Art + Medicine

(soft music) - Why do we need to talk about race in medicine?

- Why talk about race?

- That's a great question.

- It's really important to talk about race.

- How can we not?

- Race and racism are critical determinants of health.

- Racism directly impacts the care that our patients receive.

- Race is sort of the fable of how we've created who has and who doesn't have.

- Probably the biggest reason that I see is just all the disparities in healthcare.

- The mission of medicine is to provide medical care for everyone, no matter what the lottery of their birth is.

- If we're really about health, then we have to pay attention to the whole person.

- As a cis white woman, I have to name how I show up in the world in relationship to my patients who don't have the same experience.

- We wouldn't do it if we didn't do it by intention.

- We need everyone's perspective to come together.

- This country was built on the backs of enslaved people, and we are still dealing with all of the repercussions and all of the trauma.

- Medicine actually hasn't traditionally done a great job of understanding people's experience of race in a really racialized society.

- It is important to call it out.

- We need patients to be able to feel a connection with their physicians.

- It's not just who someone is, but it's how they're treated by others in their experience in the world.

- There needs to be a safe space.

- [Announcer] This program is funded by the Center for the Art of Medicine at the University of Minnesota Medical School, and dedicated to all the untold stories.

(gentle uplifting music) - Welcome.

I'm Dr. Jon Hallberg.

- And I'm Dr. Tseganesh Selameab.

There are very few things that are more difficult to talk about than race.

We may be used to having intimate, deeply personal conversations, but when it comes to race, we often find ourselves tongue-tied and awkward, mired in self-doubt, and weighed down with the heaviness of this topic.

So not knowing where to start, we often choose inaction and safety, or politely skirting around the issues.

- But we know this has to change.

We all need to talk about race, and we'll make mistakes.

- Exactly, and it's okay to make them.

That's actually part of this journey that we're on together.

- When faced with uncertainty, we turn to our friends and colleagues and ask them to tell us their stories.

Stories invite us in, expand our experience, and surprise us with truths and joys we may have otherwise missed.

- This show is an invitation to settle in and listen.

We start with the stories of Drs.

David Hamlar and Blanche Chavers, both leaders in their fields of medicine.

(bright uplifting music) - I grew up in Clarksdale, Mississippi, which is a small town in the Mississippi Delta.

Healthcare was very segregated.

- And I grew up in an inner city neighborhood.

Then the neighborhood was your village, and in that village there were people you could model after.

I was very lucky my dad was a dentist.

Something my father told me, he would say never say never, never say should have or could have.

If you want to pursue something, do it.

- I wanted to become a physician because of two serious life events I had as a child.

We had one Black physician who took care of me during both of my episodes.

Following that, I decided I'd like to become a physician and be able to hopefully save lives.

So I started medical school in 1971.

There were 19 women.

There were four African-American students, and one Native American student.

- When I was younger and people would walk in the room, and they would go wow, you're my doctor?

It'd be that shock.

- There were four percent African-American students in my medical school class.

There are approximately four percent African-American students in the incoming class at the University of Minnesota.

- There are actually more African-American men, specifically, in medical school during the 70s than the late 80s and even going into the 2000s.

So you actually saw a decline in the number of Black medical students.

- Progress has been very slow.

We were rounding one day on a Native American patient who had just been diagnosed with a severe kidney disease.

And one of the senior physicians said I think this is a lost cause because I don't expect this patient to take the medication that we prescribe.

And I spoke up and said the senior attending had just prejudged this patient.

We all deserve care, and a chance to be successful with our course of treatment.

- The greatest medicine in the world, the greatest research in the world, doesn't always deliver the best care.

And that's what we need to do better.

- I would believe that the needle was changing when I can actually see more People of Color in all aspects of healthcare.

- Right now, I think in this space, we're so busy talking, we're not looking for those actual items.

And maybe because of my aging, I'm getting impatient.

There's a bigger picture.

And the bigger picture is how we influence society.

How we change policy.

And that is something that's just as important.

- So there's a lot of work to be done, and we need more People of Color entering the field, because that's how we bring about change.

- When we talk about race, we have to talk about identity.

Who we are as people.

Our heritage, our family, our culture, and our language.

- [Producer] Okay, let's start at 50 years ago.

(bright music) - 50 years ago, my parents left India.

They took with them their combined histories, cultures, food, and fears.

My father, Ramaiah, was the first in his family to leave the small farming village where my parents grew up.

My mother, Vimala, was 17 years old when she left home.

And eventually they moved to Michigan where my brother and I were born.

I was born early.

And so I had to stay in a neonatal ICU for several weeks after I was born.

Because my arrival was unexpectedly abrupt, my parents had not yet chosen a name for me.

So the nurses called me Baby Boy Muthyala.

