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Episode 10 – Counterspaces in Medicine: Creating Safe Spaces and Redefining Value

Learning Objectives
1. Recognize some common factors that influence Black women's decisions to leave traditional health careers
2. Define counterspaces and understand their value
3. Apply tools to combat burnout that could be applied to traditional or alternative health careers
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The Clinical Problem Solvers Antiracism in Medicine Podcast Series aims to equip listeners with the consciousness and tools to practice antiracism in their health professions careers. Learn more.

Audio Transcript

Michelle Ogunwole, MD: Hi, everyone. This is Michelle Ogunwole, and welcome back to another episode of the Antiracism and Medicine series at the Clinical Problem Solvers podcast. Today's episode entitled, CounterSpaces in Medicine: Finding Safe Spaces and Redefining Value. As always, our goal on this podcast is to equip our listeners at all levels of training with the consciousness and tools to practice Antiracism in their health professions career. I'm very excited today to be joined by Lash Nolen and Naomi Fields. Lash, I'll let you tell the people about this special Black Girl Magic episode and introduce our guests.

LaShyra Nolen: Yes, Michelle, thank you so much for the turnover, and I am so excited for this Black Girl Magic episode. Naomi, I know you are too. It's great to have you, too.

Naomi F. Fields: Hey, everyone. I'm so happy to be here. We've got some great stuff in store.

Nolen: I'm so excited to be in community with y'all today. And really, this episode came out of us having this real, genuine conversation about how important it was for us to have safe spaces within medicine, within academic medicine in health care fields and how difficult it can be to find those spaces. And really how the two phenomenal guests that we've invited to join us today have found ways to creatively create that safe space. Both at one point try to do so within the confines of academic medicine, but found really that safe spaces outside of that, and thinking creatively about ways that we can get inspired to think out of the box in that way as well. So just really looking forward to this conversation. And I'm thrilled to introduce our first guest, Dr Oni Blackstock. Dr Oni Blackstock is a primary care and HIV doctor and researcher who recently served as the assistant commissioner for the New York City Health Department's Bureau of HIV, where she led the city's response to ending the HIV epidemic. She is the founder and executive director of Health Justice, a consulting practice that supports health organizations to sensor health equity in the workplace and reduce health inequities in the communities they serve. She was previously an assistant professor in the Division of General Internal Medicine at the Montefiore Medical Center, Albert Einstein College of Medicine in the Bronx, New York, where she provided clinical care and conducted HIV research. And Dr Blackstock holds degrees from Harvard College, Harvard Medical School, and Yale School of Medicine. Thank you so much for joining us, Dr Oni Blackstock.

Oni Blackstock, MD, MHS: Thank you so much for having me. I'm so excited to speak with you both.

Nolen: Amazing. And we also have Dr Uché Blackstock with us today. Dr Uché Blackstock is a board certified emergency medicine physician and the founder and CEO of Advancing Health Equity, an organization committed to partnering with health care organizations to address the critical factors that contribute to health inequities in the medical community. She is a MSNBC medical contributor. She is a former associate professor in the Department of Emergency Medicine and the former faculty director for Recruitment, Retention and Inclusion in the Office of Diversity Affairs at NYU School of Medicine. She left her position at NYU School of Medicine in December 2013 after almost 10 years on faculty to focus her time and effort on advancing health equity. Dr Blackstock received both her undergraduate and medical degrees from Harvard University. Dr Uché Blackstock, thank you so much for joining us today.

Uché Blackstock, MD: Thank you so much. I'm humbled and grateful to be here with all of you.

Nolen: Yes, we are looking forward to having you both, so thank you for joining us.

Ogunwole: I'll get us started and kick off. I'm actually going to start with a definition because the title of today's episode had the word counterspace in it, and I wanted our listeners and everybody to be on the same page. So counterspaces are defined as academic and social, safe spaces that allow underrepresented faculty to promote their own learning, wherein their experiences are validated and viewed as critical knowledge, where they have space to vent frustrations by sharing stories of isolation, micro aggressions or overt discrimination. And where they can challenge the deficit notion of people of color and establish and maintain a positive collegiate racial climate for themselves. And as I read that definition, I thought to myself that there are really two sides of this counterspace coin. I think one side of it for women of color is that we tend to do better when we create these spaces for ourselves, but I think the other side of it is that it's problematic that we even have to do that within our own institutions because our institutions can't always offer these spaces. And as I watched both of you, I thought to myself, these are people who really decided that they would build something, that they wouldn't need to create a safe space in the institutions that they are, but that what they are creating is a safe space. And so I was just wondering if you could share with us and our audience kind of your journey to creating these new spaces outside of academia.

