The Mrs. The Mommy. The M.D.: Speed Bumps and Not Stop Signs :Video:
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Wednesday, May 22, 2019

Speed Bumps and Not Stop Signs :Video:

This past Sunday, I had the honor of sharing my journey into medicine and some words of encouragement with the Wake Forest School of Medicine SNMA graduates of 2019. This was an emotional speech for me because, outside of the blog and Instagram, I had never formally spoken about the last 10 years. I cried grateful tears every time I practiced at home, and hoped and prayed I wouldn't be a hot mess that night.... Nate filmed it for me, and I am so excited to share it with you too!

{note: the dish sounds get quieter as it goes on 😂}

The title of the speech came from an Instagram campaign that I did last year started by Dr. Renee Rodriguez called "Speed Bumps and Not Stop Signs" to highlight overcoming obstacles in our medical journey. It is so important to me that we all share our stories because life can be lonely, and many times when you feel defeated, you feel so alone. We all have a story that could be encouragement for someone else! Please share with anyone you think may need to hear it.


   


To Associate Dean Latham-Sadler, SNMA faculty, staff, honored guests, parents, students, families, and friends – good evening and congratulations to the Wake Forest School of Medicine SNMA graduating class of 2019. 

I am honored to have been invited as the keynote speaker for your Medical Excellence Banquet. And honestly, I am quite shocked that I was asked to speak at anyone’s banquet. This event is phenomenal that you have put on tonight. You see, five years ago, I was at Indiana University School of Medicine in the exact same seats that you are sitting in now. I was full of pride and an overwhelming relief that I had finally made it through. 

I know that you too are full of pride, and so much relief, that you no longer have to watch lectures online 2x the speed to make sure you didn’t need to physically be in class. That you no longer have to wait for that financial aid disbursement to drop so you can plan your semester travel – or lack-thereof. And that you no longer have to continue to grind it out to do everything in your control for that residency match spot determined by a secret computer algorithm. 

But to be honest guys, if you don’t let up on the hustle now, this journey is about to take you places you could not imagine. We are fortunate enough to live in a world where we can share our stories with others just by posting a cleverly-captioned photo with a few keystrokes – I know this more than most. But with this seemingly “transparent’ environment, we forget that what others choose to let us see is very selective. 

In the words of one of my favorite 90s MTV shows, True Life,  “You think you know, but you have no idea”. Take these two photos of me for example, sure this looks like the story of a little girl who had an early interest in medicine, but a lot happened from here to here. 

At age 7, I decided that I wanted to be a doctor – evidenced by this overly ambitious science fair project on the human body as my mother will tell it.  And I did everything in my power to get there. I planned to go to College > then Medical School > then Residency > hopefully find a husband along the way > then have some kids - in that order.

If you are already familiar with my story, you know that things did not go in that order. In fact, not only did they not happen in that order, at one point, I worried that it was even going to happen for me at all. 

 Today, I know that my journey is not unique. Many of us take a circuitous path to medicine, but back then I didn’t know that,  and it terrified me. I couldn’t see how I could get there, and so I thought I could not be a college-student-turned-college-mother who got through medical school and residency without feeling like she abandoned her family. Since then, my goal has been to share all of the in-between. Because when I sought to get here, there were no roadmaps of how to parent through professional school on public display. And when you don’t have a behind-the-scenes perspective, it is so easy to get caught up in someone else’s highlight reel without seeing all of the formidable moments that might not have made the cut. 

BeyoncĂ© wasn’t built in a day, and neither was anyone else who did anything special. So tonight, I am excited to share with you how I go from the photo on the left to the photo on the right, with all of the in-between, and hopefully inspire you along the way as you take your next awesome step. If you asked me 10 years ago if I would be doing what I am doing now, I would have laughed in your face. 10 years ago, I graduated from the University of Michigan with a lot more than a degree. I was also a new mom of a four month old – my son Nathan. I have shared the details of my last year in college on my blog, so without getting into all of the drama tonight, my sweet baby boy making his debut in 2009 was not in the original plan. 

 Not only was college-motherhood not in my initial plan, I was unsure if it could even fit into the plan of going to medical school. So I did what any person does today when they want to be an expert on a topic, I Googled it. 

“Can you go to medical school and be a mom?” Today, it seems like a ridiculous question, but 10 years ago, I did not know any other mothers who were navigating medical school, or residency for that matter, and it was quite discouraging. Thankfully, when you are meant to do something, doors will open that you did not plan for. One of them came in the form of my first mentor. 

