The First (Black) Fellow
There are two moments that stand out from my fellowship experience because of their stark differences: my interview day when the division chief remarked, “and you could stay on and become our first Black faculty member” and 9 months later when I sat in bed with tears streaming down my face, frozen in fear at the idea of returning to work. The former moment sparked a dream and inspired me to move to a new city; the latter almost broke me.
In November 2018, I learned, in the comfort of my post-call pajamas, that I matched at my first choice Adolescent Medicine fellowship as the inaugural fellow. My independent spirit was lured by the promise of freedom to create my own experience and shape a new program. I recorded myself checking my Match results, screaming and dancing, while my family cheered on speaker phone. I used to watch the video of that version of me with pity. I no longer recognized her eternal optimism and trust. I envied her naïveté to program-inflicted trauma or anxiety. I feared for the breaking of her positivity and high expectations. Now, I look at her compassionately, admiring her bravery that dared to take the path unforged and crawl her way through it with authenticity.
On my first day of orientation, I quickly recognized I was the only Black or Latinx fellow across all pediatric programs. Within my division, my first experiences were not much better. I was so eager to finally meet my new program director I had been communicating with for months that I hugged them. A few days later, I learned that was a mistake when they informed a large group that they are not a hugger and told everyone that I hugged them on my first day. I was so embarrassed by the unnecessarily public correction.
I felt overly supervised and under-supported. With only 3 scheduled clinic patients to see each week, I had few opportunities for autonomy. I asked for more fellow’s clinic and was denied because of concern I would drain the attendings’ schedules of patients. With persistence and time, my request for two clinics was finally approved without acknowledgement of my advocacy. I was told to do administrative tasks for attendings, sometimes in front of their patients, because it was “educational”. I was told to prepare presentations above fellowship expectations, and only one faculty member would attend to support; some were not even aware I was presenting. I had to fight just to make sure the recruitment budget was big enough to accommodate a restaurant lunch for interviews, a moot point in pandemic times.
I was complimented on my “articulateness” after a speech. I was told I had to do several responsibilities because they were required by ACGME (the residency and fellowship governing body) only to do my own fact-checking and determine that was not true. I felt isolated in the office with interactions that were limited to brief questions about my weekend plans. Later on, teaching opportunities are still not a regular part of my schedule. Only as a third year, have I been allowed to supervise residents and medical students. In 2.5 years, I’ve only precepted a total of 2 clinic days. Whenever I asked for structural support, I was advised on how I could do things better. “Write notes in less time” if you feel overwhelmed. “Keep your office door open” if you feel left out. “Talk to someone about time management skills” if you can’t keep up. “Go door to door to invite faculty to your talks” if you’re feeling unsupported. I was told things would be better if I had another fellow to go through this with, especially an older one to teach me how things work, realities I had no control over. I learned to raise my tolerance for asking for help, keep my problems to myself, and only speak up when it really mattered.
I was also hungry for feedback, but found it unsettling to navigate the minefield of unspoken expectations, to only learn there was a “right” way of doing things after I have done it “wrong.” I cried in offices and poured my heart out only to learn this information was shared with other people without my awareness. Brené Brown, be damned. It is not safe for Black women to be vulnerable in the workplace. My honest mistakes were blown out of proportion, with negative intentions assumed of me long before I ever learned of my wrongdoing. For example, I posted a tweet in the fall of my first year that unintentionally revealed personal information about a faculty member. My following was small then, but faculty and staff from work began following me as it grew. Someone saw the tweet, figured out who I referenced in the tweet and months later, it came up in a faculty meeting discussion about my progress. People were reportedly appalled by my actions. I only learned after then that all this occurred; no one reached out to me directly first or gave me the opportunity to apologize and correct my mistake. Nothing makes you fear making a mistake like genuinely experiencing judgment for it.
