BGDMedS: Learning More Than Medicine

by Kayla Holston

“Kayla, you choose the music. You’re the most urban.” As a medical student at a PWI (Predominantly White Institution), I’ve become comfortable with being the only Black person in the room. From the engineering undergrad at the University of Virginia to the Master of Public Health at Emory University to now medical school at Thomas Jefferson University, PWIs have become quite familiar. But, whenever I forget just where I am and what assumptions I’m surrounded with, comments like this remind me.

My journey as a graduate student has been about finding out who I am when the security of undergrad has been torn away—who I am outside of school. Am I a yoga enthusiast, a family girl, or a travel fanatic? As it turns out, I am all of those. What I have discovered, though, is that I am also a pensive Black woman who can be disloyal to herself when it comes to confronting racism. And here’s how realized that:

At Thomas Jefferson University, our curriculum is divided into blocks, and each block focuses on a system (e.g., cardiology, pulmonology, neurology). During each block, we spend a few weeks dissecting Sally, our group’s human gift. One afternoon, two lab mates and I decided to go to the dissection lab while it was empty to re-dissect Sally as a form of studying. Since we were alone in the room, we decided it would be nice to play some music. That’s when it happened: “Kayla, you choose the music. You’re the most urban.”

All I could do was laugh. More of a crying laugh, but you know. I thought to myself, if Sally wasn’t here, I’d let you have it. Out of respect for her, I’ll shut up. That’s what I told myself but, honestly, I laughed because I wanted to make him feel more comfortable in a moment he had made uncomfortable. He laughed with me, and I became the “cool Black girl” who didn’t get upset over “silly jokes.’” Now he “jokes” whenever he sees me.

Being a Black medical student puts me in a weird place—I don’t want to be the difficult Black girl. Team learning is even more important here than in my past curricula, and I don’t want to ruin relationships with my assigned team members and then find myself struggling to group study with them. The comment my lab mate made illuminated a quality in myself that I am now grappling with. In academic situations, I tend to be conflict-averse at the expense of my mental health. I believe the reason is a combination of not wanting to hinder my learning (obviously) and not wanting to make situations awkward for myself and others.

I wish I could say, after this realization, I cut off every prejudiced person and clapped back to every racist remark. Still a work in progress. What I can say, though, is that I have become intentional about my mental health and the company I keep. I have embraced therapy for all facets of my life, began regularly engaging in mindfulness through yoga, and, most importantly, allowed God to be my center of peace. (Quick pause: Different approaches work for different people but, if you have not tried it yet, I highly recommend hot yoga as a healthy way to relieve stress and stay fit. But first, try God. Nothing will give you peace until that part is handled.)

Anyway, I have also become okay with the idea of a close, small circle. It is kind of crazy how we feel obligated to spend time with people just because we have in the past. I finally asked myself, why do you let this white girl (excuse me, white passing) keep talking to you like you’re stupid? Why do you voluntarily do Friday dinners with her? So, guess what? I. Just. Stopped. Not groundbreaking, but for me it was. I thought I needed to keep every friend I had because, if I didn’t, I wouldn’t have anymore friends and medical school is tough without camaraderie. Well, medical school is challenging either way, so may as well do it with woke people, even if there are only three.

So, what advice would I give to a future BGDMedS?

  1. Spend some time figuring out who you are because your identity will be illuminated and tested during this trying but exciting time of your life.
  2. Make a plan for caring for yourself before you get here. If you don’t, it probably won’t happen.
  3. Surround yourself with love and truth, nothing more and nothing less.

There are plenty of people who decide who I am before I open my mouth. But, even when I don’t know who I am, God is certain of my identity. So, I abide in him, embrace what He says of me, and care for myself. I hope you will too.


micahkaylagrad-23copuKayla Holston is pursuing an MD at the Sidney Kimmel Medical College of Thomas Jefferson University. Kayla earned a Master of Public Health in Health Care Management at Emory University and a Bachelor of Science in Biomedical Engineering & Cognitive Science at the University of Virginia. She is particularly interested in utilizing her educational background to improve patient flow and healthcare staff workflow in order to improve efficiency in understaffed health systems. Kayla’s current research focuses on improving quality and staff workflow in a Malawian health center in collaboration with Malawian medical providers and architecture professionals. Her second research focus is in orthopedic surgery, particularly with regard to how psychosocial factors affect hip pathology and postoperative outcomes. Professionally, Kayla hopes to blend the roles of a physician and healthcare administrator to continue projects like this, serving patients on both an individual and organizational policy level.

