Why I Left Boston Residency Program–Part 1

Sometimes people try to destroy you, precisely because they recognize your power — not because they don’t see it, but because they see it and they don’t want it to exist.”

–bell hooks

When I arrived in Boston, most people that I was going to work with knew me. My friend recorded me during match day–a very big event where graduating medical students receive an email to know where they are going to be trained as a resident, and my video went viral after uploading it on Twitter. I later received an email from the New York Times and they featured me in an article. Weeks before my first day, the hospital reached out to me and wanted to hear my opinion on racialized health disparities given it was the post George Floyd murder, and there was a racial awakening in America. They liked my writing and they published it for their website. The article also went viral and I had people from different states who told me their chairperson asked them to read it. In fact, at least two medical schools integrated it into their curriculum. Suddenly, I felt “famous”. I wanted to be in Boston. I interviewed at different programs, but three had the population that I used to care for: racialized people, and migrants. I went to Boston thinking those are the people that I want to work with. I also heard many attending physicians were working on projects that address health inequities. Everyone who has worked with me knows that I get excited when medicine intersects with social and public health factors. As a safety net hospital, Boston was the place for me. I wanted to learn from them. There was the ego part of it too because the hospital was a major training institution in Boston, and the US. I thought they could help me see that I was a valuable member of society, and I am here to make this world better. I counted on them for prestige, respect, and admiration. It was my dream to come to Boston. I chose to go there. I was that kid who grew up in a low-income family in the most impoverished country in the western hemisphere. Living and working in Boston, I could prove to the world that we deserve to be there. Although I arrived with a lot of fear, and anxiety, I also arrived with a strong CV after gaining experience in Haiti, France, Mexico, and Greece, and a strong desire to care for the most vulnerable people. Over 50 percent of all patients at the hospital are racialized people, and 32 percent do not speak English as a primary language.

I was the man for Boston. I speak Haitian Creole, French , and Spanish. I was in a clinic where only one of my patients was White, everyone else was Black or Latinx. In my clinic at Dorchester, I rarely spoke English because most of my patients are not native speakers. I was happy to make them feel seen. I knew that I could make a difference in Boston because I was built for it. However, there is something about me that my CV will not tell you. I am a neurodivergent person*. Instead of providing me accommodation, the program used that against me. They used my immigration status, nationality, and my foreign accent against me. I was dehumanized. I was put in a position where my anxiety was so high that during rounds, I would be lightheaded, my mind would go blank, my body would tense, and my hands and feet would feel wet. I received medicine to take every time I felt that I was about to be anxious. I felt like the medicine was either not working or my anxiety was too high, so the psychiatrist asked me to increase the dose. For weeks, I went so high on it that I couldn’t sleep. I would show up to work at 4 AM, and leave by 7 PM–one of the attendees even had to document that in his evaluation, but he framed it as if it needed longer time to see patients compared to my co-intern. The program always thought what I needed was remediation. I was in shock, and cried in front of my program director. When I tried to back off, they said that I need to sign it in order for them to help me. After signing it, I asked them what should I do now, they told me that I was on remediation plan months prior to that. I cried even more. The hospital called me later for more interviews on health disparities, and I gave them. More articles were published. I hated myself. Given my immigration status, and lack of social capital, I decided to go quiet about it. I felt less than all my co-interns, so I withdrawn from everyone.

In Boston, I admired everyone: the attendings, the senior residents, the co-interns, the nurses, the patients. I wanted to be a senior like most of the seniors that I worked with. I wanted to be their friend and be part of the family. I felt excluded all the time. They made me feel like I was an imposter, and the worst case they have ever dealt with. For example, my access to electronic medical records was blocked**, and my co-interns had to approve my orders. It didn’t matter what they were doing, I needed to wait for them. I was used often as an interpreter and I was never compensated for that extra work. To add insult to injury, they never sponsored a visa for me. I was working thanks to an OPT that I received from Rutgers University–I came to the US for an MPH degree, and stayed for residency. Out of six foreign grads in my class who needed a visa, I was the only one they never sponsored a visa for. It was very painful for me to know those things. I was anxious at work for the simple fact that I was not sure what would happen to me shortly, so I felt mentally tortured. The residency program was not a learning environment–In fact, I was so preoccupied. Something that hurt me and continues to bother me was on the second day of Black history month, february 2021, the hospital shared my article in all social media platforms. I felt like they had control over my body at work, and my intellectual contribution even when I am home–Mind you, I was never compensated or received academic for those works. They were capitalizing from my marginalized identities, but destroying me privately. I felt tokenized, used, and treated like a child. There was no doubt that I didn’t belong there, but at the same time, I felt someone else’s property. After seeing my article on their platforms, “Al diablo todos, me largo de aquí”, I said .