Uché Blackstock: Well, I feel like that is such a complicated and complex question. I think that my journey in the last three, four years actually is a journey that I had never expected. I actually had always thought I would stay in academic medicine, I think mostly because that's all I knew. And I had these experiences once I was appointed into DEI leadership at NYU School of Medicine, where it opened my eyes. My eyes were always open, but I just had more clarity because I actually got to see how institutions work. And part of that actually was seeing how incredibly unsupportive and toxic they are, not only to black faculty, but to our students and our residents. And I thought in a way, because of these—it was several different experiences that I experienced myself and that I witnessed that sort of made me realize that I could not do the work that I wanted to do, the work that was authentic to who I am in that environment. It became untenable to me. And so even though I had these other opportunities within academia, I decided that I had to peace out. And then obviously taking that leap was, I would say, it was a leap of faith in myself because I really did not have anyone ahead of me who had left academia and became a social entrepreneur. So it was sort of like finding that faith in myself that I had what it could take.

But what I wanted to also make a point out of is that sometimes you're in these environments for so long where you're undervalued and underappreciated, you're not supported the way that you should be, that you actually start thinking that—or start forgetting that you're actually someone with gifts to share. And I actually got into that point where I felt stuck. And even listening to Lash's bio, as soon as I listened to my bio, I'm like [inaudible] say, "How could you feel stuck?" I don't think it's all of these—I don't think every institution is the same, but I will say they are on a continuum and some are worse than others. And I will say in the work that I do now with advancing health equity, I'm doing work with academic medical centers, and literally they all have the same problems, right. The same problems. So we know that it's not just academic medicine. We know it's not just medicine. It's not just health care. We see this in basically every sort of social institution in this country. So I probably did not answer the question fully, but those are just some of my thoughts.

Oni Blackstock: So much of what Uché was saying really just resonated with me in terms of how institutions get us to think that we are only capable of doing sort of a limited scope of different tasks and and skills, and that we actually are just so much more capable of doing much more. And at least for me, just in terms of my own path, started out in academic research. I had gotten a career development award from the NIH pilot funding, and I think I felt like really protected actually in my role in academic medicine because I had this amazing Black woman mentor, Dr Schnozzle Cunningham, who many of you may have heard of. And felt like I had the support that I needed to really excel. But then there were certain things that happened when I was in academia, for instance, like I had applied for this, a very large CDC grant. And even though I scored highly, was one of the only people who scored highly who didn't end up getting funding. And mine was the only grant that dealt with Black women and HIV. And then I eventually got the funding, but it just left me with a really bad taste in my mouth. I was also involved in DEI work with residents and staff and faculty at Montefiore, but I was untitled and I was unfunded in the work. And that also left me just this feeling just really unsettled. And so as luck would have it, I found out about an amazing opportunity at the New York City Health Department to lead the Bureau of HIV. And I decided to make the move from academia to government and left all the grants that I had worked really hard to get. And was able to do a lot of really wonderful work in terms of advancing racial equality at the health department in the bureau that I was working, but I also felt very constrained in my role.

I was very overshadowed by my white male supervisor who really didn't give me space to fully inhabit my role as assistant commissioner. And I felt that—I had left academia because I didn't feel like that was a hospitable place. And then government again, everyone said, "No, that isn't also a place that is also hospitable to Black women." And so just getting involved in the racial equity work, creating the first racial equity program at the health department, treating healing spaces, implementing racial equity tools, all of this, working with racial equity consultants, seeing the wonderful work that Uché was doing with her racial equity consulting business, I thought, "This health department doesn't deserve me." And I actually had someone in my life at the time who said, "You don't need to stay here. You're being held back by the health department." I couldn't for instance, there were media opportunities I couldn't take advantage of because they were given to someone else. There were articles that I wanted to write but couldn't because of my role in government. And I said, "You know what, I need to leave here." And this is the point that Uché was making about how these institutions and organizations make us feel like we are limited in what we can do. I have a doctoral degree. I had a master's. I had Ivy League degrees and I felt stuck. And it wasn't until I saw what my sister was doing, what people close to me were saying that I could do, that I finally believed that I could do it and create a professional life in which I felt that I could do what I was passionate about, where I could have the flexibility that I wanted, and wasn't sort of under the control of sort of organizational or institutional oppression.

Uché Blackstock: Can I just say—Oni just reminded me of something. I feel like I have sort of some, obviously, still recovering from some trauma of being in academia. And so one thing that happened that I wanted to share is that I went up for a promotion from assistant to associate professor, and I was told by everyone in my department I would be a shoo-in. I had started our emergency ultrasound fellowship. I had also developed and implemented an ultrasound curriculum for the medical school, was a longitudinal curriculum from first to fourth year. What else did I do? I had done so much in my department and within the institution, and when I actually went up the first time, I was not granted promotion. And I did say before that time, I kind of felt like I was the golden child in my department. And it was not because I was the only but because everything that I had done up until that point—I didn't realize this. So I had done a lot, but I realized I had never really been mentored properly. I didn't have any mentors. I wasn't really sponsored to do anything. I had done a lot on my own and people seemed appreciative of that, and I thought that what I had done was enough. And then I've gotten all these signs and signals that said, "Yeah, you're definitely going to be promoted." And when I wasn't promoted, it really was a slap in the face. But it's a slap in the face that I needed because it kind of made me sort of think about, "Okay, what is going on? What am I doing here? Why am I doing all this work?" Literally staying at work to 6 on the clock, not seeing my kids and really not getting anything back in return. And so even though—a few months later I went back up a promotion and it was successful, but it really was that experience that made me rethink everything, because I also knew in my heart that I couldn't stay there. I felt very betrayed. But then also I knew just in terms of all the reading I had done, that this is not just something that's unique to me. This is something that happens to Black faculty actually quite often. And we basically have to fight to get promoted because sometimes the work that we do is not considered, it's not valued, and it's not appreciated in the same way that other sort of more traditional work is.

