S6E3: The Identities of a Doctor

Lina: How are your weeks going, guys? Hello? Can you guys hear me?

Hạ: Week? Yes, I can. How's your mic doing, Lina?

Lina: It is maybe stable. We'll see how this episode goes. It keeps falling and dancing around, unfortunately.

Leen: It is hilarious it fell.

Lina: So here we are. Harjit, it's okay, I forgive you, but I don't think it's manageable for long, whenever you listen to this.

All right, guys. Hi, everyone. Welcome to "Bundle of Hers" Season 6, Episode 3. I'm here in the virtual studio with Ha and Leen.

Hạ: Hello.

Lina: And I can't remember the last time we three did an episode together.

Leen: I know, right? I was just trying to think that through.

Hạ: Yeah.

Leen: Have we ever done an episode together?

Hạ: I think we did. Were you there on the "Alternative Realities" last season?

Leen: Sounds like something I would be on, but I don't know if I was.

Lina: Yeah, I think so. I think that was the last one. So it was New Year's of 2022. Wow. It's been a while.

Anyway, I wanted to talk today about our identities in medicine and how sometimes we feel like we have to restrict it to just medicine itself and nothing else. I feel like we've talked a lot about this within ourselves and trying to manage multiple things or multiple identities and feeling comfortable with who we are and what we, I guess can be during our time here.

But sometimes, or a lot of times, it feels like we can't, and I feel like it really affected me in my first year of medical school. And I think a big thing is I felt like there had to be a certain way to do med school or a certain place to do it to get to success.

And there were a lot of things going on in my personal life, there were a lot of things going on with back home, and I just felt like I couldn't really be anything other than a student in my first year and that's where I had to put all my attention at.

I felt very isolated because there were a lot of parts of myself that I put to the side, in a sense. I felt like I wasn't living really my true self for very similar reasons, and it just felt like this is the only way to be a good medical student.

But the thing is I didn't feel myself, and it took a very long time to really feel like I can have multiple identities or even just multiple ways to be other than what we're told to be or what we're told to present ourselves in.

Leen: Honestly, that is one of the biggest struggles of going into medicine in general, I think, especially in this generation. One of the biggest . . . I don't know if it's a pet peeve of mine, but one of my biggest pet peeves is when I get the feedback of, "I don't know why you went into medicine. It sounds like you like so many other things."

The times where I've been the most frustrated with being a resident or being in medicine is when if I was on shift and I had someone tell me that, or someone tell me, "Hey, while you're here you need to be more doctor-like and the other stuff is too late. You can't pursue it."

And it's funny because those comments would really drag me down for quite a bit, until I remarked it to someone or told someone about it and then they'll be like, "That is the most old school thing I've ever heard. Why are you even bothered by that?"

I think medicine is changing in the sense that they're trying to make us bring our identities back, just for the sole reason that we're not able to connect with our patients anymore.

I don't know. I tend to just really try to be my true self on shift and with my colleagues and staff. I get a ton of feedback saying, "Wow, you are the most down-to-earth doctor." And I'm just like, "No, I just can't be the doctor everyone imagines they want me to be," I guess.

But there are times where I think major depression sets in when I find out that I'm not singing as much, I'm not hanging out with my community as much. This really looms over me to the fact that I'm trying not to believe in a reality where those things will not happen anymore.

Hạ: Both of what you said really resonated with me. And one of the things that, as you talk about it, I think about a lot is I feel that a lot of our ways to get into medical school and to get into residency, we have to buy into this notion that medicine is this huge part of who we are and our identity.

And getting into med school, you have to talk about why medicine is so impactful for you, why you can't think of doing anything else in the whole world, when the truth is medicine is actually just a career.

It's wild that medicine seems to take over all parts of ourselves versus if you were to talk to people in a lot of other jobs, they go, "This is my job, but I also have a lot of other passions and a lot of things that I really love to do." I feel that it seeps into the ways that they approach our schedule and our workload and our feedback, as you brought up, Leen.

I've been feeling this quite a bit, particularly this week because this week I feel like all I have been has been a medical student. I've had so many things that I've had to get done for the medical school, a lot of things to prioritize for medicine, and it's been hard because I feel that I lost a lot of connection and a lot of things, like being able to hang out with people, being able to read the webcomics that I like, even that small thing, or watching the TV that I like.