When I told the program that I was switching to psychiatry, and needed letters of recommendation, they gave me a letter to go to the SOAP (Supplemental Offer and Acceptance Program)–you read that well. None of them expected me to match into psychiatry. One of the APD (Associate Program Director) told me he saw me more as a physician assistant, and not as a doctor. When I asked him what he meant by that, he told me that PAs do well, and I shouldn’t stay in medicine. He didn’t trust me, and I was too old to be in residency. He added “Boston is not the place for you”. When I told my PD that, he asked me to stay home. Mind you my two roommates were also my co-interns. Seeing them going to work, and coming back was painful to me. Their presence in the house hurt because I didn’t want to ask them about work. Their absence also hurt because they were at work, and I was not. My home was not safe for me anymore. I was isolated, and placed in a position to kill myself. I was suffering so much that I thought only death could be less painful than what I was experiencing. I would wake up in the middle of the night, take pills for anxiety, and call for help from a co-intern. I asked myself, as a Haitian, if this world would never be safe for me. If I could one day belong somewhere or if life was worth it. I remember leaving my place to buy something to eat only two minutes walk, but got lost, and ended up somewhere else in the cold winter. I received help from a therapist and a psychiatrist–in fact, the psychiatrist was part of the hospital, and I was scared they would have access to my personal information that I moved the therapy part of my care to a Black woman therapist. Some of my co-interns would ask me how I was doing, and also attendings during the hardest time. However, I would remember a Haitian friend out of Boston called me late at night and let her Facetime on just to make sure I was safe. I am also forever grateful to a co-intern who would text me daily to know how my day was.

Guess what, there were three unfilled psychiatry spots available for the SOAP nationally. I was on an OPT thanks to Rutgers University ( I received an extra year to work in the US from the government after obtaining my MPH degree in May 2020). The OPT was about to expire– Which means if I didn’t match and find a SOAP position, I would be illegal in the US or go back to Mexico or maybe come back for match 2022. When I matched in Minnesota in March 2021, Boston program director had an urgent meeting with me asking me to resign. They even sent me a draft letter that framed it in a way that I decided to leave. I was confused, they want me to leave, but they want me to resign. I told them that I was not going to sign their letter. they told me that my visa would expire, so I needed to sign it. I told them Boston never sponsors a visa to me, but Rutgers University, so I needed to talk with Rutgers first. The program didn’t know what to do with me, but I was told to not get into social media with it. Before leaving Boston, I asked them to give me my evaluation, but they told me their lawyer didn’t want me to see my own evaluation. When I asked to meet the GME, they brought a lawyer. I freaked out. My legs were shaking, hands and feet sweating during the meeting. They told me to go to Minnesota, and forget about Boston (Believe me, I do all my best to forget about Boston daily). The lawyer’s presence made me feel confused. (I later learned that Boston lawyer works for HR).They made it sound like I was the abuser and they were the victims. I felt gaslighted. It was at that time that I reached out for my dad. Given my father’s personal history, my siblings and I always filter all information to him, and reach out to him on last resort. He is one of the most marginalized people that I know in the country as an undocumented person. My dad cried over the phone, and said to me: Bondye patap kitem pran kou sa. Se sel ou menm wi ki soti nan fanmi. M priye twop, papam siye dlo nan jem–God would have never let me receive that hit. You are the only one in the family to make it out. I pray too much. My father wipes the tears from my eyes (my dad lost both of his parents and three siblings when he was 7, and he always addresses God as “my father”. He has the equivalent of first-grade elementary school. Both of my parents didn’t finish elementary school)