My parents wanted my grandmother to help choose a name for me, but the phone connection to her small village was poor, and so we couldn't hear from her for days and weeks, and this went on and on.

And the NICU was about a 30 minute drive from our home, so everyday my dad would pile everybody into the car, drive to the hospital, drop my mom off.

He would take my older brother to school before going to work himself.

And then after work, he would pick my brother up, and they would go to the hospital, we would all spend time together, and my family would return home, only to just do it again the next day.

During this time, my brother, who was very outgoing, made friends with the neonatologist.

And they would actually go on rounds together.

And one day, the neonatologist asked my brother, does your little brother have a name yet?

And in classic fashion, he said yes.

His name is Brian.

And so the next day, when my parents returned to the hospital, written above my crib was the name Brian Muthyala.

To this day, no one knows how he came up with it.

And my parents, as you could imagine, were a little surprised.

But in our traditions, it is considered bad luck to take a name away from a child once it's given.

So eventually, I got old enough, and I was sent home to join my family a Brian, living with Ramaiah, Vimala, and Sharat.

As the son of immigrant parents, I often felt torn between cultures, values, and beliefs.

Brian could play soccer, go to the mall, play video games, whereas Kirti, my middle name, was a dutiful son, and who knew just how to act with the aunties and uncles who lived in our small Indian community.

As a teenager, I was grateful that my brother gave me a name that allowed me to blend in.

Strangers would see my brown skin, my last name, but my otherness was often less visible because Brian felt so familiar.

Today, as a doctor, I watch my patients stare wide-eyed at my ID badge after I introduce myself, trying to enunciate Moothealla?

And I quickly interrupt them, and I say you can just call me Dr. Brian.

And I often will see the relief wash over their face as we share a quick smile together.

I have often reflected on how my life has been simpler because of the mysterious split second decision of a six-year-old brother.

But more recently, these thoughts have made me uneasy.

Names are important.

And while my name made introductions comfortable for others, it also put me further away from the rich history and traditions that my parents worked so hard to maintain in our family.

So when it came time to name our children, my wife and I intentionally chose traditional Indian names, realizing that they will not have some of the benefits that I had.

And at times I fear for my two young beautiful kids.

How will I teach them to not be afraid, shy, or embarrassed of the richness of those that came before them?

I hope I'm as courageous as my parents who braved an unknown world to make a better life for me and Sharat.

I hope I can be the parent, son, partner, doctor, friend, and neighbor, and live up to the name I was given all those years ago.

(soft music) - May 2020.

Two days after the murder of George Floyd.

I am seeing a two-year-old Black patient in my primary care clinic.

He's a ball of energy, full of joy and curiosity, not yet aware of the cruel inequalities that will surely shape his life, and already have.

My heart breaks for his mother as she shares with me her fears for him, and her hope that by the time he becomes a man, the world will be better.

I promise his mother that as his doctor I will do whatever I can to help him have a better life.

And yet this is a promise that I'm not sure how to fulfill and I wonder how she perceives me, sitting there across from her in that cramped exam room.

Am I an allied underrepresented minority, or as another white person with good intentions, but little understanding of her and her son's lived experience?

The truth is, I'm not sure how to answer that question myself.

I identify as Latina.

But I've recently been questioning what that means for me.

My father's parents immigrated to the United States from Peru, and my mother identifies as white.

My younger sister and I are proof that genetics are complicated.

Her skin is much darker than mine, and I'm six inches taller than she is.

She looks more "Latina" than I do.

Recently I've wondered what role our physical appearance played in shaping our lives.

I realize now that my identity has always been a choice.

Our society uses appearance to define race and set expectations.

My appearance does not tell my whole story, and I find myself consumed by the questions around my position as a Latina who looks white, and in recognizing my privilege, I struggle to keep hold of my identity.

Do I count as a minority?

Am I getting all the perks without having paid the same price as my peers?

I grew up with the trauma of racism surrounding me, but not directly touching me.

I can still remember the pained expression on my grandma's face on the day that her car was impounded after she was pulled over for speeding on her way to the airport after her brother died.

She was flustered and sad and the police officer didn't understand her English.

At the time, I could not yet understand the complexity of her expression, and I could only offer a hug.

Now, I know I should have been angry.

Angry for her, but also angry that these situations for which my family led to inconvenience and shame, might have cost someone, like my young patient, their life.

In learning to recognize my own privilege, I also see the harsh reality of injustice and indifference based solely on the color one's skin won't be limited to this generation.

I think about something as seemingly innate as our last name.

I take pride in being an Alejos, but also recognize its role in defining my identity.

And so I make a promise to myself, to continue putting myself in the humbling position to ask patients about their experience with racism, their fears for their children, and their hopes for the future.

My own experience constantly reminds me that race is not simple or straightforward, and each person experiences it differently.