When I first found out that I was pregnant, I was very ashamed. In my own close-mindedness, I assumed that a unplanned pregnancy meant that I was not fit to mentor pre-medical college students, so I went to resign from a peer advising position that I held on campus. My supervisor looked at me like I was insane. Not only did she tell me that she did not want me to resign, she connected me with a young woman who also had a baby while she was a college student at Michigan who was now in medical school. I met with her within 24 hours. This was a game changer. 

Until meeting with the now, Dr. Monique (Bowles) Swain, I could not see myself doing it because I had not seen anyone else do it. It was then that I realized we are only limited by our mental capacity to dream what is possible. We all have a story. And as doctors, we bring our story with us into our profession. And your patients will bring their own stories. Your story, no matter how you feel about it, can be a powerful influence on the physician that you are going to become. 

 Part of my story is that I know what it is like to be an young, unwed, Black mother. I joke today that my pregnancy was low risk medically, but because of my life at the time, high risk socially. I know what it is like to be publicly insured through Medicaid and to have Medicaid for my child. And I know how it feels when clinicians look at you differently because of the assumptions they make about you. Thankfully, my second important mentor was my own obstetrician, Dr. Kimberly Wallace, a Black woman, who supported me and believed in the woman and mother I could be despite what society would want us to believe about the potential of young, unwed, Black mothers. And she did that with minimal resources at a hospital in the middle of Detroit. 

You don’t need to have a national platform to make an impact on the lives of your patients. No matter where I practice, I want my patients to walk away feeling that empowered to reach their own potential.   The impact that we have on our patients’ lives is something that can get lost in the busyness of the clinical responsibilities during residency. My first piece of advice to you is to remind yourself of this before every patient interaction. It will help you to find meaningfulness in what sometimes becomes routine. It will make you a better doctor. 

Although many advised me to put things on hold for motherhood, my heart would not let it go. So out of a little bit of denial of the immensity of the task ahead, and having no plan B, C, or D, I took the MCAT anyway. I was invited to two interviews to medical school - that I went on with my two week old newborn – and walked away from that application cycle with more than 15 rejections. Devastated by the fact that no acceptances came,  I packed up me and my 5-month-old baby, and we moved to Indianapolis so that I could complete a post-bac program and hopefully matriculate into medical school the following year. You have to “be stubborn about your goals but flexible about your methods.” – Unknown This is easy to see in hindsight, but man was this a tough lesson for me to learn. Mainly because a lot of my self-worth was tied up in the professional goals I had set for myself and in the approval of other people. I saw this detour initially as a failure because I was not moving along at the speed of some of my peers. But friends, comparison is the thief of joy. 

As medical trainees, we all fall victim to this. 

 So my second piece of advice to you is SO important.You are a doctor but that is not all that you are. You are not defined by a bad day, week, or rotation. You are not defined by your in-service exam or your Step scores. Your job is simply to become the best version of yourself and no one else. 

So I retook the MCAT. I got a few more interviews, and was accepted to medical school with a full tuition scholarship for the next academic year. 

 And that Spring, Nate and I got married. Looking back on the ups, downs, tears, and frustrations, I realize now that when I applied to medical school the first time around, I was not ready. I grew that year as a new mom, a student, and as a woman. I was stronger than ever, and today I wouldn’t change a thing.  

We started medical school newlywed, newly-med, and with an 18 month old toddler. We joke now that we just enjoyed making some of life’s most difficult tasks, more difficult. 

On July 28, 2010, I wrote my first blog post, and The Mrs. The Mommy. The MD was born. What started as an online journal and free therapy for me on my mishaps and adventures as a medical student with a husband and a toddler, grew into a form of virtual mentorship for others that has touched professional students – both parents and non-parents – all over the globe. Even today, there are so many others asking Google my very same question. 

 In 2012, I started a series called “See It. Do It.” to highlight other amazing mothers in medicine. Because “You can’t be what you can’t see”. Which brings me to my next piece of advice. You made it, and now you are going to be very VERY busy. Like barely having time to eat and perform basic hygiene busy. Trust me I know. My intern year, my hair stylist, with the most loving concern, asked me, "Honey do you comb your hair in between your appointments?". I told her it was either sleep or hair and I did not have the time. 

But no matter how busy you get, you have to leave breadcrumbs for those coming after you because “your testimony may one day be someone else’s road map”. 