The only thing that I remember was that I advocated for a couple of Black patients who deserved better treatment. If I center some people in my talk and action, it is because I grew up disenfranchised and marginalized. There was a time when an attending was interviewing a non-English speaking Black Haitian without an interpreter who was a Jehovah’s Witness to receive blood patients to receive blood, the patient was very uncomfortable. Making the case that her pastor would not know if she receives blood. She was saying no, and yes. When I talked to the patient in Haitian Creole, she said she would prefer to die than to receive the blood. I told the attending that the patient felt uncomfortable. I told him that God is extremely important for Haitian people, they go through a lot, and sometimes that is the only thing they have. If she “betrays” God now, she would never recover. She would spend the rest of her life regretting her decision. It may be difficult for a Black female elderly Haitian person with low literacy to say no to an old white man, but she already made up her mind. The attending called me dangerous because I didn’t want to give the patient blood. He couldn’t trust me with any patient. I felt like whatever I said could be used against me; it didn’t matter if I was right or wrong. I didn’t experience microaggressions, but I did experience violence. I grew up in Haiti, but I never experienced such violence in an academic setting in Haiti directly at me despite witnessing political violence. School and church in Haiti were my only safe place. I trusted, and admire people from those two places. All the identities that I carry made me so vulnerable: Black, Haitian migrant, foreign accent, neurodivergent, first-generation medical graduate, and former refugee. My self-esteem was very low. I couldn’t recognize any doctor in me. During rounds, for example, I felt safer to set aside if I am not presenting a patient. I felt my only way out was to be quiet, but when I am quiet they would say I didn’t know what was happening with the patient. I was confused. Here is the thing, none of the program leaders were Black. When I was there, four people in my class were Black (out of 55 interns). No other classes had a Black resident. 70 perecent of the patients that Boston sees are People of Color.

I left the program being conviced that If I was a White person my experience would have been different. They would have found all excuses to keep me there. I know three non-Black residents who were on remediation from the program who repeat their intern year. I talked with all of them, and they were surprised that the program put me in that situation. One resident told me this looks strange to her because she was on remediation plan, and she received a leave of absence for mental health. Although I admired her emotional support and I advocated for myself, but being a Black male did not grant me the same privilege of my White female colleague. Another resident told me he would advocate for me. I told him nobody wants to be in a place where a White resident needs to tell the people in power that a Black resident deserves equal treatement. Four attendings that I worked with asked me what they could do. Should they organize? I said no because Boston was not safe for me anymore. Strangely enough, when the program was looking for reasons to dismiss me, the attendings sent very strong evaluations, so the program would extend my contract. Even the program final evaluation about me to the ACGME was not appropriate. In fact, they didn’t know what to say, so they decided to lie. For example, I never did a procedure during my intern year in Boston, but they made the case that I was bad at doing procedures. They mention that I had a “lack of awareness” of external factors that affect people’s health like their socioeconomic background or their cultural background. Mind you, I co-launched a social medicine podcast and we talk only about those things. I got an MPH degree after losing my mother from diabetes. In addition, Boston certified me as a bilingual provider. I am a Haitian born, I moved to Mexico as a refugee, and went to France and Greece to study abroad, but they wanted to convince ACGME that I can’t see cultural and socio-economic factors. Interestingly, someone like me who had to deal with housing and food insecurity couldn’t recognize those things in my patients. I was very confused when I was leaving boston. I left Boston feeling less than any of my co-interns, from the guy the New York Times said he was coming to Boston to trash that nobody wants. I couldn’t focus on the next step because I was wondering that I did I that I must have hurt that attending feeling so hard, I mean the APD.