New Decade, New Me: Post-Student Life and Embracing Candidacy

January– the start of a new year and a new semester. This semester is a little unusual for me because this will be the first semester since I’ve started graduate school that I have “off.” The deal is that if you are a teaching assistant (TA) or a teaching fellow (TF) one semester during the academic year, then that semester of work for the entire year. This is absolutely an institution-specific thing, a program-specific policy even. I have friends in another department at my school who have some sort of graduate assistant duties each semester, no matter what. However, they’re guaranteed at least one full year of funding where they have no obligations except to write. It all varies.

So much feels like it’s changed since I last wrote. Last semester (Fall 2019) seemed like the end of an era in a lot of ways. It was the first, and likely last, time that I’ll be a teaching assistant; the next time I set foot in a classroom for an extended period of time, I will probably be teaching my own course. It also marked the end of a series of trials and tests; with coursework, comps and prospectus behind me, as well as the experience of getting my feet wet with pedagogy under a tenured professor, I finally feel ABD (all but dissertation). I feel like everything I do from here on out is for me, on my time, on my terms, and I can begin to craft my career the way I want to, as opposed to satisfying the whims of others.

 

I’m not a student anymore.

And that means I’ve been spending a lot more time than usual thinking about how I want my career to look, studying the careers of others, reaching out, daydreaming, and hustling. A lot of things have been put into motion that I can’t necessarily say much about at the moment, but in the last few months of 2019 and into this first month of the new decade, I feel myself finding my footing as I begin to walk in my purpose.

The one thing that’s abundantly clear is that I want to write. It seems so obvious to say, but nothing feels like writing for me. Nothing feels like the moment when I get the first words down on a new document or in a new journal; nothing like working through rounds of revisions; and nothing like seeing those words find a home and make their way out into the world.

An important note is that I want to be a writer with range; I recently got to see Lamar Giles in conversation with Meg Medina and the discussion about range has stayed with me. My scholarship, my blogging and my essays are starting to find homes and an audience. I want that for my fiction, too– my novels and short stories. And one day I want to write a comic. I would love to write lots of comics, but let’s just start with one. (I won’t say who I’d want to write but let’s just say her initials are LL.)

One day, I’ll write a post about how I balance all the different types of writing that I do/want to do. For now, just assume I spend a lot of time juggling and dropping the various balls.

As I get further down my path and closer to aligning myself with my own goals, I have come to resent grad school less and less. Yes, I could write a book about what’s wrong with higher education as it stands, but the time I got to hone my thinking, develop my writing, read widely, meet people– specifically, authors and writers…those are skills I can take with me, no matter where I end up. I don’t think I ever would have wrote the novel I drafted last summer if I hadn’t been in grad school, day-dreaming about digital Black girlhood, blogging and writing. I maybe wouldn’t have made the time, or perhaps never even had the idea.

Things happen for a reason, and they’ll reveal themselves in time.

At any rate, there’s still the practical business of having a semester off. What will I do? Well, I still have plenty to do. I still have a whole dissertation to write, research to do, stuff to read to get there. I’ll be making some appearances at conferences: Chesapeake DH in February, SXSWEdu in March and the Lemon Project Symposium later that month. I’m still the graduate advisor of the Africana House on campus so I’ll be working a little more closely with the students this semester. Of course, I’m already back to yoga, but I’m adding in a new cardio class for fun. And I’ll probably be writing across the internet (I’ve already had pieces in Black Youth Project, Wear Your Voice, and ZORA) in addition to my dissertation work and noveling.

I have some cool projects and news dropping soon, too, so stay close to the blog (and Twitter) to be the first in the know.

I’m so glad I’m finding my magic in this liminal space between life as a student and a lifetime as a scholar.

Deferred Maintenance

By Enjoli Hall

How and why I made healthcare my top priority in my first semester

Twenty-nine. The number of visits I made to a doctor’s office during my first semester as a PhD student. In any given week, my Google calendar was a fall-themed collage of classes, advising meetings, on-campus events, and doctor’s visits. Scheduling my doctor’s appointments was akin to a research assistantship—I mapped the locations of Black female primary care physicians. I analyzed what combination of dental procedures I could afford with my insurance benefits. I reviewed literature on the antidepressants recommended by a counselor. I wrote reports detailing my medical history on intake forms. I presented my life story to the six therapists I was forced to meet with in order to evaluate my request for an emotional support animal in university housing. While I couldn’t add these lines to my CV, perhaps I could add a few years to my life.