Fields: Yeah. Thank you both for sharing your journeys. I'm just sitting here reflecting about the sort of common threads between what you both brought up. And what's sticking out to me, it was never about the amount of work that you're doing because you were both clearly working very hard for what you believed in. Your chief complaint, so to speak, were more so feeling undervalued, undersupported, untitled, unfunded, overshadowed. And what stuck out to me there is that these experiences that you all were talking about goes sort of beyond career of friends. These are things that really wear on your spirit as a human being and a person who is trying to do something in the world. So I thank you for illuminating that point, that even though we're talking about career success, this is even broader than that. It really goes beyond it.

Oni Blackstock: What I wanted to also add is that just thinking about my time, for instance, when I was at the health department in a leadership role, I think also Black women, there's so many eyes on us. And I just remember feeling so wrapped like I literally felt like I was bound by a rope. I could not be like my authentic self. I remember a white woman who I supervised and had actually accused me of rolling my eyes at her in a meeting. And I remember being, mhh, first of all that wasn't true. But second of all, just being so upset because I knew the ways in which I had self policed my behavior at work, I knew in meetings I would have like a poker face. I'd be nodding, super attentive. And I realized that when I left the health department, I literally had the best week ever. So I left last July in 2020, I had the best week ever, because I was so exhausted. I was so emotionally drained from sort of how I felt like I had to be when I was there as a leader. And I said to myself, "I'm never going to put myself in this situation again."

Uché Blackstock: And actually you just reminded me because I will say, even though Oni is talking about her experience, what she went through, the time that you were there at the Department of Health, you shared to me how much your presence meant to especially the Black staff at the Department of Health. So it's like we are dealing as Black women with these experiences where we're wearing these leadership positions, we're under a microscope, we're not being supported, we're not being valued. But then we also feel like we have to be there for our folks, right. Like Oni [crosstalk] health: me when I was at NYU, I mean, for our students, right. When I left there, the part that I felt the most horrible about was for our students because I felt like I was leaving them without any support in an incredibly unsupportive environment. And I didn't want them to think that I was abandoning them. I mean, at least now I think differently. I think that for them, hopefully, I am an example of it, an option, a path that you can take after you become a physician. But these are the burdens that we have to carry, not just for ourselves, but essentially for our folks, our communities.

Fields: And that's a tough sort of burden to shoulder. I'm wondering if even though you were speaking about some of the value that you did find when you were in these institutions and in public health leadership roles, that I imagine it's difficult to step away from. Can you speak about the value that you have each found stepping away from these traditional academic institutions and public health sort of leadership sectors?

Oni Blackstock: Yes, I'm happy to start with that. I think especially as someone who left government, because they're just—and just in terms of being able to have a voice and speak out, there's a lot more different sort of policies in terms of like how freely one can speak. So I would say the best part of being out on my own is that I'm uncensored. I can have my own voice. I mean, of course, sometimes I have to be careful what I say. But I was very much muzzled at my last job and unable to speak on issues that I felt very passionately about. So I think like being able to have my own voice, being able to also harness and take advantage of the many wonderful relationships that I've made along the way in academia, at the health department, with community partners. Now in the work I'm doing as a racial equity consultant, I am taking advantage of all those wonderful connections and relationships that I poured into not thinking that they would be beneficial in the future, just poured into them because I thought they were the right thing to do at the time. So that's been really wonderful. And like has created this abundance in many ways, like a lot of times I'd like to do things on my own. But I'm realizing that there are people—that I have a village and a people that I can reach out to and that want to work with me. And so that's been incredibly heartening and really encouraging.