I am in a much better place now. Contrary to Boston, nobody here asks me to prove myself. They encourage me to be better at things I am already good at. Not everything is perfect in Minnesota, but I feel seen and listened to. I Have a Black woman as a faculty mentor, and a Black woman as therapist, so I feel comfortable talking about racialized trauma. Maybe because I was dehumanized for so long, so when people treat me as equal I think it a lot. I don’t know, but I can say I moved to this place too late. For example, when I feel uncomfortable about something in my program, our chief or the leaders in my program listen to me. They change it or provide an explanation why they cannot work on it now. I am so surprised to know that the program acknowleges and gives me credit for any extra academic work that I do–I usually like to talk about social medicine and public psychiatry. My co-interns and some faculty members make me feel that I am contributing to something bigger than myself, and I am part of their family. Maybe because people in Minnesota are more lay back, and not competitive as Boston. Maybe because they are psychiatrists, and they deal with human pain and suffering. or maybe they think everyone deserve respect and inclusion, and maybe a chance to achieve their drea. To be honest, I feel like, for the first time, I have the space to love myself, and need nobody to remind me of my humanity. I am developing new hobbies, and going out with friends. I still struggle to trust people especially people with a little bit of power over me like senior residents or attendings, but I know I would get there. When I survived the earthquake in Haiti, I couldn’t get into the train in mexico because it reminded me the ground shaking in Haiti, but after a lot of exposure, I was able to use the train. I am hopeful in my ability to recover, and my Haitian spirit.

In Minnesota, I am empowered and receive the permission to just be me. I am doing a lot of personal work. For example, I am learning from the trauma-response behaviors that I developed in Boston. For example, I don’t like to be around attendings before or after a round, I felt like they are evaluating me, and going to report me. Thanks to my therapist (I love her so much), I am learning to trust again, name my emotions and know what they mean. Meanwhile I am helping my patients to do the same. However, there are days that my mind goes straight to New England. For example, I wrote this article after feeling dissociated, and my mind went blank during rounds. I forgot what I was saying, and was doing my best for people to not notice it which made me anxious. I talked to my therapist about it and told her that someone said something to me, and it brought back memories from Boston. I wanted to run to the bathroom just to breathe, but couldn’t so my mind went black, like if it was telling me “I am out of it, get yourself out of here too”, so I forgot what I was saying to the team. My therapist told me “Whatever happened in Boston has been very traumatic for you”. I left Boston feeling shattered, so I am still picking up the pieces and putting them together. The worst that can happen to you as a minority trainee is to have the voice of an old White man who is angry at you in your head coming back everytime you doubt yourself, and have to prove him wrong all the time. It’s excruciating because that little voice cannot go away. I remember telling the APD in Boston, you cannot destroy the Haitian in me. We are too resilient. While I am in Minnesota to prove nothing to nobody, I want to leave my mark in here especially for the Minority and migrant people. I will definitly continue to contribue in Mexico and Haiti. I definitely want to understand how economic, social, and political policies influence their mental health and prevent them from having access to care. I only need good mentors and people who believe in me. For Now, I continue to work on myself. I do my best to break the rumination that is happening in my head when I perceive that I am in danger or when I feel one of my identities being attacked. I am doing the work far away from Boston. Writing this for example is healing, but retraumatizing at the same time. However, I share it because our stories also matter. I want this to not be the end of our story. Haiti was the first Black country in the world, and we organized the only revolt led by enslaved people to free themselves from slavery, and colonization. We also fought in Georgia for the Americans during the American revolution. African American looked for asylum in Haiti when Slavery was legal in the US. I take a lot of pride and inspiration from Haitian history. Adressing health inequity is our current “revolution”. we cannot, and must not abandon our patients, those who are the most marginalized. So, I believe we need more Black doctors. Our patients deserve us.

The truth is I hate Boston, but I don’t want hate to distract me from my real objective which is caring for my patients, addressing barriers in care, and advocate for them. I am 100 percent focusing on Minnesota. I writing this out of love. I write it to validate the feelings of trainees who are going through a lot during residency in addition to the pandemic, and also the medical students–I see you. I believe in a world where we all belong and receive equal treatment. I believe our stories need to be told, and better learning environments need to be created. As I continue my healing journey, my only prayer is for the neurodivergent, former refugee, migrant, first-generation medical graduate, racialized person, the one who grew up in low-income family, the one who has history of racialized trauma and the one with a strong accent like me to also find a place that can make you feel seen, loved, admired, validated, heard, and most importantly SAFE.

I wish the best to Boston.

For this Black History Month, I want to advocate for safe learning environment and equal treatment for our Black trainness. And to the Black residents and medical students, I want you to know that you are NOT alone. We are only separated.

• anxiety & PTSD.
• from August 2020 until I left Boston, my access to EPIC was blocked, and I needed co-interns to approve my orders. By being blocked, I could place the order, the would be saved, but a co-intern or resident must approve them.