Why Identity Matters

“You have a Chinese face,” my mom said to me.  I was ten years old, maybe twelve.  I can’t remember how it came up.  But the message was twofold and clear:  1. What makes you different from almost everybody around you is visible.  You cannot hide it, you cannot escape it.  2. People will judge you for it, so like it or not, to them, you represent us—your family, your ethnicity, all people who look like you.

That was it—straightforward truth, unvarnished.  And I understood immediately.  There was a gravity, an importance to her expression.  It was not meant to apply pressure or expectation; Ma was simply teaching me about reality so I would be prepared to meet it when I left home, whether it was at the mall or farther out in the world.  And I felt equipped to meet the challenge.  We lived in an affluent suburb.  My parents are both educated professionals.  They are still leaders in the Chinese community, heading initiatives to liaise with “Americans” in business, government, and news media.  Growing up I was known as the ‘smart’ kid—I fit the Asian nerd stereotype.  And people were impressed that I was also bilingual, could paint classical Chinese art and perform classical Chinese dance, and also play volleyball and win at statewide speech tournaments.  I thought I represented well.

I brought my Chinese-American identity with me to college, where I estimate about 20% of my fellow undergrads were Asian.  In medical school, residency, and now in practice, there are still proportionally more Asians than in the general population—we are an overrepresented minority group among physicians.  But we are still a minority, occupying proportionally few seats in medical and academic leadership. 

Once again I find myself in this strange, middle, white-adjacent space, considering how I can and should use my unique identity for the greater good.  How does an anti-racist message land differently/better/worse when I express it?  How do my white colleagues hear me differently/better/worse from/than my Black and other underrepresented minority colleagues?  Do I have a bridge role to play here?  Or should I keep my head down and my mouth shut (this is unlikely)?

Someone told me recently that our racial (and other) identities do not matter at work.  We should just think of ourselves as doctors, teachers, engineers, CEOs.  I respectfully and vehemently disagree.  If I were ‘just a doctor’ I would not be the only one fluent enough in Mandarin to care for non-English speaking Chinese patients without a translator.  If my Black colleagues were ‘just doctors,’ they would not inspire young Black kids to become doctors themselves.  If women physicians and surgeons were ‘just doctors,’ there would not be so many women physician groups all over social media, where countless of us seek reassurance that we are not insane, weak, and otherwise broken for all of the horrible, unbelievable-yet-totally-believable discriminatory experiences we endure at work in 2020.  And so many of us would not have our own stories of women in medicine who went in front and inspired us, encouraged us, and gave us the wherewithal to follow. 

Medical culture slowly evolves to see and treat patients as whole people, not just sets of diagnoses.  When will we come around to seeing ourselves and our colleagues also as whole people, interconnected, inseparable, and in need of full integration, inside and out?

* * * * *

The two articles below describe well how our ‘identity blind,’ assimilation-centered work cultures harm our Black colleagues, especially now.  Please take a few minutes to read each, and really try to put yourself in the writers’ shoes.  For us, taking this perspective is a choice; not so for them.

Maintaining Professionalism In The Age of Black Death Is… A Lot  by Shenequa Golding

I just witnessed the lynching of a black man, but don’t worry Ted, I’ll have those deliverables to you end of day.

…If I am to perform my duties for 40 hours a week, it’s asinine to assume that the life I live outside of those 40 hours won’t rear its head. Whether I’m a sleep deprived single mother of two or a struggling college student who really needs this internship to graduate, the belief that only the part of me that fattens your bottom line is allowed in the workplace, is stifling.

This is magnified for young black professionals who are recruited for their culture, but told, in so many words, that their blackness and the struggles that come with it are to be left at the door.

 …Forgive us if our work isn’t up to par, we just saw a lynching. Pardon us if we’re quiet in the Zoom meetings, we’re wondering if we’ll be the next hashtag. Spare some grace if we’re not at the company happy hour, because the hour of joy that most adults look forward to has been stolen from us due to the recent string of black death.

We’re biting our tongues, swallowing our rage and fighting back tears to remain professional because expressing that hurt caused by witnessing black death is considered more unprofessional, than black men and women actually being killed.

So if you can, please, be mindful. Your black employees are dealing with a lot.

7 Things That Need To Be Said About Black Trauma In Predominantly White Workplaces  by Samantha E. Willams

You know what’s worse than America treating racism like a new album that just came out? People moving on like nothing ever happened.

Over the last few weeks, you’ve probably noticed most of your white colleagues have abandoned their outrage over George Floyd and Breonna Taylor, trading it in to enjoy summer’s finest things — sailing, bonfires and lake house getaways. But not us. Those tough and uncomfortable conversations everyone boasted about having have slowed (maybe even stopped), and once again Black trauma in the workplace has been placed back in the hands of Black employees. While I wish I could say everything about this is new or shocking, the truth is we’ve been here before.