Uché Blackstock: I will echo what Oni just said, like literally it's freedom. Like I feel unburdened. I can decide how hard I work. I can also decide who I work with. I can also decide, like, what is the culture—what kind of organization and culture do I want to develop within advancing health equity? Like even with my assistant, I always think about these elements of white supremacy culture that are within the institutions that we've been navigating for so long and really have to check myself, because I don't want that in advancing health equity, right. And when I interact with my facilitators and my analysts and the people that are on our team, I really want to make sure that I'm not bringing any of those elements into the organization. But I will say that it's really hard. I feel like I'm covered in that, right. I've been in those environments since I was a little girl. And so it's really hard just to wash it off, but we need to do it through intentionality and being mindful of it. But what I love is really the autonomy. I love the independence. And I always say to Oni sometimes, "I can't believe we did it or doing it." Right. Like we are carving out these paths for ourselves that we didn't have any role models doing this for us. Even though our mom is no longer here, I think our mother would be just so incredibly proud of us. I mean, I think that she would support what we're doing. I don't know if that's something that would have been in her head because she grew up during a certain time and became a physician during a certain time. But she's proud of her babies.

Oni Blackstock: Yeah. And I wanted to add our dad, I know he was very—I think he was like a little concerned about each of us going out on our own because he's Jamaican. He immigrated here when he was like a teenager. He still has a lot of ideas about the right way of doing something. I think it's been eye-opening for him also to see us. Even up until a few months ago, he's like, "Oni, I just really worried about you. I'm really worried. Do you need money?" And I'm like, "Daddy, I have this. It will be fine." And also makes me think about like that Rene Brown saying about like just thinking about who you take advice from and taking advice from people who have been brave in their own lives, and not taking advice from people who haven't been brave in their own lives. So that just made me really think about it because I think so many people are just used to a certain way of doing things. And I think during this pandemic in particular, I think it's given people, particularly Black women, time to reflect on what is the personal and professional life that I want for myself. And actually, I have seen data that more and more, I think out of any group of people, Black women, the highest proportion of Blacks are the high proportion of new business owners. And so that was exciting to see, and I totally get it.

Uché Blackstock: But I'll say the other thing is that this idea now of providing a service or just having organizations, clients come to us to do work that is so meaningful and then to be compensated for it. I think that in academics I was so used to just working, working, working, working, and there's no boundaries on it, right. There's no boundaries. Literally you could work 80 hours a week. You work 40 hours a week, and still make the same amount, right. And I feel like to some degree, it makes the work feel undervalued in a way. So I think this is a really interesting experience for me to have organizations come and you say, "Well, this is what my work is going to cost." Right? And they're like, "Okay, sure." And then you realize all this time you've been undervaluing yourself, right, and you don't even know what your work is valued. Like what is the value of your work? And not to say that—I'm talking about sort of a capitalistic mindset. But the fact is, is that we have never been, as Black folks in this country, we've never been given what we deserve. And I feel like now actually doing this work, I can say this is what I deserve for this work.

Nolen: Absolutely. 100%. I feel like all of us over here snapping and all of that in the background because we feel it. And y'all are just speaking all the facts and we appreciate it. Naomi dropped a comment. She said unburdened, unbought, unbossed. And I'm like, "Yes, that is exactly the energy that y'all are giving us." And what you've both done is created this blueprint that so many of us needed and didn't even know existed. And I can only imagine how scary that was, being brave and stepping out into your own space. But I just hope you all know that you come up in conversations—you both come up in conversations often as we all think about what our next steps might be. And I can say that as I started my first year medical school and I was like getting into Twitter and everything, seeing y'all speak truth to power and seeing how you were just doing your own thing, it really encouraged me and so many others to continue to do that. So I just hope you both know just how inspirational you are. And as I've also kind of stepped into this space of trying to become a social entrepreneur and really looking at the ways that y'all have done that, sometimes I feel this internal struggle where I am asking to be compensated for the work of doing social justice. And I should be compensated because I'm putting in the work, I'm learning the material. I'm taking the time to confront whatever trauma might come from being in front of this group, right. But then I think that I'm also trying to make sure that I stay true to myself and not necessarily benefit off the struggle of my folks. And I'm wondering if that's ever come up for y'all and then also making sure that you stay genuine in the work that you're doing, because I think some people might say, "Oh, well they're Hollywood now or etc." You know how that goes. So I'm just wondering how you've learned to really balance and manage all of that.

Oni Blackstock: Yeah. I'll start off. This question makes me think of that Zora Neale Hurston quote about if you're silent about your pain, they'll kill you and say you enjoyed it. As Black women in medicine, as Black women with doctoral degrees and whatnot, we are in a privileged position, whether we like it or not or whether we agree with it or not. And we can often be the voice for our people whose voices are often silenced. And so I think we have platforms like Lash you are just been doing amazing and getting your voice out there. And so why not leverage these platforms, leverage these opportunities to really uplift our people, speak on behalf of our people? I feel like also, I think Uché would agree, like for both of us, the work that we do is very mission driven. It's part of our life purpose. And so I think as long as you are acting in alignment with what your values are, you can't go wrong. And so our values, our beliefs, are like uplift our people, and so that's what we are we're trying to do.