However, regardless of how I see myself, I know society places me among the privileged.

To ignore that is to be part of the problem.

(soft music) - I first came to the United States as a 24-year-old.

Coming in, I thought it was very obvious that I was cool.

I mean, for me back then, it was aspirational in a way that I kind of cringe at now to be as American as possible.

I was arguably well-spoken.

I got the pop culture references.

I engaged in sarcasm very well.

I watched all 10 seasons of Friends, and all the episodes of "Star Wars".

I thought I had it down.

I saw myself as one of the guys, every bit American as the next person.

However, I remember the first time I ordered at McDonald's in Boston.

The person at the counter kind of double checked that my non-vegetarian order was in fact intentional.

Then it happened a few other times before I realized that the color of my skin may mean I was automatically considered vegetarian in some circles.

It was not a big deal at all, but as a hardcore bacon lover, I was very offended.

Then, as an exchange medical student, I started taking my first patient history.

I saw this split second look of confusion on the elderly gentleman's face.

He screwed up his eyes like he was bracing to not be able to understand me before eventually realizing I did speak English in a way he could understand.

My eager and insecure little 24-year-old heart however sank a teeny bit.

Then the same thing happened with a younger guy who showed me around the first gym I joined.

Eventually, that split second look of confusion became so familiar, I began to expect it at every new interaction.

I have now realized, after all these years, that maybe it was not so obvious to others, my coolness, or my fitting in-ness.

I think it finally clicked that one time I realized my friend here, who to me was just my friend, referred to me to her other friends as her Indian friend.

My dear friend meant no harm at all, obviously, but I essentially had failed in my aspirational Americanness.

Whether these aspirations were acquired or well-placed is a question for another day.

And I cannot help but feel like these are trivial grievances.

That is a common theme with these experiences often.

Am I imagining it?

Was it because I'm brown, or a woman, or young?

Was it even real?

I must be overreacting.

This is all in my head.

I'll go take a walk now.

Do they matter that much?

Another close friend asked once recently while we were discussing the perceptions and nuances of racism.

Must we all be such wallflowers?

Of course none of these people meant any harm.

In fact, they were all genuinely lovely people.

But the thing is, sometimes it's the little things that define our otherness.

When you look back in middle school or high school, do you remember not wanting to stand out in any way at all?

I did.

The most pressing motivational factor was the need to fit in.

The need to not be seen as different or weird in any way.

But then do you also remember that first day you had to wear glasses to school, or braces?

You can perhaps still feel that anxiety in the pit of your stomach as you turn the corner of the hallway and walked into class.

When you think about it, that motivation remains for most of our lives on some level.

At the end of the day, you kind of hope you fit in within the community you spend most of your time with.

And that's why it matters, because it feels like middle school a bit, all of the time, for all of our lives in this country we as immigrants earnestly choose to call home.

The anxiety in the pit of your stomach, everyday, at work, at school, at the grocery story, being a little bit fearful, fearful of microaggressions and exchanged glances, and subtle changes in body language indicating discomfort, fearful of being dismissed and talked over.

It makes the path a little more arduous.

But these discomforts are going to be here for a long time, for People of Color, because change is hard and takes time.

And there are far more overt racially charged experiences we need to tackle first.

So in the interim, what can we do?

What we could do is maybe offer some extra kindness to that one intern who's treated a little differently.

Thank you.

(man singing) - When I was eight years old, I was in my grandparents' house on the reservation, and my grandpa asked me what I wanted to be when I grew up, and I said I want to be a doctor.

His response to me, this man who loved me very much, and took really good care of me, his response was well, you're too stupid to be doctor.

My grandpa is really wise, so I thought oh, okay.

I believed him for about 20 years, and then in my late 20s, I was a cop, and I was driving my patrol car down the road.

I had this really striking thought that came to me, it was like somebody else was telling me.

You know, you can do this.

I decided right then that that was what I was gonna be, was a doctor.

I still doubted myself every once in a while.

I remember telling my Elders who were like grandpas to me, this is too hard.

Thinking maybe I need to be doing something else.

And they said no, we need you.

How could I say no to that?

(bright music) My name's Bret Benally Thompson.

I'm a palliative care and hospice physician at the University of Wisconsin.

What we do as physicians is really precious.

I hear people's stories all the time.

A lot of times, they're really tough stories.

And sometimes we can fix them, sometimes they don't need fixing, but we still hear their stories.

We walk people through that part of their life that they're there, asking us for help.

Most people don't want to leave this life, and most people don't want to leave their families and the people that they love.

As a vet myself, I a lot of times will connect with veterans.

I figure they've probably suffered in some way to take care of us, so it's something I can give back to them, by taking care of them.

A lot of times, the families or patients thank me for taking care of them.

