S3E8: Allyship, Part II

Margaux: What is the episode? Are we really calling it allyship or . . .

Harjit: Yeah, we're going to call it allyship. Even though we introduced that word in the end, I think we should call it allyship.

Margaux: Okay. Hey, everyone. This is part two for continuing our conversation on allyship. Be sure to check out part one in last week's episode, and we will continue the conversation now in part two.

Harjit: I like how you said, Dr. Cowan, so you were very sad and angry and made it kind of . . . because it becomes personal 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's 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?

Dr. Cowan: I mean, at that point, when I first started this, I couldn't even talk about it. Like, I couldn't articulate because I was just so wrapped up in all of these different emotions. And so for me, it was journaling about it, talking to a therapist and counseling about this because it was starting to change my identity. It was, like, rattling me to my core. And I didn't realize my identity would start changing until much later. But that's really what was happening was there was all this dissonance. It was like, well, this is what I was told was real, and now I'm finding out that I have a lot of unlearning to do.

Harjit: We all do.

Dr. Cowan: It was, like, just kept blowing my mind, and it felt really overwhelming. But I stuck with it, you know. And at the time, my boyfriend, he would sort of tease me because, like, another box from Amazon would show up and he'd be like, "Wow, is the word white in the title of any of those books?" Like, "Babe, when are you going to read something happy? When are you going to let this go?" Or he'd sort of joke around like, "Babe, you're white. Like, you're still white." And it wasn't like I was ever going to change that. Like, I know I'm white, and yet could I become a white woman that was doing work to be an anti-racist? That was what I sort of was after, but I didn't know how to get there.

And so I was sort of like, "Well, I'm going to read another book. And then I'm going to watch this, you know, TED Talk, and then I'm going listen to this podcast," and looking for, like, just tell me what to do. And unfortunately, like, there isn't anything to do, except you just have to get into it yourself. And you have to do this work. It's social accountability. And it's not easy. Every day I have to think about this. And every day I think about my white privilege, and what biases do I have, particularly when I'm taking care of a patient, particularly when I'm, you know, working with a team. That's my work. I'm not crying anymore. You know, like, it's still not, like, easy to read about certain stories. I'm getting to this place where there's, I guess, maybe I'm a little more comfortable being uncomfortable.

Margaux: I like that.

Dr. Cowan: If that make sense?

Harjit: I like that a lot. I think that's such an important space that every person should experience. And I always say this in my community because we have a lot of young kids. And there's some ideologies I don't agree with the parents kind of that are very racist, sexist. And, you know, I grew up with them, and now they're adults, and they kind of perform the same things as their parents. I understand that they were taught that.

Dr. Cowan: Sure.

Harjit: But when does it come to the point where you're old enough, you have a mind, we should all work to change these things. I think that that's where I always get hung up is it's so easy to just go with the flow, and to go against the current is so difficult. And I think with that comes a lot of our own pain on both sides. Thank you so much for sharing kind of the background of how you came to this work. And now that you are kind of in the midst of it, I will never say it's completed. I feel like it's never completed.

Dr. Cowan: I wish it was.

Harjit: Yeah, it's ongoing. In what ways, like actionable ways, have you tried to integrate what you've learned into your work . . . or sorry, integrate into your life?

Dr. Cowan: So as a clinical educator, the teams that I work with are really in a hostage situation. You know, I walk into the team room, and I use my privilege. Like, we're talking about white privilege today, we're talking about bias. I'm reading you a story about racism in the OR. I'm reading you a story about a Muslim woman who was assaulted by a white man. You know, like, I'm bringing things even that are happening in our community to team, and we talked about it.

Harjit: And what's your experience been with that?

Dr. Cowan: I've had some beautiful disasters, and that is the [inaudible 00:04:52] of the whole part. Like, if it was easy, everybody would be doing it, but it's not easy. And you know, I sort of stepped into this space. I don't do this anymore. But when I first started thinking like, "Oh, well, everyone believes like I do, right? Like everybody wants to do this work," and that's not the case. And so I'm really making people uncomfortable, particularly if, one, they disagree, or two, they don't want to participate. I've learned to create some good ground rules when we talk about these sensitive topics. So how I set it up, and I do this for every grand rounds, every lecture, every noon conference, I say the same thing, "Talking about race is tense for everyone. See if you can use it as a learning opportunity."

