Photo by Kate Drabinski.

I’ve lived in lots of cities as an itinerant academic without a permanent gig, and in each one of these cities there is an entity or two whose size and scale translates to an even more outsized influence over development patterns in the city. I say “outsized” because when we build our cities and distribute our resources to meet the demands of institutions and not people, a whole bunch of people find themselves bulldozed over—both literally and figuratively. In Baltimore that entity is Johns Hopkins.

Johns Hopkins University is the largest private employer in the greater Baltimore area, and Johns Hopkins Health System comes in third. Taken together, Hopkins is massive, and it has massive influence on how the city is organized. Its nonprofit status means Hopkins doesn’t pay taxes, and that’s a lot of money out of city coffers. Sure, Hopkins pays taxes indirectly to landlords when they rent out property and on things like properties used for non-exempt purposes, parking and hotel taxes (for dorm beds), and payroll taxes for its thousands of employees. But if their properties remained on the tax rolls, Baltimore would have a lot more cash on hand. No amount of consumer spending by low-wage service workers at Hopkins will make up for that.

As I learned more about the history of Hopkins in Baltimore, I learned more and more ugly stories about the effects of the institution on communities of color in the city. The story of Henrietta Lacks, finally well-known, is just one case of muddled research ethics at the campus. And then there’s their development of Middle East, now known as Eager Park, the plunking-down of shiny new condos and shops and private security into a neighborhood laid bare by decades of planned displacement. It’s an ugly history, and one that repeats itself in this city as time after time our collective monies are poured into institutions and neighborhoods already awash in relative wealth as the rest of the city starves.

This has been my understanding of Hopkins since I moved to Baltimore, an analysis deepened by the work of writers like Marisela Gomez, Lawrence Brown, and D. Watkins as well as bike rides across the city week after week for years, noting the both very slow and very fast changes in neighborhoods bowled over by Hopkins.

And then I got cancer, and Hopkins became a very different place. It’s taking me a minute to figure out how to make sense of this newest field trip, given all that have come before.

I found out I might have cancer at the beginning of November when I was called in for a second mammogram. I’m in my 40s, have great health insurance, and am a rule follower with a family history, so I’ve been getting these screening tests for awhile now. This wasn’t the first time I’ve been called back, so I wasn’t worried.

I went back for a follow-up and an ultrasound, and the radiologist told me I would need a biopsy. I asked if it was an emergency, or if it could wait until I returned from my work trip to Chicago. She said it could wait, but I shouldn’t wait long. My twin sister had just gotten a biopsy and it was benign, so I went to Chicago, had a wonderful time, and decided I’d figure out the biopsy when I got back. When I got back I looked at my actual report from the radiologist. It said “BIRADS 5,” which is the scale they use to rate the chance of what they’re seeing on the screen being cancer. I googled it. Ninety-five to ninety-nine percent of the time, it’s cancer. Everything changed. I was already a patient at Hopkins because they take my insurance and I can get to the community clinic on my bike in 10 minutes, so I emailed my provider and asked her what to do.

And the answer was to stay at Hopkins. I was quickly shuffled to the Greenspring location for a biopsy that showed I indeed had cancer, and then the Hopkins system took over. I got an email from the breast surgery center in the very East Baltimore campus I’ve side eyed for years telling me to come in for a consult. Then they called to schedule surgery, and a few days later made appointments for me with a medical oncologist and a radiation oncologist. By the time this hits the paper, I’ll be a week out from my first chemotherapy infusion, three more to go. Johns Hopkins is running my life not just in the structural ways it runs all of our lives, determining how development dollars get spent and who lives where, but in the tiny minutiae as it turns my body into a toxic waste dump in order to save it.

I’ve been thinking a lot about how to square the critiques of Hopkins with the reality that the hospital is also saving a whole lots of lives. The cancer-related rooms I’ve been in over the past two months have all been packed. So many of us have cancer or love people who do, and we all want to get through treatment and get on with our lives. Hopkins is helping loads of people do just that, even as doing that means pushing people out of their neighborhoods and sucking up huge swaths of our collective resources to do so.

Mostly what I’ve felt, though, on a totally personal level, is lucky. I’ve got great health insurance through my state job that means I’m not worrying about paying for this care (mostly—I still worry because the side costs are bananas). I’ve got flexible work hours and a workplace that is taking tasks off my plate so I can focus on my health and still get paid. I have a partner and wider community that is doing all it can to shoulder some of the cancer burden. And a world-class hospital that will give me the care I need for a good prognosis (which I have).

I feel lucky, but I also know it’s not just luck. The same structures that push people out of Middle East to make way for Hopkins produce this particular care for me. It’s complicated, and everyone should get the level of care I’m getting, and not just in cancer treatment.

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