And as I keep reflecting on, "Why did this happen? Why did my schedule become that way this week?" I realized it's because it's this learned behavior that's been ingrained in me. Over and over, this is the messaging that I've gotten, is that medicine has to be all that I am. And it's really hard to push back against it, especially when it kind of becomes this habit that you've taken on.

Lina: Yeah, exactly, Ha. I think it happens before medicine in a way, like when we're applying into medical school, but it feels like, "Oh, this has to be your passion, this has to be your life, this has to be everything that you are." And through the months, you feel a little . . . at least for me, I felt a little bit more and more of myself taken away from me, like you both brought up, whether that is hobbies or your community or things that you used to do before medical school or residency that gave you yourself. We're not doing them as much anymore. We're not paying attention to that.

For me, it feels that we get to fourth year and interviews and it's like, "Oh, tell me about yourself. What do you like to do?" And my mind is, "What do I do other than anything associated with medical school? That's kind of scary." I don't want to be in that position, but I kind of felt like I had to be put there.

Leen: I think that's the most frustrating thing that now I'm towards the end of residency, going into fellowship. I almost feel like they used our passions and who we are and our identities and our goals to just kind of make us into this cog of a healthcare money machine. It kind of sucks to feel that.

I know when I'm on shift I forget that this is one big healthcare disaster of a system that we work in, but it almost feels that way. It's almost like, "Tell me about your passions. Tell me about how round of a personality you are," and then, "Let's run them through a machine that makes them all the same cookie cutter and then judge them if they have a little bit here chipped off or something here," and then do it all over again. "Tell me why you're unique again." Revisit that whole sense.

Oh, man, I just don't know. And I think it's one of the biggest frustrations when it comes to medicine in general. I think especially nowadays the healthcare system is completely at an all-time high with visits, and I think going through medical school education and residency at a time like this, people tend to forget that we also are human. And it's been a huge problem. I think it's been a huge problem within our community in general.

Hạ: And it really does show how much injury a lot of people have in medicine because their identity just becomes wrapped in medicine and how they perform in medicine.

For instance, we've had so many within this last year. There's been so many news about the resident suicides and physician suicides, and I think it's really is a reflection about how we're taught to give and give and give all of ourselves to the point that we lose the parts of ourselves that bring us balance and bring us joy to a system that is inherently not really backing us.

They don't really care what happens to us in the end because we are, in a way, a bit disposable. We save a lot of money, especially as medical students and residents, to provide care. We have so much passion and so much energy that often we're giving so much time trying to navigate systems for our patients to get the best care that they deserve. And we don't really get that space to really enjoy ourselves and to be with family, be with friends, and value other things that are super important to us.

Lina: I feel like, Ha, you brought it up, that standard. We're not expected to have time for family and friends and hobbies because we sacrificed that in order to be a good doctor, or I guess that's what it's thought out to be.

I guess at the beginning it feels like everyone's doing it this way. That's how the system is. Everyone's working these hours for the longest time and it's worked like that. And I feel like, before, you never really looked into kind of wellness and finding other things than medicine. It was just kind of this status quo of things, right?

We all just conformed to the same thing over and over again, and we all just kind of go into it being like, "This is how it should be, this is how we get better, this is how we're going to be good doctors," sacrificing everything in a sense and putting all our time and effort into this job.

But we shouldn't call it a job. This is your life. But I don't know. Leen, you brought it up. I don't think that's the way it should be anymore. I mean, I thrive more and I'm a better doctor when I am being myself and having other things other than just medicine, I guess, or other than just being a medical student.

Leen: Absolutely. And I think it's actually interesting to hear that we're using the word "what a good doctor means" is to be that identity-related kind of person when it's truly the opposite. Our patients don't need us to be robots who spit out medicine and knowledge at them. Our patients need us to listen to them, our patients need us to relate to them, and not even just be someone who can connect with but someone who understands where they're coming from.

I think sometimes we just kind of put it in the back of our minds, but half of medicine doesn't just necessarily occur in your clinic office or in the emergency room. Medicine starts from their homes. Medicine starts from their backgrounds, it starts from their traumas, their generational traumas. It starts from how they live, what they eat, where they go, what's their society like, how are they ostracized, right?