I mean, if you think about it, like, in medicine, we do all kinds of uncomfortable things. I mean, it's stuff that I'm like, whew, you know. We can do this too and . . .

Margaux: It's no different than . . .

Dr. Cowan: It's no different.

Margaux: . . . talking about death and dying with the patient.

Dr. Cowan: Exactly.

Harjit: Right.

Margaux: So, Dr. Cowan, I'm really glad that you shared sort of the process of your learning. And I feel like I'm in that struggle right now where I'm trying to order all the books because I've finished all my required clerkships for fourth year and so . . .

Dr. Cowan: Congrats.

Margaux: Yay, thank you. And so I'm like been getting all these book recommendations from various Instagram accounts, and I've ordered a bunch of books. And so like you, where I am searching for that answer because I still feel very much uncomfortable having those conversations. And I think a lot of it comes through my own confidence of, like, when someone does challenge me, do I have the right, you know, "right words" or right things to say? And like, what sort of qualifications do I even have to be talking about I think is what I'm struggling with a lot right now.

And so it's really encouraging to know and to hear you say, like, you know, the books are great, they will give you some foundation, but, like, at the end of the day, there's no manual for this. You just have to go and pave the way and do it. You may have a beautiful disaster, like you said, and those are ultimately the best way to learn. So for me, that's really encouraging because I think right now in my mind I'm like I'm just going to read all these books and then it will be great, and I'll be able to talk about it. But, no. Like, no, it's not.

Dr. Cowan: Right, or that feeling of, like, I will talk about it when . . .

Margaux: Exactly.

Dr. Cowan: . . . you know, when I am perfect, when I am a racial scholar. I will do this when I have all the right arguments, when I know all of the dates for everything and . . .

Margaux: Collected all the evidence.

Dr. Cowan: Yeah. And it's like, that's not how it works. I mean, you didn't wait to practice medicine, right? Until you knew every single pathway, and every pharmacokinetic . . .

Harjit: And we will never know.

Dr. Cowan: No. So I'm sort of like, I cannot continue to sit on my hands and wait until I have arrived. What I tell people is, look, I'm not a scholar on racism, but I am an expert witness on my own white life lived experience. And so that is my starting ground.

Margaux: And I think at the bottom, the root of it comes like empathy and compassion and being able to be vulnerable and be wrong, say something that may be wrong and take that feedback. I think that's a very scary thing for me when I just want so bad to, you know, fight and make a change, but to be wrong seems like the worst thing ever, but I don't think it is. It's a great learning opportunity.

Harjit: And I also wanted to add that being an anti-racist in general, any person, these are things that it's a social accountability like you said, but especially in medicine I feel because we are directly in contact or have some type of effect or impact on another human being. And that's, in a sense, almost transferring our beliefs onto people or hurting them in ways that can be life-long and life-lasting. And I would almost make this comparison of, you know, living with our families, like the way my parents really impacts the way that I think, or I've kind of seen life and it took a lot of work for me to kind of break away from certain patterns in my families. So I think it's a very big obligation for us as people going into medicine.

Dr. Cowan: But I also think that it comes back to this compassion that you mentioned because if I can have self-compassion, then I can maybe hold the space of compassion for some of my white learners that are just completely imploding next to me when we're trying to have a conversation about white privilege in the team room.

Harjit: Yeah, that's so necessary.

Dr. Cowan: Because I recognize, like, oh, they swim in the same swimming pool I do. They drink from the same well. Like our groundwater is contaminated with racism. And so of course, they're going to come with this sort of set of bias.

Harjit: And everyone has their own journey, like their own learning journey, and I think it's important that we are graceful that everybody's journey is different. And it doesn't have to look like yours.

Dr. Cowan: Oh, God, I hope it's not like mine.

Harjit: Also, it doesn't have to look like ours, but also the way people create actionable items can look very different than everyone else.

Dr. Cowan: Yeah. So I tend to be pretty verbal. And I love stories, and I love writing. And so I'll often bring art whether we're looking at photographs, or we're reading, you know, 55-word stories written by medical students or something from "Rubor," which is also a publication from the university.

Harjit: We love "Rubor." It's super cool.