Twitter had been and continues to be an outlet for me. When I realized I was the only Black fellow sitting in the room on the first day of orientation, I tweeted my experience and the medical community saw my discomfort and empathized. When I needed local friends and mentorship for writing and advocacy that my fellowship didn’t provide, #MedTwitter became that for me. Knowing that co-workers were reading and judging my musings in ways that negatively impacted my fellowship experience made me feel like I was losing one of the few spaces of community I had. While I took the lesson of disclosure to heart, I opted to block all those I worked with to give myself space to continue tweeting and protect myself from further damaging misunderstandings. Also, I used to tweet summaries of my Friday didactic lectures as a way of solidifying key points and enhancing my visual learning. While I would inform presenters before they spoke about this practice, I was asked to send an email to each speaker in advance to get their permission. This request felt overly burdensome so I gave up these summaries up altogether, even though it negatively affected my knowledge retention.
I approached my breaking point over a dance class. It was a block from work and the only place I felt fully present and free, besides church. I learned with two weeks notice that my new schedule for 6+ months would prevent me from ever attending that class. With tears in my eyes, I pleaded, “but it’s therapy for me”. My request was declined with an additional sentiment that I had frequently tried to shortchange clinical responsibilities. (I had asked to leave early once after a full day of clinic in the suburbs so I could arrive home early enough to study for Boards before bed.)
I had bad experiences with feedback in the past, but never so personal and presumptive. When I reflected on just how much I carried while doing my best at work every day, I was told, “medicine keeps moving and so must you.” I felt stuck, trapped into a role too small and ill-fitting for me. When I did my best to convey these concerns, I was gaslighted. “We’re concerned about your mental wellbeing.” “Talk to [GME leadership] to learn what fellowship is about.” When I reached out to others at the institution, the message was often the same: sympathy for the program not living up to my false expectations, explaining it away as “personality differences”, or offers from Black women to coach me on how to work within the system.
That contained feeling is how I ended up sitting in bed, willing myself to show up on time to clinic against the inertia of fear. The hardest part of this experience was navigating it as the only fellow. When leadership perceived the challenges differently and conveyed that to others I trusted, I started to question my sense of reality. Am I crazy? Overreacting? Am I just a brat for asking and expecting too much? One of the ways I would talk myself out of that spiral is returning to a post-match e-mail that promised the opportunity to build a fellowship together. Only a leader would assume the risk of being a program’s first trainee.
I also questioned the role that race played. I can never divorce myself or my experiences from my Blackness. Everything did not just happen to a fellow. It happened to me, a Black female fellow and former faculty hopeful. Hearing calls across academia and within the division to “hire Black faculty” while living through harm from these structures was ironic at best, and discouraging at worst. An unwelcoming environment can never really become home.
The only thing that got me out of bed that morning was the possibility of more breathing room. I submitted my first application to a general pediatric position, then got dressed for work. Looking outside helped me see my value as a pediatrician. While the offers I received did not suit my goals, the experience plus the support of outside mentors helped me return to fellowship with confidence in what I wanted to accomplish and a list of education priorities I needed to achieve. Looking back, I’m so grateful I did not allow anyone or anything keep me from my dream since college of being an Adolescent Medicine physician. I also built up my support system, reaching out to Black and Brown fellows in adolescent medicine across the country by painstakingly searching program websites and texting friends for e-mails. I wanted us to know, acknowledge and support each other. We hosted Zoom gatherings and created a group chat that continues to add incoming fellows. Together, we even published a statement about promoting equity in our shared field.
I met with GME leadership, as directed, who wanted concrete ways to help and seemed overwhelmed by the larger issues; they agreed to support my attendance at dance class. They also offered an internal review of my program that never happened and I was too tired to follow-up. The energy of advocating for my program felt futile compared to the opportunities to advocate for marginalized communities beyond it so I turned my energy outward. My program agreed to let me return to dance every other week. I am grateful for one leader’s voice, who believed me and was willing to attend all my feedback meetings with program leadership to provide insight about what’s required and not, while helping me feel safe.