…The day was July 7, 2016…  That morning I did all the things one does to “maintain professionalism” because let’s be real, as Black professionals we often feel like we can’t be caught slipping (aka displaying feelings). But when putting my best face forward failed, my colleague asked what was wrong? I explained my stoicism was due to Sterling’s and Castile’s death, which was ultimately the result of the racism and systemic oppression that plagues our country, constantly making Black people a target.

What came next was disappointing but not surprising. Her response was, “Well, did you know him?” In that moment, just as it had in others, it became clear that Black trauma had no place, no weight of relevance in white workplaces. This wouldn’t be the last time Black trauma was ignored, displaced or misunderstood.

 

Witnessing

So much suffering, friends—everywhere, all the time, every day.  It’s overwhelming. 

Our current circumstances feel like the most distressing case of sensory overload I have ever experienced:  intense, prolonged, and complicated.  Paradoxically, I also often feel like my head and heart could explode from sheer hopefulness—at no other time in my life have I felt so much potential for meaningful, positive collective change.  We stand on the knife edge of a continental divide of sorts, simultaneously overlooking the worst and best extremes of humanity.

People. Are. Losing it. 

Patients with underlying anxiety and depression are increasingly agitated and even combative, at home and in the clinic.  They threaten themselves and/or office staff, sometimes with mortal results.  Lifelong friendships are ending from irreconcilable differences over politics, ideology, and disagreements over social distancing and masking, among other things.  People lash out in rage at the slightest, often innocent provocations.  We doom scroll on social media, amplifying and reverberating (mis)information in our echo chambers, driving ourselves to the cliff’s edge of sanity with fear, fury, and hatred.

I watch it unfold before my eyes, escalating in the past few weeks.  I have joked for a while that the world may end in my lifetime; now it feels less and less like a joke. 

How we do process it all?  How do we get through?

Physicians, therapists, nurses, and many other professionals make a living watching and listening to people through their suffering.  Often we cannot cure people’s problems; sometimes it feels like we can’t even help.  But the truth is we can always help—all of us.

By simply being present to someone in pain, we help.   By not looking or running away, by sitting and facing them full on, we help.  By allowing, even embracing our own discomfort, and holding safe, quiet space for another’s suffering, we help.  We know this because when we suffer, the loving presence of others is what heals us first.

I cannot take away your depression or anxiety.  I cannot create a stronger social support network for you.  I cannot get you a job, bring back your deceased loved one, make the pandemic go away, or stop the next police officer from profiling your son by his skin color.  But I can sit with you in your grief.  I can stand in solidarity with you and advocate for our common cause.  Most importantly, I can take good care of myself so I can keep showing up for you and all those who may need to lean on me from time to time.  I have those who let me lean on them sometimes, too, and I make sure to thank them often.

To witness means to see.  The best witnesses make us feel seen, heard, understood, accepted, and loved, no matter what.  This is what we can do for one another right now.  It is the highest calling of humanity, to take care of each and every other as ourselves.  It is an infinite rather than a finite calculation.  Love shared is multiplied, not divided.  Caring for you feeds me too, whereas disconnecting from you costs me more than I know, and diminishes us all.

“Although the tale of human experience is certainly universal, it contains unique elements for each us and we continue the art of storytelling, both verbally and nonverbally, each and every day. While some stories are sweeter than others, all long for the benefit and necessity of a witness, for a witness assures us that our stories are heard, contained, and transcend time; for it can be said that one is never truly forgotten when one is shared and carried in the hearts of others.” –Kristi Pikiewicz, PhD

The only way out is through. The best way through is together.

Amplify the Important Stories

This weekend we lost another selfless leader, Dr. Joseph Costa of Baltimore.  Chief of his hospital’s intensive care division, he continuously led his team on the front lines of pandemic patient care, despite his own high risk medical condition.  He succumbed to COVID-19, in his husband’s arms, surrounded by colleagues turned caregivers. 

My friends, are you exhausted like I am?  4.2 million American COVID cases (about a quarter of total global cases).  At the current rate we will likely cross 150,000 deaths by the end of this week.  And it won’t stop there.  We will lose many, many more mothers, fathers, sisters, brothers, grandparents, sons and daughters in the coming months.  This, all while PPE shortages still put healthcare workers at risk across the country, caring for those who follow prevention guidelines the same as for those who do not.

Read Dr. Costa’s story.  Remember him.

Then honor his memory and those of the almost 600 healthcare workers who have died of COVID-19 by wearing your mask and protecting the people around you.

***

“Oh, are you from Maryland?”

Her name is Odette Harris, MD. 