Dr. Cowan: So like, those are all ways that I can share with the team and then just create a moment where we get to reflect about it, you know, what did you notice, what's coming up for you, and then we brainstorm, like what are some ways that you all can create spaces that are safe in your community? So if you're at Costco and you're walking down the aisle, and the woman in the hijab is being harassed by two white guys, like maybe you could call security, maybe you could say something. It's, like, there's just little things that we can do to create safer spaces. So, like, I like to work out at the local climbing gym, and it is predominantly white people. And in fact, lately it's sort of feeling oppressive. And so when I do see someone of color, I feel like, wow, like, I want to go out of my way, and, like, "Hey, welcome to the gym. My name is Amy," you know, just like so that they feel warm and welcomed. You know, like, it's little things that we can do.

I can't tell you how many times I've been taking care of an African-American. I take care of mostly men at the VA. And, you know, the white team comes in, waltzes in and just sort of, like, dumps the plan. And we all stand around the patient's bed, and then we all kind of scuttle out, and then the other services come in from maybe infectious disease, or cardiology, or renal, or whatever, and it's sort of same drill. And it's like sometimes I just go back to the bedside and just ask like, "Can we just start over? Can we just start with what matters to you?" And I acknowledge, like, "I'm wondering if you're just feeling a little bit overwhelmed. There's a lot of white people here, and nobody looks like you. How are you doing?" Like, it's super awkward, and I don't have to do that. And yet, like, talk about like rich connection.

Harjit: And what responses do you get when you say that to patients?

Dr. Cowan: They're so grateful. They like, "Hey, pull up a chair. Sit down. How long can you stay?" We have to, like, just call it out. And this is sort of what I think, like, for me lately as being an anti-racist. You know, Angela Davis, she's a black activist, and she talks about this a lot, like, you have to chase after this even if it's within yourself. I have to keep looking at like, how am I contributing, how am I benefiting, being aware of my biases. So do I offer opioid replacement therapy like Suboxone or Buprenorphine for everyone, or just my white patients? If I need a medical translator, and you don't look like me, and you don't speak English, like do you get different care for me? Probably. So just being aware of those biases.

Margaux: In the conversation you were just having about how having these, you know, going up to that black patient and saying, "You know, there's a lot of white people, how are you feeling with this?" can be so awkward at first. But now that I'm thinking through it, in our first couple years of medical school we're taught the sexual history, and that is so awkward the first few times that you are asking a patient their sexual history. And with time and practice, it becomes more comfortable. And I think this is a similar situation where you just have to be uncomfortable being . . . sorry, you have to be comfortable being uncomfortable asking those questions at first and then it can become more comfortable.

Dr. Cowan: Yeah, exactly, because what we're all trying to do is developed this capacity to self-reflect, it's develop this capacity to, like, have sensitivity. It's not my experience. It's like can I try to develop the sensitivity for what someone else's experience is so that I can I can be more aware. And I can actually deliver better care.

Harjit: And I think that that's kind of the key, that this work that we're doing on ourselves, it both impacts us and the people that we care for. And I think that there's a lot of self-growth that comes out of it, which is a beautiful thing to see, but sometimes it's not something that you see instantaneously. It takes years to see kind of the work that you do and what drives you and why this work matters to you so much.

The reason why this work matters to me so much is because I've grown up being very silenced both in my home and outside the home. And I don't want anyone to ever feel like that. And that's why I do the "diversity work" that I do is because I think it's so important that people hear stories. And I think it's so important that people make connections and not objectify, like, people rather than actually figuring out who they are, knowing them, and understanding them. And I think that we're all full of knowledge, each one of us and our experiences are full of knowledge. I'm learning so much even from this podcast right now. I always jokingly say I'm selfishly am a podcaster because I learn so much through these interviews. But this is kind of the work that is ongoing.

In line with that, I wanted to bring up this term allyship or being an ally. So Dr. Cowan, I view you as an ally. Is that something that you view yourself as? Can you tell me kind of what it means to you to be an ally? Is that something that you kind of self-saw or kind of came upon you?

Dr. Cowan: It just makes me really uncomfortable.

Harjit: Do you want to tell me why?

Dr. Cowan: I think because I have this sort of bias of, like, white women who are really loud, and kind of obnoxious, and have to let everybody know at the table that, like, they're an ally, and so it just kind of makes me cringe. Like, ew, I don't . . .

