Ossian Sweet arrives in Detroit in 1921, alone and unknown, carrying with him two hundred dollars and his diplomas from Wilberforce and Howard. He takes a room in Black Bottom, a mixed-race neighborhood in "the heart of the city." Ossian hopes to begin practicing medicine for the "entire generation of southern migrants jammed" (105) into the four-square miles around him. Living in squalor and working in factories' most dangerous or miserable jobs, the black migrants in Black Bottom suffer frequent disease and injury. However, with so few black doctors in Detroit, and because of segregation and poverty, they can seldom seek treatment.

Ossian, "with his sharp businessman's eyes" quickly sees an opportunity for himself. He doesn't have enough money yet to rent an office of his own, so, in November 1921, Ossian seeks a partnership with Cyrus Dozier, the owner of Palace Drug Company, a pharmacy close to Ossian's rooming house. Ossian invests "one hundred dollars in the pharmacy" (113) and Dozier allows him to use the pharmacy's back room as his medical office. Through the end of the year, Ossian's practice grows at a steady pace. He treats ailments of all kinds, receiving "twice as much" a day in payment as "Black Bottom's best-paid factory workers" (114).