I say well it's an honor for me to take care of you.

I don't tell people that I'm Native unless they ask me.

Because I'm one of those guys that could pass for either.

But it's definitely a part of who I am spiritually.

The way I've been taught, and the way I've learned as an adult in our ceremonies, and our way of life, really helps keep me grounded in what I do.

Part of what I really love about being a physician is I get to go back and talk to young people about what it's like to be a doctor, and if they have any inkling about being a doctor, that it's actually something that they can do.

Some people go right from high school to college to medical school.

That's probably the most common way that people become physicians, is they just go straight through.

But my path has never been a straight path.

I've had a very rich and full life, but it's taken a lot of twists and turns, and I think a lot of Native people are that way.

We don't have the same opportunities, maybe don't have the same resources that some other people have.

When I encounter an obstacle, if I can't go over it or through it, I go around it.

That might take some extra time, or it might take a more ingenious way to do it, but Native people are pretty ingenious.

It's how we've survived.

I always tend to get there, and that's how I got to be a physician.

I never gave up, never gave up on my dream.

- Why is it important to tell our stories?

- If we tell our stories, we understand each other better.

- When everyone is able to share their story, when we understand those multiple perspectives.

- We all come with a special nuance that makes us different.

- We're able to build systems and structures that take into account the diverse needs and desires of the entire community.

- When people hear these stories, they feel like they're part of something.

- It's important for my story to be told, because people are oftentimes not even aware that Native Americans still exist in this country.

- The world is very harsh and unkind, and when we share stories and connections, that is how we build empathy, and that is the only way that we can possibly begin to heal the world.

- Understanding the narrative really identifies elements people can latch onto.

It pulls them along.

- And sometimes we just need to be quiet and listen to patients.

- We have a head and a heart and a hands problem.

So the head is just the data, the facts, that we have these healthcare disparities.

The heart are the stories, right?

They're the actual stories that we all tell about how we experience them, how our patients and families experience them, and then the hands are what we actually can do to make a difference.

And so without having the heart, it's really hard to do the hands.

- Our stories have to be told so that we can activate change.

- Traveling a path less worn requires constant calculation and readjustment.

It involves celebrating milestones, as well as marking the hazards and pitfalls for those who come after.

The experience can be both lonely and exhilarating.

These next storytellers take us on that journey, and share with us the lessons that they've learned.

- I have come to understand that in the fight for health equity, my presence as a Black woman physician is welcome so long as I am seen and not heard.

This conditional acceptance has been a painful realization, and dissent is not without its consequences, a lesson I learned one night while working on the adult inpatient medicine ward.

I received a call from the nurse of Patricia, a Black sickle cell patient.

I learned that a pill find while cleaning out her handbag had been identified as a narcotic medication.

Security and nursing staff requested our presence for a room search.

Patricia's mental status had not changed.

There had been no change in her vital signs or clinical status, and there was no indication that she had consumed any pills preceding security's presence.

Upon relaying this to the nurse, and asking for time to review the policy, she paused briefly before asking me to confirm that I would not be participating in the room search.

I sat for a while in stunned silence.

If a room search was indicated for Patricia, why had it not been indicated earlier in the week for my other patient who happened to be a white male, when he left the unit, returned somnolent, and returned to normal when he got Narcan, the antidote for opioid pain medication overdoses.

By the time I had learned there was no defined room search policy, it had concluded.

When I visited Patricia later, she wept while recounting the indignity of being separated from her belongings, and being patted down by uniformed staff.

Nothing had come of the room search, but she was left to pick up the pieces of her mistreatment.

My internal response was a visceral thing.

A living, breathing amalgamation of ancestral voices coalescing into a single reverberating word.

No.

This was wrong.

But even rooted in the assurance of advocacy and social justice, an insidious, intoxicating fear pressed forward, determined to lull me into the safety of silence.

Speaking up would be a radical act of defiance for a Black woman who has been conditioned to keep her head down, to be agreeable, to not make trouble.

When Patricia's nurse asked to debrief, I steeled myself in a stance of curiosity, and asked many questions.

What was the concern from a nursing perspective?

How could we have improved our communication?

How do we make decisions on when to implement a room search?

What alternatives did we have?

When invited, I shared my own perspective.

Together, we created a plan to address similar concerns in the future.

We shook hands and hugged.

The chasm between us didn't feel so wide.

While it wouldn't change what happened with Patricia, we could prevent harm to another patient, and that was something.

The next night, I was informed that nursing staff had filed a complaint stating I had been unsupportive, and refused to act collaboratively.

First came shock.

Then anger.

And when the anger was spent, an overwhelming emotional exhaustion.

I cried for days afterward.

It had taken me years of training and education to learn to abandon the lessons handed down by my forefathers to keep my head down.