She is a neurosurgeon and the director of brain injury care at Stanford Medicine.  She is a Black woman.  “Something as absurd as putting the initials of your state next to your name seems more plausible than the fact that ‘MD’ stands for doctor.  I can’t even tell you how many people ask that.”

Someone handed her their car keys outside of the venue where she gave a keynote address, thinking she was the car valet.  [Michael Welp mentions this in Four Days to Change—it is a common occurrence for our Black sisters and brothers.]

During an all-day meeting, after she stood up from the conference table to stretch her legs, her own colleague asked if she was going to set up for lunch.

Nobody has ever asked me if I’m from Maryland because ‘MD’ comes after my name.  I have never been mistaken for a car valet or wait staff at a professional meeting.  And I am not the chief neurosurgeon who runs traumatic brain injury care at my hospital.  Let us white and white-adjacent folks meditate on Dr. Harris’s experiences for a moment.  Because that’s all we have to do—consider them for a minute or two.  Our Black colleagues and peers live such denigration their whole lives.

***

The Wall of Misogyny

It started with, “Your hair smells incredible.” Followed by, “My hands may touch you. They are hard to control.” It even went as far as, “You were in my dream last night. Did I mention it was wet?” He made my skin crawl. I spent more time focused on trying to be where he wasn’t that I had no space left to focus on why I was there in the first place, and that was to learn. The awkward stares from OR staff looking upon me with pity made me want to vomit. And the number of male physician on-lookers who seemed to watch this behavior for sport did nothing but enable his behavior (when one brought his daughter to work with him, it was all I could do but hope she never had to experience from a man what I was experiencing from him). The lack of shock of such behavior from everyone aware in the system confirmed its normalcy.

Read this stark essay by Dr. Megan Babb, a fellow physician mom.  Inspired by Alexandria Ocasio-Cortez’s incisive speech on the floor of the House of Representatives this week, Dr. Babb published her own story and those of many other physician women.  They recount the everyday misogyny that for too long we have blithely accepted as ‘the way things are’ in medical culture.  Peruse them slowly (a few choice samples below).  Imagine they are your mother, your sister, your daughter, your friend, your colleague.  How would you upstand for them? 

I was asked by a male patient if I needed to practice my prostate exam technique because he was happy to allow me to do so on him. When I asked the administrative team to move him to the service of any one of my many male colleagues I was told, “These are the sort of things that build character. I think we need to thicken your skin. The patient will remain on your service.”

I recently gave a presentation at grand rounds in my hospital. When I walked to the podium, I overheard a male physician say to a group of others, “Isn’t the lecture today supposed to be given by an orthopedic surgeon?” I am the orthopedic surgeon he speaks of.

 As a medical student I was on a surgical rotation with a male urologist. While assisting him with a TURP [trans-urethral resection of the prostate] he asked me, “Would you like to see what a well-endowed penis looks like?”

***

And There Is Still Hope

A specialist physician and woman of color consulted on a patient in the hospital, a white man.  He was frustrated at having to see so many doctors and answer so many questions.  So he demanded that she sit in silence until he was good and ready to talk.  After the 25 minute hospital visit, she rightly documented his behavior in the chart, as she had done for so many episodes of patients’ abusive behavior in the past, especially since these patients often levy complaints against her for treating them badly.  To her surprise, the white male attending hospitalist paged her later to discuss the occurrence.  He had read the chart and apologized for the patient’s behavior.  He also called the patient out, asserting that if our colleague had been a white male herself, the patient would never have treated her like that.

An authentic white male ally, wow. 

…White men are more likely to listen to and follow other white men, I thought.

So I wrote her, “Can his actions be amplified so that he feels empowered and inspired to do this more?  So that other white men can see his example more easily and feel safe to follow?  Can someone mention his actions on rounds, share them in a newsletter, make them as visible as possible?  Examples like this can go such a long way to recruit white men to the cause—so many men sit on the fence, and just need to see one of their own lead the way, and then they get off on the side of doing what’s right.”

She agreed to highlight his actions in an upcoming community spotlight, noting that now he would likely be the target of any patient complaint.  We agreed that he would then need the support he gave her, given back to him, and then some.  We reflected on this great opportunity for colleagues to unite in solidarity for one another, standing up to cultural norms that oppress us all.

***

Stories like these humanize ‘others’ to us.  If we are honest, we may recognize that the ideas of ‘healthcare workers’ and ‘women of color’, among others, too often float on the surface of our consciousness as abstractions.  It does not occur to us to try to relate or empathize, to see them as real, flesh and blood people like ourselves. 

But that is what the world needs the most right at this minute—for us all to relate and empathize with each and every other human who suffers, who lives a different life from our own.  Our connections are the only thing that will heal us.