I wanted to move on, hoping that I would never really have to talk further about how I felt with faculty and risk advice on how I could fix everything. I also didn’t want to go to therapy. For the record, I love it and have benefited greatly from it. I just hated the idea that I would have to go because of the environment I am in. It somehow felt like admitting defeat, saying I could not change the program so I had to find the support to deal with it. I was not ready to do that until May 2020, when my stress finally crept under my skin.
While on staycation due to cancelled travel plans, I felt off. My heart was constantly pounding in my chest, even if I just laid on the couch. I tried to reduce as much stress and activity as possible. I avoided social media, made no plans, slept more, and just laid down all day, watching endless reality TV. Still pounding. As the world learned that George Floyd had been murdered, I couldn’t let myself read beyond a new hashtag and city, afraid my heart could not take it. At my pediatrician father’s suggestion, I set up a medical telemedicine appointment. The physician ordered labs and an EKG. Sitting in the parking lot after my tests, I cried for the first time that week. This is how I am spending my vacation, I lamented; this is what broke me.
While my phone and e-mail received messages from the faculty checking in on me after George Floyd’s murder, I felt frustrated. I hoped since my arrival that people would recognize I move through the world and am treated differently just because I’m Black. I had tried to highlight this to no avail. My feedback on microaggressions was returned with making me responsible for bringing them up because “there is no way we would ever know every wrong thing we can say.” The pain of my loneliness was responded to by comments from white women with established relationships in the office saying they felt the same way. I did not have the energy or gall to argue further.
In my follow-up appointment, I learned everything was normal, as I anticipated. I beat the doctor to the punch, “I think it’s anxiety related to work and I made a therapy appointment for next week.” Yet, that good news led to a more uncertain outcome: how long would this last? Would I ever get better? My mind recalled every conversation I had with patients about psychosomatic pain, how empathetic I tried to sound while clueless about their experience. I now knew a sliver of their pain and tried to show myself the same compassion I show them and use this lived experience to bring greater understanding in the future. I also wondered, “why now?” I had lived through my sister’s diagnosis of cancer, her bone marrow transplant and successful recovery, three years of residency, and marital challenges that could have ended in divorce. Through all of that, I had bad days, but came through the other side intact. What made this different? Finally, did I cause this breakdown? If I had taken their poorly-timed advice to engage in therapy, could I have prevented my stress from reaching this point?
I knew one thing: I had to speak my truth fully; my heart seemed to demand it of me. I wrote an e-mail to all the faculty saying their sudden and delayed acknowledgement of my Blackness made me realize “my experience as a Black person has generally felt invisible.” Pre-pandemic, I was never asked by clinical or research faculty to meet in their office or over coffee to get to know me or discuss my goals. After detailing my experiences, I wrote, they “led me to feel like work was unsafe, that I did not belong there, and the future…that inspired me to come here may not be possible.” As an attachment, I included a list of practices for promoting inclusion so those behind me would hopefully not have a similar experience.
I still admire the strength in my closing paragraph: “It hurts to feel alone as the only Black provider. It hurts to be talked about behind closed doors and be presented with misunderstandings about me. It hurts to be asked by the division to participate in anti-racist patient care without acknowledging the experiences of those inside. Dr. Tamorah Lewis, a Neonatologist and Physician Scientist at Children’s Mercy, stated, ‘diversity without inclusion is injuring.’ I have been on the receiving end of that injury, both emotionally and now physically. I am doing everything I can to reset my physiologic equilibrium, engaging in therapy, debriefing with friends, exercising regularly, participating in church community remotely, and now speaking my full truth.”
I received many positive responses with apologies, expressed empathy, and requests to get to know me. I am thankful for them and the connections I built with some thereafter feel like the support I had longed for. Yet, I also received an e-mail from GME Leadership informing me they were aware of my e-mails and congratulating me on my bravery. Once again, my information was shared without my permission or knowledge. One step forward, two steps back.