Uché Blackstock: Yeah, but I think it's a really great question Lash, because I mean, I go through this. I have a lot of opportunities presented to me and I don't say yes to everything. But for example, Uber approached about doing this commercial, this kind of PSA about the transportation that they're offering to vaccine sites. And I was feeling kind of eh about it. And so I texted Oni and my best friend and I was like, "What do you guys think?" Because I really want to be thoughtful about who I engage with and make sure that what I'm doing, the work aligns with what's important to me and what's important to our community. And so after talking to them and a few other people, but I have like my village that I consult with, right. Just to make sure, because I think it's important that we do stay grounded in this work. And I think because of this moment, I think you'll get offers from Uber's and other sorts of companies, but I really just want to be thoughtful about who I choose to work with. And I actually say no to the majority of opportunities and inquiries if I feel like, one, it doesn't align with what's important to me and what's important to our community. But the other piece of it is the self-care piece that there are times I felt like I need to be out there. I need to make sure that I'm amplifying this message. And then realizing that no, no, no, no, no, no, no. Like, you want to be in this for the long run, you have to conserve your energy. I also have two small children. I have a sister. I have other roles in my life that I need to also conserve and preserve my energy for. And so that's the other piece of it that we have to make sure that we don't burn out doing this work. And there's more than enough work to share, so that I also will refer people or potential clients to other consultants, other Black men and women who are also doing racial and health equity work and have the capacity. So, yeah, there's more than enough work to go around.

Ogunwole: I think earlier Uché you even said, I think you mentioned the word abundance. And when I was listening to you talk in this last piece, I was thinking, as I personally have been trying to learn how to operate in that spirit of abundance instead of scarcity, that you have been able to embody that. And it sounds like that's part of the reason why you don't have to say yes to everything and that you can make these choices.

Uché Blackstock: Well, that was a lesson that I learned. It was a hard lesson because last year I literally was burning out. I was burning out from all the opportunities that I was saying yes to. And it meant that I was a little bit less patient at home with my kids. And I'm like, "No, no, no. The reason why you started your own company is so that you could create the life that you wanted, and part of that life was to be present time wise and emotion wise for your children." Right. So, yeah. And I had to reassess everything. And then I said—and I talked to Oni about this all the time. Actually, Oni is the one that is the grounding force in my life because I was also doing part time clinical work. So when I left NYU, I transitioned to urgent care just because I was afraid of making that leap without having some sort of protection. And I remember I got to a certain point earlier this year where I said, "I really want to give up urgent care, but I'm worried can I afford it? I'm not sure." And she said, "Yes. Of course, you'll be fine." And I just need someone to say, "Uché, you're going to be okay." And what it did was it freed me up to take on other opportunities that could replace that income. So it's just the way things work, just having your village, right. Having that abundance mindset, I think can help us sort of live the lives and the work lives also that we want and need.

Ogunwole: Yeah. And can I ask a kind of a follow up question, because I think a lot of us who may be navigating our careers are at this space where we don't always know what we can say yes or no to, especially when it seems like it can help our promotion. So I think one example of this is we all have kind of seen what's happening at JAMA, like this huge academic journal that for people like me who are researchers, it's a really big deal to publish there, right. And so even in those situations, when you're trying to make these kind of calculations, right, how do I stay true to myself and what's right? And at the same time, can I actually afford to not say yes to this opportunity? That makes sense. I'd love to hear how you all navigate that.

Oni Blackstock: Yeah. I think just the first day that – Uché was just talking about, like, whether she should give up this other clinical work that she was doing and what if she'd have enough to support herself. And just to say one lesson I had learned from someone who was really important in my life was it that the universe will provide. Some doors will close, other doors will open, and just to have faith in that. And so that's sort of been my mindset. As soon as I left the health department, I didn't have anything lined up. I was lucky to have some money in savings, but I just kind of like had this mindset. I was like, It's going to be okay, it's going to be okay." And so far it's been okay. And I've been able to take care of things. But just in terms of opportunities and whether to accept them or not, I think pausing because we know like this whole idea of like sense of urgency. So people will make you feel like you need to make this decision now. So often saying, "Okay, let me get back to you in a week." Just getting a sense of how much time do you—when do you need to have an answer to this? Okay, I need this amount of time to really think about it. I need to maybe talk with a family member, my partner, whatever it is. So I think just taking the time, because often when we react reflexively, we're actually not reacting from like our true, authentic self. We're reacting from what the culture tells us we should be doing. So I think time is really important.

And then again, making sure that these opportunities are opportunities that excite you, that you're passionate about, that aligns with what your values are. And then obviously ensuring that you have the time available to do it and not just do that, but be able to do all the other stuff that you care about and all this other stuff that fills your cup and that nourishes you. So there are a lot of things to consider, but I think taking time and pausing and figuring out whether this is something that is in alignment with you or not, something that you have time for or not, because more opportunities will come. I think Uché said this. There are more than enough opportunities. I think we all have a lot of fomo, and we feel like we're making the wrong decision. But if whatever you do that's in alignment, again, with like what you're true values are, what your core values are, you cannot go wrong at all.