Margaux: I share that sentiment with you, Dr. Cowan. I feel, like, especially now with social media, it's very easy to be vocal about wanting to be an ally, or it's very easy to say you are an ally. But I think that kind of takes away from the root meaning of what it means to be an ally. I think your actions speak way more than any words in terms of you just self-defining as an ally. And I think ultimately, it's the people that you are working around that get to define whether you're an ally or not, not yourself.

Dr. Cowan: Yeah. I like that.

Harjit: I like that too, Margaux. I think that's super important. I've worked with people, particularly in regard with race that either self-proclaimed that they're an ally or some that don't self-proclaim that they're an ally. I think allyship or "what people think is allyship" can be very harmful. There's been spaces where I've seen that there's more harm than good. What have your experiences been in that? Was there a time maybe that you did something and then realized, "Oh, maybe this wasn't the right time for that."

Dr. Cowan: I can certainly speak to that. So being on Instagram, I'm following several black activists because I was curious and I wanted to learn. And then getting really excited, so I also followed Black Climbers Matter, and I got really excited about like this event that was happening I think in Oakland, and it was like Black Climbers' night. And so I made a comment on Instagram like, "Oh my gosh, that's so cool. I really want to do that at our gym." And I got handed, handed, like I don't know how many character limit there is on Instagram, but it was the max. It was like a paragraph about, "Your white, and you think you're an ally, and you have no idea, and this is black space, and you just come in here, and you really need to read," and he had these, like, book recommendations.

You know, a part of me got really hurt because I was like, "But you don't know me. Like I'm trying." And then I felt good. Like, I need to be called out because I sort of think like, "Well, I should just be able to go wherever I want, and be safe, and heard, and I have something to say." And it's like I had no business, even though I had read all the books, and the references, and the cross references to the books that he was recommending. It didn't matter. He called me out. So I wrote back like, "Thank you. Thanks for the reminder."

Harjit: I think that could go two ways, you could become defensive and be, like, "No, this isn't right. This is what I thought."

Dr. Cowan: You don't know me.

Harjit: Right.

Dr. Cowan: I'm an ally.

Harjit: Or you can, like, take that feedback.

Dr. Cowan: Exactly. And that's where the growth happens. Like, can I recognize, like, there are spaces that I don't have any business? I can be there to listen and learn, but I don't need to comment. I don't need to recreate Oakland Black Climber Night, like, stop, like that's not appropriate. Yeah, I definitely thought about that a lot.

Harjit: And I think allyship looks different in different spaces. It also can mean different things to different people. It's a very, I would say, almost like a fluid term. And I think that, for me, what it means to be an ally is actually learning. That's kind of like my biggest place. This is how I can be an ally is learn and understand. And somehow, in a way, I think it just becomes natural when you learn. You kind of just learn things, and I feel like it impacts your whole world. Like I did bioengineering as an undergrad. I understood the importance of critical thinking in such that you have a problem, you really have to investigate it before you can find a solution. Otherwise, the solution doesn't work for the problem. I apply that at home when I'm cooking. I apply that in school when I have patients, and I have to think about their diseases. So, for me, learning is kind of like the core because you end up applying it to all areas of your life.

Dr. Cowan: And I love that you said that because that's what I really try to develop as well with my learners is, like, can you think critically about this? Can you look things up and then understand the why? Like, why did we end up where we are, you know, with 45,000 white students and 6,500 Black or African American, like, how did we get here? That's the work. Look it up. Read about the GI Bill and how African-Americans were totally discriminated against. Look at redlining. Like, do your homework, start understanding how did we get to where we are. And I think . . .

Harjit: Right. Ask the questions.

Dr. Cowan: Ask the questions. Be like I want to prick your curiosity. I want you to get excited that you're not just sort of, like, going along with the status quo, but really understanding how we got here because I think it's too easy, at least how I was raised, to just blame people. There's a little bit of data, I create a story about it, I have this prejudice, and now it's people's problem.

Harjit: But you know, what the difficult thing is this critical thinking is historically discouraged as well in the sense that, you know, everyone, this is what you need to learn. And sometimes, we've had conversations about this. Medical school feels like that sometimes, like you need to get these grades, you need to do this for step. Everything becomes such a routine that innovation is almost, like, I feel like watered down.