And if we don't get to connect to them on that level, if we don't get to understand them on that level, if we don't get to be part of them as a community and as a co-community member, "our identity," then what are we? What are we really doing? We're just reading facts and spitting it back out, reading facts and spitting it back out, and then you just kind of get in trouble for not seeing enough patients, not doing this, right?

I mean, honestly, there needs to be a take-back of the healthcare. And with the way social media, media, and maybe post-pandemic, people tend to think we are part of the problem. And to some degree, yes, doctors are part of the problem, but also to some degree, we're kind of trapped in the problem. And I almost wonder if we also need a little bit of saving.

Hạ: Yeah, it is like thinking about it in the greater community perspective. It's so interesting because it's true, these patients come in with so many afflictions and so much pain because of the capitalistic system that we exist in and all of the inequities and the disparities that come from it. And yet we in medicine abide by a capitalistic system to get success. That's what we're told we have to do. "Do more, work more, achieve all of the numbers and things like that."

And we keep thinking that by doing this capitalistic work, we will get to the point where we can help our patients, when in reality, you kind of have to think about how you're just approaching it in the exact same way that's hurting your patients.

And for me, especially as a person of color, someone who comes from an immigrant background, my communities are the most affected. And sometimes I feel really small realizing that I went into medicine hoping to help those communities, but now I'm trapped in this, as you described it, Leen, system that is the one that's hurting my community.

Leen: Yeah. And I think also when you act as the person you are, the building blocks of that personality come from a background that maybe most doctors typically don't relate to.

And then they see that maybe you're acting a bit different in terms of your personality is not the same way they expect doctor personalities to be, or you interpret things differently, you read things differently, your thought process, your connections, you connect differently with the world.

And then that becomes more of the feedback of now not only are you not enough of a cookie-cutter doctor, but we have to question that whole method to say, "Is this what's going to be a good doctor?"

Because they don't know. They've never seen anyone with our identity be a doctor per se in their eyes, unless that person with our identity has become the cookie cutter. That's so frustrating because it's like you want to keep telling them, "Look, I can be this passionate Palestinian singer woman with this background who freaking loves video games and God knows what. I can still be myself and be a really good doctor. I don't have to necessarily be the very stoic, the very strict doctor."

Patients don't relate with that. I literally was sitting with a group of people from Palestine yesterday. We're just kind of a little community hangout. Everybody was like, "On TikTok, we saw this. On TikTok, this is what they're saying." And I'm just throwing out, "EBM, EBM, EBM." Nobody's listening to me and I'm like, "I've become the doctor they want me . . ." It only took them seven years. I am now the robot they want me to be.

Lina: EBM has nothing over TikTok.

Leen: Exactly.

Hạ: Leen, you telling that story, it just reminds me so much that as I keep going into higher education, there are so many moments where my mom needs to check me, where I'm going on these vents and talking about these things and she says, "Hey, approaching this in a very intellectual way, you think you have this education, that you think you know what it's like, but this is the reality of the people in my work. This is the reality of how everyone else experiences it."

And whenever my mom gives me that check, I go, "Oh, wait, yes, the system has really ingrained in me how to think and how to act." And I sometimes think, "Oh, I am very radical and I'm really pushing things to the limits," but I still also just naturally fall into what the system wants me to do.

Leen: Exactly. And I think that's the key that a lot of people in healthcare, including our mentors and the people who are over our education, don't understand. The difference between TikTok per se and us connecting with our communities and them preventing us from being ourselves to connect with those communities is that TikTok has personality. It has personality and then people will be like, "This is real. This is totally real."

My biggest thing when I was a med student on rounds was the way you say things doesn't make sense. I'm like, "How does it not make sense? I'm literally giving you objective data. How is this not making sense?"

And it's because our storytelling, the way we portray information, the way we give information isn't to the standard that they want. I'll be like, "I'm telling you a story of all the information in a way that makes sense to me. You are refusing to connect with it, but I have to connect with your way of objective data."

Lina: Yeah, exactly.

Leen: And I think we all need to be a bit more insightful that there are different ways of interpreting the world to get to the same ideas as well.