Uché Blackstock: I think Oni answered that perfectly. I have nothing to add.

Ogunwole: Well, thank you both for that. I think the other question that we've definitely talked about kind of as a group, is this idea that I think kind of permeates medicine and it comes with being a physician. And it's this idea that extreme altruism or self-sacrifice is really the highest virtue, or that in order to serve that we have to suffer, whether that be physically, financially. I think it's something that really permeates medicine. I just wondered, have you all felt this? And really, have you had to work against it, maybe even mentally or however you work that out in action as well?

Uché Blackstock: Yeah, I mean, I've just been doing so much thinking since I left academic medicine, and the further and further away that I get from being in that culture, the more unrecognizable it is to me and the more sort of—medicine it's a subculture. I think a lot of people outside don't even really even understand it. But it's that culture that you mention of extreme altruism. But also the overwork culture, I think it's also part of that. I didn't even like—the idea of not having to work—I'm in emergency medicine. So holidays or overnights or just to sacrifice so much or not to see your family. People take pride in that. I'm not going to see my family. I haven't seen my family for Christmas because I have to work and take care of patients, right. We can just say like that kind of sucks. And that's something that I didn't recognize until I had my own children. I'm like, "I kind of don't want that. I kind of want to be able to see my kids on Christmas." But I think a lot of people would probably be afraid to say that out loud. And so, yeah, I think that is part and parcel of medicine. I don't think it's healthy at all. No. And the thing is, Black people would be sacrificing or Black women—or self sacrificing our Black women. Literally, we have so much on our plate and we are going to burn out if we take on our problems and everyone else's problems and then work these long hours and take on projects that we are not compensated in any form. I'm not talking about just dollars, I'm talking about in [protected?] time, right. And in value towards your promotion. So, yeah. I mean, I literally feel like the last year and a half has been such a relief for me, and I didn't even realize it until I got out. I didn't realize it [inaudible] got out until I got out. I’m not being dramatic.

Oni Blackstock: What's so funny, Uché, was talking, I was writing down I do honestly feel a little bit like Harriet Tubman in terms of like leading our people to liberation. I didn't feel like that when I left the health department because I felt like I was like modeling for people that you don't need to stay in a situation that isn't serving you. And just to say the whole thing about self sacrifice and all of that, I mean, I think it's really about like white supremacy culture, right, and capitalism. It's like this extractive nature of the culture where it's taking people time and energy without providing renewal of those resources, right. And so it's all about working to ensure that you're operating from a full cup. I like tweeted out today one of my favorite quotes, which is like, "Learn to drink as you pour so the spiritual heart cannot run dry and you always have love to give” because this culture will take and take and take from you. And just to say that I am still on a journey—I'm on a journey. I have not reached, and I don't know in this lifetime will ever reach a point where I am sort of fully in alignment with myself and what my needs are. But I think as long as we are cognizant day to day of the ways in which these systems are working against us, and that we have in our toolkit all the different tools that we're using to to fight back against it. So I try to meditate daily. I try to do yoga several times a week, again, working out. Have a gratitude list, every morning the three things I'm grateful for. Just because I'm like this culture is not going to let me kill myself.

Uché Blackstock: Something that people often ask me about is sort of what's it like to leave the ivory tower? My decision to leave academia and what and what's the significance of that, right. Because we know that there is prestige, privilege associated with having these titles or having that association with an academic medical center. Even when you're watching the news, people put their titles, so and so professor at, right. And so I think part of me, the process of making that realization that it didn't matter what institution I was associated with, I actually didn't need them. I did not need that affiliation to give me value, right. But I was enough on my own. And so it didn't happen right away. It happened over time. But I think that was another sort of growth piece for me in terms of leaving academic medicine.

Ogunwole: Thank you for sharing that. And I was just going to shout out, because I know that Uché has a book deal in the works, so hopefully we'll get some more of that knowledge to the listeners. This is a little preview.

Uché Blackstock: Yes, absolutely. Can I just share about the book deal?

Ogunwole: Yes, please.

Uché Blackstock: This is something that I had never even—I mean, maybe I thought about the book before or writing a book. I think Oni and me have talked about it and every now and then we're approached about it. But again, having that abundance mindset—like my literary agent, she found me. She got me on Twitter and she reached out to me, and she's a Southeast Asian woman who what's very important to her is elevating Black women's voices. That's just what's really important to her. And we just vibed right away. And she is very well known in the industry. I put the proposal together. It's a lot of work, the book proposal. But literally 10 publishers, 10 publishers. I'm talking about Penguin, HarperCollins, they bid on my book.

Nolen: That's the universe provides right there.