And I think that that's why it's maybe so uncomfortable for a lot of people to have these conversations specifically in this space is because we're so, you know, step by step it's very driven by capitalism and production. We're making med students, will then be doctors who can then give care and then we can get . . . it's like an economic benefit. So it's very difficult to fight that. And that's where I love that we discussed compassion because we need to give people that space because, you know, for so many years, there was such a checklist of things, doing things that are kind of off the road is it's hard and it's scary. But I also think that's also what's necessary because that's the reason why medicine has come to the heights it has, someone tried something different, and we got a new treatment.

Dr. Cowan: And that's why we went into medicine because we're curious and because we want to hear about other people's story. I don't need everybody to look like me, think like me. I'm curious. I want to learn and keep learning and find out about how other people live. And so this is sort of all part of it.

Margaux: And on lines of that critical thinking too, like where you're talking about it's not taught, or it's not necessarily a systemic part of our whole education system, I think a lot of medical students get tied up . . . or medical trainees and healthcare professionals get tied up in the fact that there is this hierarchy and you can't change it. But the reality is we can change it. If enough of us want to, and if you feel so passionately that it is an oppressive system, or there's something you can change, we can change it.

It feels really hard as a medical student to feel like you have any power. But even just recognizing and reflecting on what you think is wrong in that moment, you can change each step of the way. I like to say sometimes you have to play by the rules to break the rules. And so initially as a medical student, I think a lot of it is, like, feeling the oppression, and feeling, and finding what is really uncomfortable and what you don't like about the system that you're training in. But instead of letting it break you and molding into it, take that forward with you into residency, into fellowship and into being an attending where then you do have some privilege to change it.

And so I just encourage all of our listeners who are pre-meds, and medical students, and other healthcare professionals that you can change the system. It doesn't feel like it, but we can.

Dr. Cowan: And collectively, we have so much power. So even let's say you're a third year medical student, maybe you witness something, and you don't feel safe to say something in the moment . . .

Harjit: Especially if you're the one who is in the minority.

Dr. Cowan: But let's say you're a white medical student and you watch something happen, you know, maybe you practice by just going to that person later and saying, "That was wrong. How are you doing?" Notice I didn't throw a second dart and make this your problem. I am showing that like this was awful.

Harjit: The way that we are taught to, in the bigger picture, look at medicine is we're discovering diagnoses and what's the best treatments for these diagnoses, or what's the best care. If we kind of apply that same thinking to all of the areas of our lives, I think that we could understand racism a little bit better.

Dr. Cowan: You have to practice who you want to become. You have to practice it every day, in little ways, in big ways, and if you want to become an anti-racist, you got to do the work.

Harjit: And we can do it together.

Margaux: One of the things I've taken away from this or that we try to emphasize in this episode is how important it is to listen to stories and the narratives of those people around you, especially those who have different backgrounds and different experiences. And that's really where a lot of growth and learning can come from. So I have a response here to one of our Instagram questions that I'd like to share, which demonstrates how something so simple can either really hurt and make a huge negative impact on someone even if you don't think your actions are that hurtful.

So this is from Elena on Instagram. "One of the most impactful/hurtful things I lived in college was so close to that. I was living in my sorority house and chose to make a typical Honduran breakfast that morning. I was so excited to eat what I always had back home. One of my housemates looked at my breakfast and said, 'That's what you're eating for breakfast? Do you want me to give you some Cheerios or something?'" Elena, that sounds like a very difficult thing to navigate, especially when food can be so connected to your culture. Again, this is how important it is to listen to the stories and impact people around you.

Harjit: I want to remind you that this is your space. This is your space to claim. So cook your cultural food, and let people get used to those smells because I think that they need to get used to them eventually because you're going to stay here forever.

Margaux: That's awesome. So with that, we always have stuff going on our stories at Bundle of Hers on Instagram. If you want to can tribute to this conversation, please drop us a message, Bundle of Hers on Instagram, or at Bundle of Hers Podcast on Facebook, and at Bundle of Hers on Twitter. Thank you.

Harjit: Thank you.

Dr. Cowan: Thank you. She's just like sitting here, like, this is like 10 hours of work. No, I was just kidding.

Margaux: Maybe I don't know.

Harjit: Sorry, Chloe.

Margaux: We love Chloe.

Harjit: We love you.

Margaux: Chloe makes everybody sound amazing.

Chloe: I'm glad.