S3E7: Allyship, Part I

Harjit: The beginning is always hard. I have to do it, like, two times.

Dr. Cowan: Yeah, first sentences.

Margaux: Just start. Hey, welcome to the "Bundle of Hers."

Harjit: Yeah, I know. Hi. Welcome to the "Bundle of Hers." This is Harjit and in the studio today we have Margaux with me.

Margaux: Hey.

Harjit: We also have a very special guest. We have Dr. Cohen, who's a hospitalist at the VA in the University of Utah.

Dr. Cohen, thank you so much for coming today. How are you doing?

Dr. Cowan: I'm doing great. Thanks for having me. It's a real honor to be here.

Harjit: We're super excited about the episode today. One thing that we hope to accomplish with "Bundle of Hers" is getting out voices of people that are unheard. But also, I think that, in general, the four of us have really tried to uplift voices in all arenas of our lives, be it at home, in our communities, or in medical school.

And I remember when I first met you, Dr. Cohen, I was like, "I need to have a connection with this doctor because I feel like that's kind of the work you do on the daily."

And I was so appreciative because you actually invited us to an Iftar dinner. So Leen and Bushra, who identify as Muslim, they were invited to this dinner and Leen's like, "You have to come. It'll be so fun." So we ended up going . . .

Margaux: What's Iftar?

Harjit: Oh Iftar . . . so there's the month of Ramadan that Muslims observe, and Iftar is when they break their fast. So that's the breaking of the fast dinner that we were all able to join you and eat a meal. And we just had great conversation about life, of being Muslim, those that were Muslim there, of just our experiences in medicine. I just felt so comfortable and so safe that if there was ever a situation where I needed to talk to someone, you were someone that I felt like I could go to.

Dr. Cowan: Yeah. And just so you know, the backstory on that, I wanted to support some of our residents in internal medicine as well as medical students who identify as Muslim who were fasting. And so I decided I would try to fast to support them. It was a disaster. I don't think I even completed a full two days of fasting.

But at the end of that sort of attempt of a week, my friend and I, Dory, we cooked and prepared this meal and then invited basically a lot of strangers because I had never even met you.

And so, you know, the time comes and the sun has set and nobody's knocked on the door and we think, "Oh, no. What have we done? We've made a terrible mistake. No one's going to trust these two white ladies."

And then all of a sudden, pounding on the door and everybody starts rolling in. And we have dates and water to break the fast, and then just this incredible community all at once. That just sort of ignited my fire to, "We've got to keep doing this." And now I think it's going to become an annual event, and I'm hoping we outgrow my apartment.

Harjit: That would be amazing. That was one of the most memorable nights for us, and me and Leen ended up having a conversation afterwards about it and just how fun it was to get to know all these people.

And that's kind of what is the important part, is the human connections and hearing people's stories, hearing their experiences, and just knowing a little bit more about the world.

So along those lines, what prompted you to even do this in the first place? I know you do a lot of other work in the community, in the medical community specifically, surrounding topics of race and privilege. And I kind of just wanted to know your story. What kind of got you involved in doing this work?

Dr. Cowan: Sure. And I'm wondering if it would be okay if we kind of backtracked a little bit and just went through some definitions.

Harjit: I think that would be great.

Dr. Cowan: Okay. Because I think it's going to be really helpful if we're on the same sort of sheet of music so that when I tell you my story and I use certain language, you have a good understanding of what I'm talking about.

Harjit: We would love that.

Margaux: I think that's super helpful.

Harjit: So helpful.

Dr. Cowan: So let's start with bias or prejudice. Essentially, can we agree that a bias or a prejudice is really when, with very little information about another group, you create a story or a narrative?

Harjit: I like that.

Dr. Cowan: Yeah. So let me give you an example. So from academic year 2018 to 2019, there were over 45,000 white students enrolled in medical school, and students who identify as black or African American, there are only 6,500. So with that data, I could easily create a story, right? "Well, maybe black students just aren't motivated. Maybe they're just not as intelligent, academic, or they just don't want to become doctors." So you can see how dangerous that bias is.