Uché Blackstock: Yeah, and bidding on my book, what that meant was that they saw the value in the book the same way I saw the value in the book, and they were willing to put their money on that. And then the editor that I chose actually was the editor that [inaudible] did for my book, but she wrote me the three page letter. She's like, "This is what we saw in the book. This is what we think this book could do." And I was like, "Oh, my goodness." Like, "She sees me." I felt like I was never really seen when I was in academic medicine. I'm like, "Wow." So I'm just saying we just have to—we just have to keep doing what we love, keep doing the work that we're passionate about. And again, these opportunities will come to us, opportunities we never even imagined.

Oni Blackstock: And Uché, I was thinking like that would have probably never happened if you stayed in academia, right?

Uché Blackstock: No, no, never, never, never, never, never.

Fields: Everyone deserves to feel that way in their life: to feel valued, to feel that support, to feel that little yes from the universe, like we were kind of alluding to. But the church kid in me is coming out because the line in my head that now that's reverberating is how your gifts will make room for you. The eyes have not seen and the ears have not heard. Oh, I'm truly so excited for you, that is just awesome. I want to pivot just a little bit because I know we've been talking a lot about how you both found success outside of the academy and what that has meant in terms of personal fulfillment, even outside of career success. And at the same time, we know that that's not going to be everyone's path. There are people who will stay for a season. There are people who will sort of trek it out for a long time. And we found this piece by Dr Anique Forrester that was published in the media sometime in July 2020 that sort of speaks to that idea. And it's entitled, "Why I Stay." There's an excerpt from here that I like to sort of share with us to build into the question. She says, "I stay because I want to be an agent of change, to add to the experience of the trainee students and colleagues with whom I work daily. I've stayed to silently hold vigil for all my colleagues who have left. To them, I say, I understand. You did what you needed to do. Words cannot express what it was like to watch you go, and yet I stay hoping that one day, the reality you could not abide will be shifted and no longer tolerated by those who have benefited the most from its existence." So with that in mind, we're wondering, what advice do you have for those who are going to or feel that they have to or even may aspire to stay in more traditional academic research or government roles, especially when they feel that those roles may not fully serve them?

Oni Blackstock: Yeah, I think there is a role for us to do the work outside of these academic institutions, but there's also a role to do the work within institutions. And I just have to say that I would never judge someone or knock someone for deciding to stay in academia. I would make sure that if you're saying that, regardless, just being a Black person in the world, ensure that you have your village, you have your support, people who encourage you, people who you can go to when you are facing those challenges. If you have a circle of friends, a healing circle, whatever it is, to make sure to leverage those support. I would also just say, white supremacy culture does tell us that things are either or a lot of times. And so I do think when people don't feel like they're options, again, so just things that the culture telling them, and to realize that there are options outside. But for those who are dedicated to staying, I think just making sure that you have all of the supports that you need to make it through each day. And that if you do have this, just listening to your intuition, that's like our main form of knowing. We have all these other forms of knowledge in books and what we're taught in school, but really many times, the answer lies within us. So, again, just making sure that we're in tune and listening to what we feel like our needs are. And if they're telling us to leave, that we are true to those voices and we leave. And if they're saying there's work for us to do here, we want to stay and we have the support to be able to do that, then do that.

Uché Blackstock: Yeah, I know I agree entirely with Oni. I think everyone has to do sort of what feels right for them, I would just make sure people are aware that you don't need to burn out in these environments. It could look like maybe leaving for a few years and then coming back. I think it's also important for people to realize that they can do work that means a lot to them. They could do research outside of academic medicine. There are foundations that can give sizable grants to you. So I'm just saying when you think you don't have options, you actually may have options. You just sort of need to think about it. And like I say, being stuck is a mindset. So it really is about getting unstuck. And what that's about is sort of just like talking to people who care about you, thinking about what are the possibilities, right. Yeah, and I also agree that there's a role for us internally and externally within these institutions. We just need to figure out individually what is best and what's healthy for ourselves, our partners, our families, because we are whole people. We're not just physicians.

Nolen: Absolutely. We're just so thankful that y'all have given us this gift of being able to have you both here dropping all these pearls and knowledge. And this last discussion that we had really reminded me of Michelle's question about Jama. And just like this challenge that you have being in academia, where it's like if I publish the paper, there's no guarantee that anyone from my community is going to have access to this paper because they don't have access to Jama. But being able to publish this data, I hope, will allow me to change the health care system and help reimagine how they'll get access to that. And it's just always this challenge because it's like more of a deferred gratification, but a lot of that deferring is really dependent on a system waking up and having this reconciliation with how inherently racist it truly is. So I think that y'all have really laid out this path where it's like you really can recognize. It's like you really just have opened up our eyes, this is what's happening around us. And if it's not right, if it's not serving you, if it's not feeding you, then it might be time for you to step out and create your own safe space for yourself and for your community.

[unknown]: [48:56] Yes, absolutely.