To be agreeable.

To not make trouble.

I wonder if they understood that through the weaponization of their feedback, they had taken something from me that I couldn't get back.

What had they given up?

I was ready to have difficult conversations to bridge the divide.

But even though I had arrived, had been welcomed, even, I am still subject to the same inequities that my patients face.

I think of Patricia often.

I worry that the damage done to her is irreparable.

I worry that progress is too slow, and patients are being harmed while we strive for what could be.

I worry that while I believe being the dissenting voice was right, I may not always have the fortitude to always be a voice for the voiceless.

- Are you the doctor?

(gentle music) (monitors beeping) Your frayed undertone alerts me to what's coming.

Grievances, waiting for a scapegoat.

I suppress a sigh.

17 patients to see, and you were the only straightforward one.

This is not how I wanted to start my day.

I fix my face.

Yes, I'm your doctor.

My hollow words hang silently in the air.

The most charitable observer would find no warmth in your gaze.

The nurse's curt assessment of you is still fresh, difficult and standoffish.

How are you feeling?

I silently repeat the mantra.

I'm here to help.

Tell me your story.

Projecting a safe space that doesn't exist.

You reject the mirage.

The rigid lines etched into your face don't soften, but it's your eyes that speak the truth.

Exhaustion has smothered everything, leaving muted embers of anger in its aftermath.

Dread crouches at the periphery, waiting.

I came here because I can't breathe.

I've been asked four times already if I do drugs.

Why do y'all keep asking the same thing?

This question is not an extended olive branch.

It's the crisp crinkling of a test booklet as you prepare to grade my answer.

I'm restless.

Precious time is leaking away.

Weariness coils tightly around me like a boa constrictor made of impotence and cynicism.

My legs can no longer bear the weight.

May I sit?

You nod.

I settle in at the edge of your bed.

There's no quick way through this conversation.

I could say we ask all patients about drug use.

Normalize it, and attempt to sidestep the traumatic undercurrents.

I might acknowledge your distress, and ask you to tell me more.

The med school answer.

I could even say I'm sorry that happened, and then take control of the conversation by asking about your breathing.

The hospitalist answer.

Suddenly, I'm back in college.

An officer is approaching my black Honda Civic with his weapon drawn.

He's shouting show me your hands.

They shake as I stick them out of the driver's side window.

I'm taken to jail.

I spend my phone call on a friend who doesn't pick up.

I'm released the next day with a gruff apology from the officer.

You aren't the right guy.

Sorry.

My doctor mask slips, exposing the human beneath.

My answer is all bitter edges.

Some people get the benefit of the doubt, others don't.

I can't promise it won't happen again, but I'll do what I can.

At some point I ask you, when did your symptoms start?

You have trouble answering me.

I reach back to a conversation with my dad.

I don't get why doctors expect us to know the difference between regular discomfort and bad discomfort.

Life is pain.

You work through it until you can't.

I reframe the question.

When did life start getting harder than usual?

Your answer is instantaneous.

Five months ago.

Gathering the rest of your history is easy.

You're comfortable with my plan.

You smile for the first time.

Thank you, doctor.

Later today, we'll discuss your abnormal results and upcoming procedures.

You'll cry.

I'll sit with you again.

You'll talk about the pressures of your job, and the challenges of being a single parent.

When I look at you, I see family.

Several generations of hard lessons discouraging vulnerability.

You can't afford to be less than invincible when shielding others from the struggle, and yet you're here, unable to go on.

I can't resolve this cognitive dissonance for you.

All I can offer is this small fleeting space carved out with the keen edges of shared trauma.

Maybe here, you can temporarily afford to be human.

Two days from now, you'll ask me about life as a Black hospitalist.

You'll listen as I talk about George Floyd, sick family members, protests, and COVID-19.

I will no longer track the time during our visit.

Flakes of clinical detachment will fall from me like a shattered cast, revealing the exhausted husk beneath, The wall separating the personal from the professional will completely vanish, trapping me in a moment that is both cathartic and triggering.

You'll extend an incredible amount of compassion as tears soak my mask, and ragged breaths fog up my face shield.

You'll take my hand, lending me your resolve.

Somehow, you'll know exactly what I need to hear.

Don't give up on us, Dr. Williams.

You're not alone.

We need you.

- And the summer of 2020 was really hard.

(soft tense music) We were all, I think, feeling isolated and stunned.

When we finally started talking about the issues of race, and I kept waiting for something to happen, and nothing seemed to be developing, specifically for healthcare professionals, and so I talked to our whole department, and the medical students and the residents I worked with, we decided to partner with White Coats for Black Lives, and to organize our own rally.

Safety was at the utmost importance for all of us, because we didn't want to take ourselves out of the essential workforce, and so we decided that a silent sit-in would probably be the most safe.

