, showing how microaggressions accumulate in her daily life. The scene underscores the chapter’s exploration of prejudice’s spectrum: from overt (Bauer’s tattoo and demand) to covert (the woman’s gesture). It also highlights Ruth’s resilience—she chooses not to confront it, but the incident clearly lingers, adding to the emotional toll of systemic racism (page 43).

    3. How does Marie’s justification for accommodating Turk Bauer’s request (“religious preferences”) fail as an analogy, and what does this reveal about institutional complicity in racism?

    Answer:
    Marie equates the racist demand to religious accommodations, arguing both are about “patient preferences.” However, religion involves neutral practices (e.g., dietary restrictions, prayer), while Bauer’s demand actively excludes a racial group, perpetuating harm. Ruth’s rebuttal—“How many other African American personnel are on this ward?”—exposes the hypocrisy: the policy only affects her, revealing its discriminatory intent. Marie’s dismissal (“this isn’t about you”) reflects institutional complicity—prioritizing a white patient’s comfort over an employee’s dignity. The hospital’s compliance normalizes racism under the guise of “smooth operations” (page 44).

    4. Critical Thinking: Evaluate Ruth’s decision to slam the door after her confrontation with Marie. Is this an effective response? Why or why why not?

    Answer:
    Ruth’s door slam is emotionally justified but strategically limited. It expresses her fury at Marie’s gaslighting and the hospital’s racism, asserting her refusal to accept the injustice. However, it’s a solitary act that doesn’t challenge the systemic issue. A more effective response might involve documenting the incident or escalating to HR, though the text implies such actions could be futile in a biased system. The slam’s power lies in its rawness—it communicates the emotional impact of racism, forcing Marie to witness Ruth’s pain, even if it doesn’t change policy (page 44).

    5. Application: How might Ruth’s approach to the Muslim father’s request inform strategies for addressing discriminatory patient demands in healthcare settings?

    Answer:
    Ruth’s handling of the Muslim couple demonstrates balancing cultural sensitivity with medical ethics: she listens, explains constraints (e.g., emergencies), and collaborates on solutions. This model could be applied to discriminatory demands by (1) acknowledging the patient’s concern without endorsing prejudice, (2) explaining why blanket bans violate anti-discrimination policies, and (3) offering alternatives (e.g., assigning a different nurse if feasible). Unlike Marie’s capitulation, this approach upholds professionalism while rejecting racism. However, the chapter also shows limits—when patients like Bauer refuse dialogue, institutions must prioritize equity over “customer service” (pages 44–45).

    Note