Ogunwole: I think this episode has been really special for all of us, as we've thought about kind of some of the questions that we want to pose to you both. But as we close, I really wanted to recognize how special it is to have both of you here together as sisters. And I'm obsessed with the organization GirlTrek, which is an organization that really--they center of the power of sisterhood to improve the health of Black women. And I saw you both get a shout out on there, and so I was just really excited. And so we thought a lot about, when we were planning this episode, in having us all together as sisters. And we were really excited for that energy. And I just wanted you all to have a chance as we close to really discuss what sisterhood means to you in this moment and how we all model that support for one another as sisters in this work.

Oni Blackstock: Yeah, I don't know if any of you follow, I know Uché does, Dr Temma who's a Black woman psychologist who always has these very affirming tweets on Twitter. But one thing she talks about is how important it is for Black women to have a space where we can become undone, and actually makes me think about the way I felt so wrapped up when I was at the health department. And so I think part of sisterhood is creating those safe spaces. And I think you're talking about counterspaces at the beginning for Black women, for us to come undone with each other and to be there to support one another. And I think she had mentioned, I remember when I was on a panel with her recently, this idea of like these sister circles. And I don't have a sister circle, but the whole idea is that when someone is people are doing really well and people are down, people who are doing well to support those who aren't doing well and then ebb and flow. And I was thinking, yeah, we don't have a lot of spaces where we're able to come together as Black women and provide the tenderness that we need. So I think about sisterhood is like loving and accepting each other, but also supporting and inspiring each other as well. And so I know Uché and I have our little sisterhood like the biological sisterhood. But even if we weren't related, hopefully we would still be really close. And I just think about that's something I want to do really to cultivate like a little circle or a village of Black women where I can have that safe space to come undone or to provide that to my sisters.

Uché Blackstock: Yeah, I mean, I think that's the perfect answer. Actually, we were talking about this the other day actually about having these spaces where we can become undone. But I just think that we obviously need to be there for each other to support each other. I mean, the experiences that we have navigating these spaces and institutions, they really are something. And I know that some Black women physicians have done it sort of more informally in Zooms, in person. And so I think we just sort of need to keep going in terms of supporting each other and looking out for each other.

Ogunwole: Thank you for sharing all of those things. And throughout this conversation, I've been writing down questions for myself because I think a lot of this work is about reflection. And so kind of just as a summary, some of the things that I wrote down that I'm going to go back and ask myself as I reflect. One of them was, what are the things that are making you question your gifts? If you're in situations or scenarios where that's happening to really think through what that means for you. I heard Uché talk about kind of the wakeup call that she got, and I wrote down what are the wake-up calls that we need in our life? And so when disappointments come to really reflect on what those mean and how they can help me in my next step. Who are you taking advice from? So I know Oni talked about this a little bit, but if you're going towards a path that may be uncharted to just be mindful of who you're taking advice from. And I think we talked a lot about bravery in that context. And then what is keeping you from being your authentic self? And that's one thing that I also I hope people can think through that question, too, as they're navigating their journeys. And then the last thing I love to end these podcasts with quotes, but I thought it was—I thought it made a lot of sense to close with a quote that I actually heard from the GirlTrek crew. And even though this podcast is definitely for everyone, but I think it's been beautiful to uplift the work of Black women. And so I just want to leave kind of the listeners and everyone with this quote.

And it says that, "And when the dust settles and we're writing the eulogies and telling the stories, if we are left with the words, I have suffered, as the final words of Black women, then we have failed. The work of liberation is the work of freeing the soul to be exactly who we were meant to be. It doesn't mean no pain and it doesn't mean no suffering. But the cost of being alive should not be greater than the joy of being exactly who you have come here to be. Anything, any struggle, any ideal, any person who is leading you, Black woman genius down the path of eternal suffering is no leader at all. It's time to rewrite the narrative of suffering martyred women. It's time to center liberation work around wholeness, and leave behind the narrative of sacrificing ourselves to a liberation or a career or relationship or friendship that doesn't love us back." And as we all try to find and navigate these kind of counterspaces to create safe spaces, I hope that we can reflect on that and kind of what our journeys are going to be moving here, moving forward. And so thank you so much for being here, for taking the time out of your very busy schedules to just uplift us. You're role models and your people that I think we all look up to. And you're doing such important work, and you're just allowing us to reimagine what our careers and what our lives can be. So thank you so much.

Oni Blackstock: Thank you, everyone. It's been a wonderful, fulfilling conversation. Thank you.

Uché Blackstock: Yes. Echoing Uché's [inaudible], and it's total honored to be here in conversation with you all.

[music]

Uché Blackstock: All right. Just to give everyone a heads up, when Oni are on together, I mean, literally this is my bestie, so sometimes we can be a little bit goofy and whatever. This is just how we are.

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© Copyright 2022 The Clinical Problem Solvers, Inc. All rights reserved.

Disclaimer: The CPSolvers provides information for educational purposes only. It is not intended to be medical advice.

View show notes for each episode at https://clinicalproblemsolving.com/antiracism-in-medicine/.

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