It felt really good for all of us, to be there, and to be there in force, and to have our voice heard, and for us to come together like that.

I think messaging and witnessing are important, but only up to a point, and systems are very, very hard to change.

At some point, you can't spend all your energy just messaging, and witnessing, and demonstrating and protesting, you have to really transform that into action.

But I think at key moments, when everybody has this need to come together for our message, it serves that purpose.

So it felt like a good starting point.

- My new therapist peers at me through Zoom and asks me to describe my childhood.

Where do I start?

- [Producer] Brenda Her, take one.

- In my culture, childhood begins before you are born.

I am the daughter of Cher Thang Her and Xong Yang.

I am a descendant of the Hmong people who fought during the Secret War, some who are shaman spiritual healers.

I carry the imprint of trauma from war and genocide, sexism and racism, passed down from one generation to the next through parenting, modeling, and societal pressure.

I carry the unhealed wounds of my mother, my grandmothers, and Hmong sisters, living in a culture of silence ruled by patriarchy.

I witness my parents hide their wounds and suffer from the unresolved trauma they didn't have the luxury of healing.

And so, they imprinted their children with the lessons of survival that were given by our ancestors.

The survival lessons I learned in childhood continue to be my inner struggle.

I learned that in order to survive as a Hmong woman in America, I had to please, perform, and perfect.

No exceptions, no mistakes.

And anything less was a failure.

I worked hard on fixing myself, cycling between podcasts, online cognitive behavioral therapy, and self-help books, searching for something to teach me how to balance my mother's worsening heart failure and dialysis-dependent kidney disease to teach me how to make sure my brothers and sisters had what they needed to thrive in school.

To teach me to navigate the grueling work hours in the middle of a pandemic, to prove that I belong as a woman, and Person of Color in medicine.

But all of my efforts only led to frustration when I fell back into the old habits and gave into the negative thought patterns.

The critical inner voice, and the behaviors that I thought would help me fit in, but instead, dimmed the light of who I really was.

And that is what led me to that moment.

Sitting on my couch, laptop in front of me, asking for help for the first time in a long time.

It was worth it.

Through therapy, I learned mind body practices that have transformed my life.

I learned to ask for and accept help, not only from my therapist, but also from family and friends.

Healing meant going inwards and embracing my roots as a Hmong woman, finding community, and honoring the warrior in me who had overcome the challenges of childhood trauma and abuse, sexism and racism.

It meant learning to accept that my parents are human beings, with their own unresolved trauma, that they didn't have the luxury of healing.

My journey to healing and understanding my traumas has shaped and influenced my career in medicine.

Healing is a daily practice, and an ongoing journey.

With it, I honor my ancestors and parents, their blood, sweat, tears, and efforts that led me to where I am today.

- My dreams and hopes for the next generation.

- Is that we can create a system of health that is trauma-informed, not trauma-imbued.

- Is that they can simply be physicians.

- Whether we have a commitment to our communities in our profession, that we don't have to pick one over the other.

We can really satisfy our full selves when it comes to practicing medicine, and knowing that we are not only improving the wellbeing of our individual patients, but our communities and society as a whole.

- When talking about race, it's easy to feel stuck, and hard to find a way forward.

However, as we're about to hear, there is room for hope.

(upbeat music) - [Tseganesh] Looking at me, you see how I appear when I enter any space.

A youngish Black woman with a big smile and a strong handshake.

What you don't see is the manifestation of my inner white man.

Yes, you heard me.

I have an inner white man.

Joe became a part of my life the first time I put on a white coat in medical school.

I had him knock first before we entered the exam room, and had him sit next to me as I took a patient history.

I channel him often when I have to explain no, I'm not the nurse.

Or yes, I have done this procedure before, and no, of course I don't mind if you talk to another doctor about this.

Medicine is the space designed to make me feel alone, uninvited, and constantly second guessing.

Joe is expert at protecting me from the questions about my right to be here.

Joe can pull up a seat at any of the tables and be made to feel welcome, even wanted.

Listen, Joe is not an internalization of systemic sexism and racism that tells me my worth is only based on a scale of whiteness, nor is he a demonization of the white male narrative.

I know every story is different.

But my Joe, he serves a dual purpose.

He reminds me of the systems that I live, and I work in, and he is a powerful tool that I can use to thrive in those environments.

For example, Joe and I looked in the mirror this morning.

We made sure that this dress didn't show too much cleavage and that it didn't hug my hips too tightly, because I want to be judged on the content of my words, and not the shape of my body.

Joe also reminds me to push back my shoulders and stand assured that my words are important, and my voice is worth hearing.

My inner white man, my Joe, is my shorthand.

Joe is also my systole.

Systole is the powerful part of the cardiac cycle.