Communication is the biggest thing that they seek out in medical students, right? And yet it's the biggest thing we forget once we're out of med school and probably in med school.

Lina: Exactly. You're kind of taught to communicate in a certain way and to explain things in a certain way. And I feel a lot of times they leave out the patient in this and they don't understand what you're saying. They don't understand you. They can't relate to you, and so there's this huge barrier.

I've seen it a lot at the beginning of, let's say, my third year with starting rotations. "Don't share too much of yourself," all these things, kind of advice I guess. I've connected more with patients and I've helped more of my patients when I was myself, when I told them about my hobbies, things I like to do on the side.

It's the same thing with my aunt sending all these medical questions, and the way they listen to me is when I talk about stories rather than sending them random information.

But I don't know, just that experience itself and that communication, like you said, Leen, that's a big thing. And also my confidence itself. I didn't feel so blunted, if that makes sense. And not just with my interaction with patients, but my interaction with myself.

Giving myself back my life and my hobbies and my family and my community, I think all of that just made me feel better in myself and better in why I went into medicine and who I want to go into medicine for, and it's not the system. So I need to get out of this kind of circle that we all get lost in to be where I want to be.

Leen: Yes.

Hạ: Leen, I don't know if you remember, but I distinctly remember that in one of our rotations, we were given a talk about using medical language and how to present with appropriate language. And it bothered me so deeply.

We say that we value diversity and inclusion and we keep saying that we want to push for that, but at the end of the day we just . . . Even the people who are diverse and who come in, as I think has been mentioned earlier and so many times before, we are asked to then box ourselves in and fit this mold that they make for us.

It's painful and it's stressful. It makes you feel like even when you go to work, you can't be who you want to be, and that if you ever let it slip, if you ever are who you are, then no one will really want you anymore.

Leen: Yeah, and that was a very tough reality for me my fourth year of applying for residencies. Me and Harjit used to always say, "Why is it always . . ." People will get great feedback and things like that on their evaluations, and me and her always got, "Great team player." And it was that very fact of people don't see us per se as "someone who we can tell that they have good medical education, they can think with us, they're intellectual." Maybe that's what I'm trying to say.

Maybe it's because of the medical jargon. Medical school I think is so interesting because they'll teach you medical words and it's the only place that they're going to teach you how not to talk in medical jargon. I'm like, "Maybe if you support the different personalities that are around you that know how to communicate with people, then other peers will start looking to them as well, and you don't have to be . . ." Let's unteach the robot for just two seconds.

Lina: Yeah, exactly.

Leen: It's just so interesting how quick we are to judge in these regards. It was even last week . . . man, we had some sort of residency hangout and there was karaoke. We all know how much I love karaoke and I love to sing.

Lina: Yes.

Hạ: Yay.

Leen: I know, right? I was like, "Finally something I can do that I love. I love to sing." And I didn't know any of the songs and everybody kept handing me the mic and they're like, "Sing this one for us, Leen. Sing this one." And I'm like, "I don't know this song." And they're like, "How do you not know 'Sweet Caroline'? How do you not know this? Wow, Leen, what do you do? Live in a hole?" And I'm like, "I'm sorry. Do you guys know Fairuz? Do you guys know Arabic singers? I bet you don't. Do you know Nancy Ajram?" I wasn't raised with your Beatles, just as you weren't raised with my Fairuz and my Abdel Halim Hafez. You just didn't get that.

And so I started arguing with them and I was like, "How about you guys be a little bit more culturally sensitive and just not quick to judge me?" And then the feedback was, "You know what would really improve your musical ambitions and careers? Is if you just learned some of the songs that most people know."

We just don't support it among each other enough. We don't support each other's identities, we don't support each other's quirks, we don't support each other's hobbies, we don't support each other's mannerisms that might be a little bit off, right? And I hate saying that, "a little bit off." What the heck does that mean? I mean, I'm off all the time, but . . .

Hạ: I mean, it translates to then patient care, right? Because I think that we come in with these biases where we respond better to patients who have the mannerisms that we have, who are able to be more intellectual. And if we aren't able to accept within our community different people and different personalities, then how do we expect us to really embrace our patients' different personalities and backgrounds and perspectives?