I wrote about what medical school was like, what being a mom in medical school was like, and how we powered through.  Little Nate still looks at me like that by the way. And with an awesome husband and extended family support system – we powered through. 

During my fourth year of medical school we were even crazy enough to add another one - meet Nate’s sister Isabelle.   

 My third mentor personified the “breadcrumbs” mantra. Dr. Tara Benjamin was a Maternal-Fetal medicine fellow on my OB clerkship, who saw my pregnant MS3 self on labor and delivery looking enamored with the antepartum service and she invested her advice – candidly speaking about how she did not match into MFM fellowship initially – and the time that she could to help me be the best applicant I could be for residency. 

If you are wondering how you will find your mentors in residency, it does get easier than it was in medical school, but it is still kind of awkward. Watch the people who are professionally where you would like to be and approach them for advice. It can be as simple as asking them to be your mentor and taking notes. 

I have doctor mom mentors, leadership in medicine mentors, research style mentors, and even social media mentors. You cannot have too many, but you need to bring something to the table too. You will be very overwhelmed with residency stuff, but don’t rely on your mentors to chase you down. They remember how it is, so they don’t expect much. Seriously, they know you don’t even have time to comb your hair, but check in every once-in-a-while so they know how to best help you. 

Then we graduated! And three days later we moved to North Carolina.

When I started my training at UNC, I knew that I was coming into an environment that looked much like all the environments I had been in throughout my education – predominantly White. And by now, all of us in this room are comfortable with that. My third piece of advice for you is more of an ask. You are not here to be anyone but yourself and sometimes it is exhausting being the only underrepresented minority in your camp. But I charge you in your training to continue to challenge your institutions to value diversity and inclusion. 

Our department recognizes the importance of diversity and through the continued efforts of myself and my colleagues, we have helped to make sure that there are more intentional efforts to support this. The future of medicine and the outcomes of your patients depend on it. 

 Residency came in like a lion, and like I said before, I did my best to leave breadcrumbs. When I found the time, I kept blogging about it, and my husband made sure he was in the new logo ;-) 

There are no words in the dictionary to accurately capture the essence of residency. I don’t want to scare you, but since you all have signed your contracts already. Residency, is like a pressure cooker. For most, it is moving to a new place, it is meeting complete strangers who are supposed to become family, it is chronic lack of sleep that can distort our view of ourselves and the motives of others. 

When you are in it, residency feels like it is the most important thing, but it is not the most important thing. Here are the things that mattered most when residency was over: the love of your family and friends, your self-identity, your integrity, and your education. 

 Life is still happening outside the hospital - even though sometimes it doesn't feel like it. Call your family and friends. They may not understand everything about the rigors of medical training but those who care about you won’t make you feel bad for being absent. Try and reach out when you can! It’s good for your heart.

And for the parents out there, your kids will still love you. I promise. Isabelle doesn’t care that she didn’t have the 1 year old birthday party I thought I was going to plan the month I started residency.  

As I said before, you will barely have time to do basic things like eat and sleep and comb your hair. Don’t feel bad if you don’t feel like going to the gym. That being said, find time to do something for you every once in a while. It’s good for your soul.

Look at your student loan balance and do that budget. You’re going to want to ignore it, because you’re so busy. And tired. But you’ll regret that when the dust settles.

Take time to step back and recognize your growth. Give yourself some grace because everyone starts as an intern. It doesn’t seem that way as you look at your chief who seems to know all the obscure details about patients and never forgets an abundance of GynOnc facts asked on rounds, but they were here too and one day you are going to be just as fire. 

Remember the things that will matter most when residency is over: the love of your family and friends, your self-identity, your integrity, and your education. 

It is not going to be easy, and I will be the first one to tell you that there is no such thing as work-life balance. There is only love and grace. And figuring it out as you go. 

And maybe sometimes you reach that point where you think you have achieved work-life integration.  

I’ll have you know, the first time I tried to dress Nate up in a doctor costume, I spent 10 minutes chasing him around the apartment while he yelled, “I don’t want to be a doctor!” 

But regardless, my children are proud of their mama who followed her dreams. 

For my children a Black, female physician is the rule and NOT the exception. 

That is what makes me the most proud.  

My PGY3 year of residency was also a defining year for me professionally. That year, I lost my first patient. A Black mother in her twenties who had chronic lung disease and did not live more than 48 hours after her cesarean delivery. 