So then discrimination, how I define it is acting out on my prejudice. So let's say I am a white woman facilitator for School of Medicine and I have a student of color in my small group, and that student of color is trying to, you know, maybe push the group to talk about something challenging or sensitive, like race. And if I have that bias, I might discriminate by continuing to cut off that student and silence him or her.

Race is a social construct with very lived realities, like very real lived realities. So race, it was essentially created by white people in order to classify other groups to justify advantage. We needed to basically diminish and oppress people of color in order to justify our economic interests, predominantly in slavery, which continues to play out today.

Racism, and this may be actually different for a lot of your listeners, this definition, because this definition actually comes from the perspective of who's oppressed, but it's essentially when a group that's in power oppresses another group based on their race.

In order to do that, to make that happen, you create racist policy, you create laws that are racist, you create systems of oppression. So even when the oppressor is asleep, racism continues. It's in the groundwater. It's continuing.

And I think that that's genius because it also really frees white people up. "Well, I didn't create slavery. I didn't create that racist policy. Therefore, I can't be a racist."

Harjit: I really appreciate that you kind of laid that groundwork. I studied ethnic studies when I was in undergraduate, and that's kind of the gist of what I feel these definitions are. I also do understand that specifically, because it's a social construct, these definitions are fluid. But I think those are great kind of ground rules for us to build on this conversation. So thank you so much.

Dr. Cowan: Yeah, you're welcome.

Margaux: I agree with your definitions.

Dr. Cowan: All right. So the background on me. I am a 45-year-old white woman. I'm a clinical educator and a physician. And whenever I say that line that I just gave you of who I am . . . So on Monday morning, when I take over a new team, I always huddle up and we go around the circle, and I wouldn't ask anyone to do something that I wouldn't already do. And so I start. I give a one-liner about myself, and literally 9 times out of 10, someone snickers, laughs, snorts, does something because I said the word "white." And when I ask them what's so funny, they're like, "Well, you said white." And so it got me thinking, "Wow. We really don't have the tools to talk about race."

Race talk is really hard. And so what I do when I work with my teams is I let them know, "Talking about race is hard for everyone, no matter your color. Can we use it as a learning opportunity to talk about something difficult or maybe just to listen?"

Harjit: I actually love that you say that, because we always stay most generally in our patient ID. "This is a X-year-old white male," or, "X-year-old black female." And we've been told when we were trained here to use that race indicator if it's applicable. I remember I was taught that.

Margaux: Yeah, I think we were taught that, but in practice I haven't used it. And it may come back to the conversation you're having of . . . well, two things for me. Is it medically necessary to state that first and foremost? Do we need to identify this person as an African American or a black person versus a white person? And secondly, it's difficult to talk about race, for me anyway. So I know that we were kind of taught that, but I've actually never used it and I don't actually see it used that much. Is that your experience?

Harjit: I've seen it a couple of times, but the reason why I'm bringing this point up is because you stated you say your race and people will sometimes kind of take a step back, but I don't see that when people use it in the patient ID.

Dr. Cowan: Exactly, because I think I've personalized it. And I call it my "white flinchable moment" where it causes discomfort because I broke white solidarity. The number one rule of being white is you don't talk about it. It is impolite to talk about race. Race is messy, it's murky, and we just don't go there.

So growing up . . . I grew up in an all-white town, like rural Oregon. There were no people of color in my hometown. I learned about race from my family, from the media, from teachers. And yeah, it was sort of like a shameful thing to talk about. And so, if someone was describing let's say, "Well, the black nurse," almost like whispering it as if it's somehow bad.

So part of me and my process is understanding my own white identity, and I think that's been good for me to say that I'm white.

Harjit: Was there a specific time that you kind of really started thinking about your white identity?

Dr. Cowan: Yes.

Harjit: There was? Okay.