Systole is this life-giving force that drives oxygen out of the heart and pushes it throughout the body.

Systole is loud.

And it often drowns out that brief silence of diastole.

When I am in spaces of diastole, I notice that my body relaxes.

I breathe more fully and deeply, and I feel myself expand to my fullest expression.

My heart is full, so full, that I can no longer accommodate Joe.

I have expanded beyond the spaces that require his presence.

Spaces of diastole are sacred.

And I have come to understand that they are formed through intention and labor, and are not happy coincidences.

My spaces of diastole include my clinic.

I walk in, I am greeted by nurses and fellow physicians that reflect my lived experiences.

My patients are a tapestry of new and old Americans, woven together in a neighborhood that is full of history and promise.

I work in a space where my voice, my story, they are enough.

I work in diastole.

Advocacy is systole, a powerful forward movement that seeks to make change on behalf of others.

In advocacy, just as in life, systole requires diastole.

If we want the energy, the perseverance, and power to seek change, we need spaces of diastole, where we can relax and be filled, where we can heal, where we can thrive and perform at our highest levels.

We need to become advocates for diastole.

- Her eyes brightened, and her cheeks were rounded by her wide smile.

She excitedly stood up from where she was playing and walked towards me as I entered the room.

She gave me a long, unexpected hug.

Salam, how are you, I asked her.

Are you my doctor, she asked.

Yes, yes I am, I responded, matching her excitement.

She then followed me as I sat down.

She reached for my royal blue hijab as she pointed to hers, bright orange and with sparkles.

She was eager to share what she was learning in school, stories about her friends, and all the foods she was eating to help her grow.

As I wrapped up our visit, she said I want to be a doctor just like you when I grow up.

Sometimes, it's hard to remember the why when so many days are filled with signals that I don't belong.

Those quick glances down at my badge that says doctor, back to my face, and then back to my badge again.

It's hard for me to accept that the white coat I'm wearing, my stethoscope around my neck, my multiple pagers beeping, and the patient list in my hand, are still not enough to shield me from the perception that I am out of place.

On those days, she is the why.

She and many others remind me why I've dedicated so much of my life, my time, my energy, to be in the room with them as their doctor.

I often ask myself what does it mean to belong in medicine?

For me, belonging is not about conforming to the appearance of a typical doctor.

Belonging is about changing the perception of what a doctor looks like.

So every time I get asked where are you really from?

I think of bright orange and sparkles.

Every time I get surprised glances because I'm explaining life-changing diagnoses, or laying out complicated treatment plans, I think of patients with henna-speckled beards who will agree with my treatment recommendations because of their faith and trust in my presence.

As I walk around the hospital with my stethoscope and my hijab, I know that I stand between two generations.

I want to inspire my young patients to dream of becoming intelligent and compassionate doctors, and I want to be worthy of the Elders who beam with pride because their sacrifices and hopes have been realized.

If I do these things, I'll always know that I belong.

- As clinicians, we have been trained to gather information, make an assessment, and then thoughtfully move forward with a plan.

As you will see, the same process is true when it comes to addressing racial disparities.

(soft music) - It's hard to talk about race in Minnesota in general, because I think we feel like we can and we should treat everyone the same way.

And I think that is rooted in a healthy way, but if we treat everyone the same way, we assume everyone's the same.

Being Vietnamese-American, being a refugee, when I started doing work in medicine, I gravitated to particularly those who are immigrants and refugees.

As the population changed, and as the needs changed, I changed with the population.

And so then my equity work had been more around those who were dealing with opioid use disorder.

We have a lot of individuals come here that happen to be Indigenous, and I was not doing a great service at first, because I didn't understand what their life was like outside of clinic, so I knew I had to take time and practice to ask questions, to learn more about just individuals and community, beyond just addiction.

And I learned the good stuff, the bad stuff, and the everything in between.

And then also working with a researching assistant, Koushik Paul, over the last three years, he and I started doing interviews with the Native American community to understand how we can better serve them around opioid use disorder, particularly in primary care clinics, and make it more culturally-centered, or family-centered.

And all these connections that we built over time in this shared space has given me a place of joy where I am working with communities that deserve help, should be elevated and celebrated, but they have been also people who are so accepting, and allow me to learn and make mistakes along the way, too.

(gentle music) - I'm a pediatrician.

I thought I was giving quality care to everyone until one of my colleagues said you should go hear Dr. Heather Hackman speak.

And she was presenting on white privilege.

And I sat in there, at the time, at 47 years of age, embarrassed, because I'd never thought about that issue.

So then I started thinking about my patients.

I've had the honor of taking care of kids with sickle cell disease for over 30 years.

It's an inherited blood disorder, it's a global disorder.

It affects people of all races.

But in the United States, virtually all the patients are Black.