Leen: Yes. That actually brings up another thing I was thinking. They were giving us kind of a little bit of a talk and they were telling us how to tell loved ones that their loved one has passed away, has died. You don't sugarcoat it. Don't say pass, don't say went to another place, just say the word died. Say that word. And I'm sitting here and I'm like, "That's a very, very one-culture-minded kind of way of approaching things."

And I can remember an exact case where there was an Arab family who lost a loved one at our ER. I'm amazed my team actually recognized that this is someone I could connect with, and they came and they were like, "Leen, how do we approach this?" And I was so grateful for that.

I said, "Do not tell them straight up, with a translator, 'Your family member is dead.'" Because in Arabic, that just sounds so disregarding. You have to find out what background religion they are. Are they Muslim? Are they Christian?

If they're Muslim, you have to include that Allah has called for that soul back. And yes, that's total opposite of what they teach us, right? But by saying that, you are giving respect to the body, you're giving respect to the soul, you're giving respect to the scenario, and you're respecting the patient's now journey in the religion afterlife, right?

I'm not going to shy away from showing my identity anymore, because this was a scenario where now people knew I was a resource for that same situation. And I hope you guys will also take that as well.

You know what? At the end of the day, you know why you're there and you know who you're trying to connect with and you know your community you want to help.

Lina: Yeah, exactly. I feel like especially with interviews lately, there's this whole "be yourself, but not really. Just be yourself, but tone it down a little," in a sense. And I've gotten that advice.

In my latest interview, I was just really wanting to really show myself for who I am, and I connected so well with a lot of the residents and a lot of the faculty that I'm like, "No, this is where I want to be. This is where I can shine. This is where I can really have that community and have that community also with my patients and just feel okay, or more than okay even." And I think that's kind of this difference that I see.

And it also is because I have you guys. We've always constantly encouraged each other to be who we are. And I feel like day one, Leen, me and you connected over being Palestinian and we were like, "Oh, let's just hang out randomly one day and do dabka or belly dance." We did and we loved it and we had so much fun. And even though it wasn't anything that we've connected or done before, we had a really good time.

And me and Ha have been doing all these wellness things, but in reality, we went and got boba together. We go on walks because we both love to walk in nature and just really trying to fill our time with things that connect us to who we are and connect us to our community. I think this all makes us kind of in a better place for ourselves, for our friends, for our patients too.

Leen: Absolutely. It's so important.

Hạ: Yeah, I was just going to say 100%.

Leen: I mean, that's essentially why I left Utah to some degree, right? I literally just Googled "where's my community?" Oh, Patterson, New Jersey. All right. "Good EM programs near Patterson, New Jersey?" All right, Rutgers. Let's go.

You have to find the places that recognize that value, and you're going to change the field just by people looking at you and seeing that you are your authentic self. It's so important and it makes the field of healthcare truly be the purpose of healing people. And people come in so many different forms, right?

Lina: I shared this with Ha, but I think I was kind of talking about this and being myself. I was very anxious about being myself in interviews, and my therapist shared with me this poem by Maya Angelou. It's just kind of about being your true self and shining in the way that you should be. And I think there were several things that really stood out to me in the poem.

It says, "Your playing small does not serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you. It's not just in some of us, it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we're liberated from our own fear, our presence automatically liberates other."

I felt that. I felt that with you guys. I felt that with myself. And I just have this poem now just reminding me to be myself, to really stick to who I am. I'm not just a med student. I'm not going to be just a doctor. There are so many other things about me, and I can't wait to share that with everyone, because I want everyone to share that with me.

Leen: Absolutely. I think the person who wrote that poem truly gets it. Especially, oh man, the insecurity part. We're all so insecure. That's what medicine is. All the doctors are insecure. Don't joke yourselves.

Hạ: I mean, I think we act the way we do because we're insecure.

Leen: Exactly, 100%

Lina: Thank you both for doing this episode with me. I really loved this conversation. And again, we're here for each other to constantly remind each other why we should keep on shining and be every part of ourselves that we have or that's in us, I guess.

Thank you, everyone, for listening to this episode. Follow us @bundleofhers on Instagram, and listen to us wherever you listen to your podcasts. We'll see you in the next one. Bye.

Hạ: Bye.

Leen: Sayonara.