In therapy, we explored my goals. I wanted a sense of safety at work that would allow me to get through the next two years. I wanted to protect the things I did not want to share and develop rhythms that helped me release and recover. I realized my heart issues had not just suddenly appeared. Sunday nights, before the return to clinic, I had experienced a similar pounding pattern that I ignored. It made sense that my body signaling danger grew louder to get my attention. I was finally listening. I started to learn when it was loudest (when I was tired, overcommitted, and felt unprotected). I instituted boundaries, like not answering personal questions and logging out of e-mail after 5pm and on weekends. I focused on self-care habits, like getting adequate sleep and making fun plans. With time, patience, and practice, things got better, but they were never good. A comment or situation would trigger me, I felt more anxious around certain people and situations, and I would avoid who and what I could to keep myself safe. I was not just anxious, I was traumatized. While some programmatic practices changed, I can’t separate my experience from the improvements.
Therapy also revealed this experience’s deeper impact on my self-esteem. In high school, I was the “straight A,” star student; the validation of grades, accolades, and praise was the scaffolding of my delicate self-esteem. While I’ve made significant progress since then, I arrived in fellowship still vulnerable to doubting and blaming myself when I was mistreated and striving to get recognition. I love advocating for others, but I put so much energy into it that I exhausted myself in search of validation I had not received. A mentor told me, “when you give people the power to validate you, you give them the power to invalidate you.” That word changed my life; I’m still learning its significance. I learned to see myself, my work, and goals as distinct from the institution and the people I work with. It was freeing! For the first time in my life, I owned my mission completely and refused to allow anyone or anything to prevent me from its fulfillment.
I still carry with me the unhealed scars that get pricked by repeated offenses or acts that overstep my boundaries, such as texts on vacation. I could only participate in one fellowship interview day this past year. While I was excited to meet the future of adolescent medicine, when applicants shared descriptions of the fellowship they heard that contradicted my reality, like its responsiveness to feedback, the trauma boiled up again in me. My friends often prodded me, “tell them your truth.” I wanted to, but I also remember how a program director tried to negate a Black female fellow’s entire experience to me when I was interviewing. When I reflected the fellow’s concerns to the program director, they simply stated, “she didn’t know what fellowship is.” Ever since then, I have feared that someone could similarly wash my entire experience away by painting me as the rogue, misfit fellow who just didn’t get it, who asked for too much, or who just didn’t fit in. My story is too precious and vulnerable to me to give anyone that opportunity. Instead, I have used it fuel my advocacy for practicing equity and creating spaces of belonging for Black trainees through presentations to program directors across the country.
I started to imagine another way out, an early escape. I had always wanted children and my relationship was in a good place, but I was scared of how a maternity leave in the middle of fellowship would have been managed or how my mental health would be affected on my return. I secretly researched how much time I could take off without extending training and dreamed of a due date just late enough to finish fellowship on maternity leave. It felt like the perfect plan, except that it did not happen. The months of waiting for a positive pregnancy test were filled with dual anxiety about getting pregnant and a shortcut to post-fellowship life.
When both failed, I picked up Right Within: How to Heal from Racial Trauma in the Workplace by Minda Harts. It helped me realize that while boundaries had made my situation better, I had no system to manage triggers that made it past my walls. I also carry unresolved trauma that I do not want to take into my next phase. With over 6 months left of fellowship at that time, I knew my recovery could not wait. I needed to learn how to heal in place. I developed a plan that includes deeper engagement in therapy, consistent exercise, maintaining boundaries, and more reading. One friend remarked, “it’s hard to heal when you’re still getting scratches”. I’m still trying. I revisited the impact of the experiences above with my program recently and received an apology for actions and responses that harmed me. That acknowledgment was affirming and makes it easier to move forward.