Some of the appointments I scheduled might be considered “routine” check-ups: annual eye exam, seasonal flu shot, pap smear. But many of the appointments were for managing chronic pain and depression. Sometimes, these appointments were not planned, such as impromptu visits to the urgent care clinic on campus for frequent headaches or toothaches. What nearly all of these appointments have in common is that they were the result of deferred maintenance. In my field of urban planning, the term deferred maintenance is often used to describe the practice of postponing maintenance and repairs on essential infrastructure to save money, balance budgets, or reallocate resources to address more immediate needs. For example, a landlord might postpone fixing leaky pipes in an apartment to save money in the short term. Or a local government might delay replacement of lead pipes in its city’s water system due to budget shortfalls. The cumulative effects of deferred maintenance can be catastrophic—an apartment building that could have been rehabbed now needs to be demolished; a city’s population is poisoned by its water supply with lasting public health problems.

Prior to starting grad school, I deferred diagnostic tests, annual exams, small procedures, and mental health therapy for years. I was a first-generation, low-income college graduate barely making ends meet in an industry and city that people don’t choose to make money. While I am adept at understanding the functions of macro social systems such as racism and the economy, I often struggle to navigate individual institutions and bureaucracies to get my needs met. I could not afford the co-pays, the time off from work, or the transportation to get to doctor’s visits of all sorts. Sometimes I tried to schedule appointments, but would get discouraged when the closest doctor was located over an hour away, open during limited hours, not accepting new patients, or did not take my insurance. These challenges are common when you live in a poor, low-density region serviced by an inadequate public transit network. Or when you grow up in a community that discounts mental illness as laziness or a bad attitude: “You don’t need a doctor, you need discipline. Your problems will go away when you get a better job or a boyfriend.

I internalized my mental anguish as of my own making and normalized my physical discomfort as a fact of daily life. In effect, I deferred maintenance on the mental and physical systems that sustain my well-being. As a result, what were cavities became root canals. The situational depression I developed in college spiralled into clinical depression—a mighty vortex that seemed to grow more intense with each post-grad job, relationship, and life event. And what might have been managed with months of counseling sessions, probably requires several years of regular therapy. At times, it is very difficult to reconcile the access I’ve had to some of the most elite universities in the world with the barriers I’ve faced to accessing basic medical services. I don’t know how to describe the feeling of sitting in a class and knowing your lived experience is the outlying data point of educational success, the case example of why we need multifaceted definitions of “access” that consider affordability, availability, and awareness in addition to physical distance. When your GRE score is in the 99th percentile, and so is your cholesterol level.

I am sharing my story not because I think it is unique, but because I suspect it is quite common in some ways. Despite increasing awareness of the academic, financial, and sociocultural challenges experienced by minority, low-income and first-generation students, I have observed a persistent stigma and silence around health issues. I understand the disincentives and potential penalties that students—especially marginalized students—may encounter in sharing these stories. Or even just saying to someone “I have depression.” Our position in these programs is often marked by precarity and presumed incompetence. We’re constantly expected to prove our basic capabilities to handle the rigors of advanced research to our peers and professors. Our admission was not enough; at best it was a professional courtesy, at worst it was a statistical accounting. We should be so grateful. Talking about mental or physical illness—how it alters the way we process information, the way we move through space, the way we structure our schedule—carries tremendous risk in a profession that rewards intellectual acuity and constant productivity.

Grad school is hard. But for someone like me, it means improved access to care such as on-campus, free and subsidized providers, health screenings, and wellness services that I could not obtain for the last several years. The services are not comprehensive and my stipend is not enough, but it is more healthcare and more income than I’ve had for years. So, I am making my health my top priority. I cannot afford to defer maintenance of my mental and physical health any longer. Because the grim reality is, if I do not attend to these issues now, I might not survive to the end of my PhD program. I know this is only the very beginning of months and years of chronic pain, frequent appointments, and unforeseen consequences, but I am grateful for the opportunity to repair. My pain might not be my fault, but I am responsible for my healing.


Enjoli Hall is a PhD student in the Department of Urban Studies and Planning at the Massachusetts Institute of Technology (MIT). Enjoli’s research is focused on racism, social inequality, and urban policy, and the impact of these forces on local government planning, policy, and finance. Her work focuses on cities and counties facing chronic poverty related to deindustrialization. Enjoli’s research draws on over five years of experience working with non-profits, foundations, and research centers in her hometown of Buffalo, New York. She has worked in a variety of roles in community development, ranging from adult literacy tutor to youth advocate to program officer to regional planner.