Dr. Cowan: Yeah. So unfortunately, I have lived segregated my entire life. Even after I left my hometown, on the coast of Oregon, larger cities, I continued to live among white people. I had just this palpable discomfort when I was around people of color. It was awful.

And I recognize now what it was. I've learned about it. We all have identities, right? You identify as, you know, a medical student, a partner, a mother, whatever your identity was. And as a white woman, the worst thing that could happen would be that I could be called out as racist. And so I would get really uncomfortable around people of color because I didn't want to put both feet in my mouth, and so I would just avoid them.

If I happened to have to be in a situation, particularly with black people or African American, my voice would get squeaky. I would lose my words. I mean, I was just a train wreck, just a total train wreck, because I had no experience and I had no skill.

Margaux: I share that with you too. I grew up here in a pretty heterogeneous population, and I went to college in a predominantly white population as well. And then I lived in Austin, which was being very gentrified at the time. And so most of my experiences were being surrounded by people who looked like me, white people.

And like you, I similarly felt that discomfort, and I often found myself trying to overcompensate and being like, "I'm not a racist. I'm your ally and I'm your friend and I'm going to be extra nice to you and go out of my way." But that's not something I would do to the other . . . you know, the white person sitting next to them. And so, by doing that, I'm isolating them. And just that awkwardness and navigating . . .

And I think it does come down to being comfortable with my own white identity first and comfortable with race, and then also reading about and teaching myself to be comfortable.

Dr. Cowan: Yeah, doing the work.

Harjit: So what made you push into that discomfort?

Dr. Cowan: So it has to do with the Iftar. About three years ago, I had the opportunity to work with a team of residents and medical students who all didn't look exactly like me. They had different faiths. They had different ethnicities, different race. And so, over the course of two weeks of spending so much time together with them, they started sharing their stories, and all of a sudden it became deeply personal.

Now I knew somebody, and it wasn't just disrespect that maybe I saw on TV and it was like, "Well, that's just TV or a movie." It was actually, "These were real people," and I had a connection with them and I cared deeply about them.

And I recognized over that course of that time I didn't know anything about Islam. I didn't know anything about, you know, what it's like to be of a person of color, where you walk into the patient's room and they ask you, "Do you speak English? Where are you from? No, where really are you from?" and how you're treated. I have so much privilege in my white skin, where if you're a person of color, it's almost like a liability, and sometimes there are some serious consequences.

And I had just no idea. I sort of thought of disrespect in healthcare as about gender, or sexual harassment, or come-ons and put-downs. And yes, that's real, but there was this whole other world of disrespect that I had no idea.

And so I started really looking at it, and I also wanted to look at, "How do I contribute to racism and how do I benefit from it?" It was pretty painful. It's not easy work to start to deconstruct your own racism, because as white people, like there's no real reason to. There's no sort of push.

Margaux: And I think this comes back to what you were saying about how racism is institutionalized in such a way that we can disassociate ourselves from it and say, "Well, I'm not a racist."

And a lot of rhetoric I've been seeing on Instagram lately is about white supremacy, and classically I kind of associate that with the Ku Klux Klan and "That's not me. I never do that." But how it's defined into that integrated institutionalized racism that we all kind of hide behind, I've had a lot of discomfort in reading and digesting that of like, "Oh, shit. This is a big problem. I am contributing just because I am a white person and not doing anything. My inaction is contributing to this."

Dr. Cowan: Yes.

Harjit: Right. I feel like the reason why I think the way that I think is because I grew up in a very diverse neighborhood. So I grew up in Salt Lake as well, but I particularly grew up in West Valley, where basically all the people of color lived. And I would never trade that for the world.

Yes, I did get a . . . people say the high school I went to is the worst high school in this state. A lot of disadvantages from being there, but I think that outweighs the advantage of being with people from different backgrounds. Because when you actually form those connections, I believe that's the core of diversity work, is building connections with people who are different than you and learning from their experiences.