I still remember her face, her parents’ faces, her sister’s face. And even at one of the best tertiary care centers in the state, I remember a baby that lost his mother.   

We actually had no formal Maternal Mortality review committee at UNC at the time, and no one could tell me what our hospital’s data looked like for the previous five years. From there my resident research project was born.

After our retrospective chart review, we uncovered that although Black women made up only 18% of our obstetric population, they comprised a disproportionately high number of our severe maternal morbidity cases - almost 30%.

Unfortunately, what the research all over the country continues to underscore is that no one is immune - not even Beyoncé or Serena Williams. From this work, our department was motivated to provide resources for a formal maternal mortality and morbidity review committee which helps us to hone in on where we fall short and how we can better serve our patients.

When I started fellowship, I finally had the time and space to decide what it was I wanted my research focus to be. And quite honestly, although health disparities and minority health outcomes have always been an interest of mine, I was worried about being the only Black woman in the division and the person who made everything about race. 

One afternoon I was in a research meeting with a doctoral student in the school of public health, who is also a Black women, and I was sharing my concerns about this. Her response stuck with me, “who better to do it than you?” 

She is right. 

I am not here to tell you that you all have to go into your residency and become a self-appointed health disparities crusader like me, but women’s and Muslim rights activist Linda Sarsour said it best, “those closest to the problem are the ones closest to the solutions”.

We will not fix issues that disproportionately affect our communities like maternal mortality, cancer survival disparities, infant mortality, or immigrant health, unless we ALL have a seat at the table.

As you can see, unlike other developed countries, maternal mortality in the US is on the rise. In 2015, our maternal mortality rate was 26.4 deaths per 100,000 live births. 

We also know that Black women are 3-4x more likely to die from pregnancy related complications than White women.

States with a poverty rate exceeding 18% and immigrant populations exceeding 15% had 77% and 33% increased risk of maternal mortality, respectively, compared with states with lower poverty rates and lower immigration rates.

Among high risk pregnancies, black maternal mortality is 9.9x the rate of white maternal mortality for same conditions.

What makes these statistics the most unpalatable is the fact that more than half of ALL maternal deaths are preventable.

Thankfully this issue is now getting more publicity, however, we continue to struggle to find solutions to a problem that takes 700 of our country’s mothers per year. 

BeyoncĂ© and Serena Williams recently told the harrowing stories of their complicated births, but stories like that of Kira Dixon Johnson who lost her life 12 hours after a routine cesarean section from a preventable hemorrhage and Shalon Irving, CDC researcher, who died weeks after giving birth due to a delayed diagnosis of severe hypertension, have been recounted for years as catalysts for long overdue change. 

Kira’s husband, Charles Johnson, continues to be a fierce advocate in the fight against maternal mortality. This past January, the Preventing Maternal Deaths Act was passed into law which provides funding for all states to standardize their maternal mortality review committees.

As a fellow, I hope to use my research to further support initiatives that aggressively address many issues at the heart of these statistics - racial and implicit bias. This year I have presented studies on racial disparities in preterm birth outcomes, racial disparities in post-cesarean section pain management, and how implicit bias has a negative association on national perinatal outcomes. Although it can feel intimidating, residency is a great time to explore your interests and start speaking out about the issues that matter most to you.

As you move on to your next step in training, and start to find your voice, guard yourself against that self-doubt. Imposter Syndrome is real – so don’t let it catch you slippin’. You are not here by chance. But by purposeful and calculated efforts. You deserve to be here and you deserve to be all the places that you are going. Do not let your insecurities silence your voice. Remember that. 

Who knew that my unplanned pregnancy would put me on a trajectory of purpose to help women be the best and healthiest they can be in their own pregnancies?! I mean...y’all...sometimes it’s just too much. 

What seemed like an impossible task while holding that positive pregnancy test in 2008 and feeling like the immense dream of becoming a physician was slipping further and further away - has become my motivation every day to inspire other women and men to pursue ALL of their dreams despite their fears. 

Your story is going to do the same.

I am here to tell you what I tell everyone, residency is going to be one of the biggest challenges you face, BUT embrace the challenge and learn all that you can. Your future patients and the future of medicine need you. 

This road is still going to be paved with wins AND losses. But rejection is God’s protection. Delay is not denial. YOU have the power to determine what becomes a speed bump or a stop sign. 

Thank you, and congratulations!

May 19, 2019
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