As I considered jobs after fellowship, I still planned to apply at my institution. It was a default response and I also hoped the dynamics of being faculty would make things better, even though I questioned my ability to heal if I stayed. Deep down, I also was not ready to give up the dream that brought me here, hoping for some kind of redemption story that made meaning of everything I endured. I still wanted my division to see me fully through a position that would allow me to stay and do the work I feel called to. When that position did not materialize, people encouraged me to say, “I’ll only stay if I can…”. When I realized I was not invested enough to make that promise and already had opportunities that better aligned with my purpose, it was finally time to leave. This is the first time I’ve intentionally not applied to stay where I trained. I want to use these last few months of fellowship with my story out in the open to live in my truth, focus on my healing, and prepare for what’s next, beyond this institution. I look forward to seeing what adventure awaits and how the skills I developed through this will be utilized.
I am still writing my story and its meaning to me. The last couple of years have been the hardest training environment I have lived through and I am forever changed by it. It also made me a more humble, self-assured person, lessons I needed, and a stronger and bolder advocate in and outside of the institution. Yet, I still hate this experience for me and do not wish it on anyone. I am grateful for all the people and resources that give me strength. I felt less alone reading Shonda Rhimes’ experience of being an F.O.D. (First. Only. Different.) in the Year of Yes and imagining how many other Black women are navigating new territories by themselves. I felt seen in the works of Black feminists, like Angela Davis and bell hooks, who talked of struggles generations before me and in generations to come. I let go of people pleasing thanks to The Likeability Trap by Alicia Menendez, who helped me see that being liked is often inaccessible to women of color, but not necessary for success.
I was inspired by Black women physicians who boldly shared their stories of discrimination: Dr. Blackstock, Dr. Dennar, and Dr. Khoury, showing the larger plight of Black women in academic medicine and empowering me to use my own voice. Even beyond medicine, stories of Black women taking a stand encouraged me, from professionals like Nikole Hannah-Jones and Timnit Gebru to athletes like Simone Biles and Naomi Osaka. I thank my family and many mentors outside of my institution and friends within it who heard and believed me. They helped me believe my own experience. I also made the most of this fellowship season; I advocated for a well-rounded training and created community and leadership opportunities outside of fellowship that strengthened my sense of autonomy and self-expression. I found home in the city I moved to, just not the institution that brought me here. As I continue the search for my next opportunity to advance adolescent health and uplift Black youth, I heed Yamiche Alcindor’s advice to Nikole Hannah-Jones (and all Black women): “Go where you are embraced, celebrated, valued and supported. Go where you don’t have to fight for people to see your brilliance. And, avoid spaces if they barely tolerate you, even if they’re familiar and beloved.”
I more subtly shared on social media throughout my fellowship in hopes that someone like me could see a ray of hope in their isolating struggle and know they are not alone. The responses I received have been positive and overwhelming. People reached out, in conversations, texts, and social media messages, sharing their stories confirming my experience is unfortunately not unique. Yet, we don’t get to hear them, it’s hard to share while in training. With small programs, little to no anonymity in feedback, and future careers on the line, it feels safest to stay quiet and just push through. Even ACGME surveys often don’t capture information about culture and leadership, even though these deeply impact learning environments. I’m only doing so completely and publicly now, with 5 months remaining; many others never do. They just move to a new institution and start anew or keep struggles held in for as long as they can, quietly suffering from the stress of internalization.
Sometimes, I felt like I couldn’t speak up directly because I made mistakes; I haven’t been the perfect fellow, even though I know perfection is a myth. I had to remind myself constantly that despite my flaws, my experience is valid and worthy of sharing. While I am so proud of all I learned and accomplished, I also wonder how much more I could have learned and accomplished with more support and without trauma. Just as I volunteered to be the first fellow at my program, I volunteer to lead the way for affirmation of these experiences not to blame individual people or shame particular institutions, but to promote structural and cultural improvement for others like me. Academic medicine will never gain more Black faculty as long as these damaging experiences persist.