So I think that it was so beautiful that you said, you know, these were real people, and for you to actually know real people's stories, you can't be uncomfortable. You have to talk to them. Talking about race is so important.

Dr. Cowan: Yeah. And in talking about it and really getting into the discomfort, internalizing it, getting close to it, that's where the real growth happens. That's where change happens.

Something that I've been also thinking about sort of recently is what drives me? I'm kind of an anxious, hyper person, but it's not anxiety that drives this. It's my loneliness. I have been lonely my entire life and I seek connection.

Trying to become an anti-racist . . . because that's really what we have to do. It's not enough just to not be a racist. We have to do the work to actively destroy this. And racism is all about disconnection and isolation, right?

And so I have so much loneliness that, when I get some connection, I'm like, "Oh, I want more, and I want more for my team, and I want more for my nursing staff, and I want more and more." And so, for me, that's sort of what is driving me to do this work.

Margaux: I think that's so powerful that you put yourself in that vulnerable spot to admit that you're lonely, because I think a lot of people are driven by loneliness and this seeking out the connection.

And I think it can also be the opposite too, where you want connection and want to isolate to your own what you know is safe and comfortable, and so then you can create those biases and tell yourself those stories to sort of separate anything that may be threatening those that are comforting and connected to you and maybe threatening to that.

Sorry. That was kind of hectic. I was thinking it through in my head and was like . . .

Harjit: Chloe will fix it.

Dr. Cowan: I'm picking up what you're putting down. I'm with you.

Margaux: I'm just word spewing here.

Dr. Cowan: And I think we can do that too as liberal people, where we just hang out with people that only think like we do and it's comfortable.

Margaux: Exactly. I think it's that comfort, like putting this box around me that I'm comfortable with and I have a connection with and there's this idea of "the other" and I'm not connected. And it's scary and I don't want to be disconnected and have to navigate that line where I may be isolated and lonely. So I'm just going to tell myself the story that I don't need to connect there.

Harjit: Once you form these connections or started seeking out these connections, started being driven with not being lonely, can you tell us a little bit about your head space then?

Dr. Cowan: I became really, really sad. I just started to shut down. We can talk about this another time, but sort of white women tears, you know? I was the crier, like, "Oh, this is just . . . this is all so overwhelming." Then I started to get really angry, like, "Why hadn't I learned American history correctly?"

Harjit: We talk about this.

Dr. Cowan: It just made me crazy, right? And so, now in this journey, I'm reading American history written by black women scholars, and it's just like, "Holy shit. I had this all wrong. This is really . . ." It was devastating.

Harjit: Right. Like we've said, it's so ingrained in the foundations. We learn about, you know, certain presidents, certain figures in history in a certain light because it's written by the winners or the ones that have the power, not by the people who actually have a beautiful story to tell, but their story is basically watered down to the point that it doesn't exist.

Dr. Cowan: Or erased.

Margaux: But now I think we have the advantage of living in a time where we have so much access to these stories, and so it's our job to go and find them and listen to them and not let them be erased. If there is someone who wants to share their story that's not in the mainstream, we have the duty to go and listen and learn.

Harjit: Exactly. And even as a person of color, I will say that I've been on both sides. I've been on the side where I've been discriminated against, but I've also been on the side where I was doing the discriminating.

Even in spaces of people of color, there's a certain hierarchy of which races are "better," which ones are worse. So I have a lot of embedded anti-black racist ideologies that are embedded in me that I have to constantly do the work to check in on.

And I like how you said, Dr. Cohen, you were very sad and angry and made it kind of . . . it becomes personal, right, because it's about you. But then how do you make that switch from taking your own vulnerability and sadness and kind of understanding that there are so many other people that are in so much pain as well? How do you come to that point where you can both look at your own feelings, but also, you know, serve the communities that you want to serve?

Hey, y'all. I know this is a little abrupt, but we have actually cut down this conversation into two parts. There's so much wonderful learning that we feel like we were unable to edit out anything. For that reason, I hope you enjoyed this first part. Next week, catch the second part of this episode.