And I started thinking about me, and the team, and the clinic.

And at that point, every single one of us was white, and could that fact alone affect the quality of care that we deliver these patients and families, or at least the perceptions of that care?

So we asked the question, and it matters a lot.

And that was really the impetus for me to partner with Dr. Heather Hackman to develop a training module around race, racism, and whiteness and implicit bias, specifically for healthcare providers.

One very important piece to improve equity and outcomes for patients of color is to change the demographics of the healthcare team.

Right now, only four percent of licensed physicians in the United States are Black.

And we know that there are better outcomes when there's racial and or cultural concordance between a provider and their patient, because there's better trust.

So until we get that improvement in the demographics of the healthcare team, I'm the one that needs to do the work, and build trust.

- I study racism as a fundamental cause of disease.

- [Producer] Cunningham, take one.

- My research right now aims to get white providers to talk to their Black patients about their experiences of racism.

As I sat in on the focus groups, many people were saying yes, racism in healthcare is real.

Yes, I or my family members have experienced it, and recounted stories about not being able to access care.

And when I say access, it's not that they didn't, they had insurance, right?

They had transportation to the clinic.

But not being able still once they came in through the clinic doors to get care that they perceived was high quality, and met their needs, or to be listened to.

And what I'm hearing, which is very encouraging, is many of our physicians recognize the importance of racism as a cause of disease.

Many patients recognize that as well.

The challenge is whether people again are willing to have that conversation in the clinical encounter.

I really think there's the power at the bedside, but until we do something about those structural conditions under which people live their lives, we're going to continue to see health disparities.

I can only find temporary solutions for people.

So person A comes in, and I find a solution.

But what happens with structural conditions is that it's not just person A, right?

It's person A, B, C, D, E, who are all coming in, in similar predicaments.

And so to the extent that those structural conditions produce harm, then I'm gonna always have patients in my office.

That is what racism is.

It is classifying people into different groups and giving them differential access to resources and opportunities.

And with that, constructing them differently to justify that different access.

So we have to change our society, and that's more than healthcare, but healthcare can play a big role.

Physicians as important stakeholders with a voice in power can play a big role.

- Thank you for listening.

No matter who you are or what you do, we hope that you share your story, and have a conversation about race.

We believe that it is through stories that we can begin the process of healing.

We close with a poem by Dr. Tolbert Small, former physician to the founding chapter of the Black Panther party.

- The title of the poem is "We Are the Healers" and it is a message for everyone.

Doctors don't heal in a vacuum, and healing can take many forms.

We are part of a broader community that includes you.

We are all interrelated and interdependent.

We are all called to heal the wounds.

(gentle uplifting music) - To the healers.

- And their patients who have the right to be healed.

- By Dr. Tolbert Jones Small.

- We are healers.

- We toiled for years to learn the mystery of the human body.

- We nourish spirits from birth to the grave.

- We mend the bones.

- We sew the cuts.

- We kill the pain.

- We cool the fevers.

- We soothe the spirits.

- We are healers.

- We bring new life.

- We close old life.

- [Together] We pick the herbs.

- We needle away the pain.

- We cut out the cancer.

- We poison the germs.

- We calm the troubled minds.

- We are healers.

- [Together] We treat the whole body.

- [Together] As one universe.

- We treat each part of the universe.

- We keep the hearts pumping.

- We keep the lungs breathing.

- We know as long as life exists.

- [All] We will.

- [All] Be healers.

- What brings you joy in medicine?

- What brings me joy in medicine.

- [Man] Relationships.

- Relationships bring me joy in medicine.

- Connections.

- The experience of my patients.

- Young people finally get it.

- To have the light bulb go off.

- Very rewarding.

- I have joy in medicine when my patients have joy.

- They give me hope, they give me courage.

I learn so much from their cultures, their values, their knowledge, and their belief.

- The most joyful part of being a physician.

- They trust me, and I trust them.

- Is being in fellowship and partnership with my patients.

- The opportunity of working with somebody for 15 years to try to get them to consider stopping smoking, and that day when they say you know, I really need to do this.

- What brings me joy in medicine is listening to the stories of patients.

- I love to sit around, and that's probably why I can be late in clinics sometimes, since I love to hear people's stories.

- I feel very privileged to share that sacred space with our patients.

- One word that brings me joy in medicine is learning.

Actually learning about people, and learning about their stories, and learning about what makes them work, and what makes them who they are.

- To be able to apply science, but in a way that genuinely helps someone feel better and have a better day.

- The opportunity of the future, what isn't yet, how we deploy our insatiable curiosity about what if, and what can be in terms of next, opportunity for change for the better.

- This is excellent.

- Brilliant.

- [David] Oh, good.

- Yes, good stuff.

- You're happy?

(bright music)