November 12, 2025 • 49 mins
Priyanka and Hari share their jet lag survivor tips before welcoming Dr. Uché Blackstock, founder of Advancing Health Equity and author of the memoir Legacy. She opens up about her experiences as a Black physician, how racism shapes healthcare and what keeps her hopeful in the fight for real change.
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Speaker 1 (00:00):
This podcast is for information purposes only and should not
be considered professional medical advice.
Speaker 2 (00:08):
Do you really not get scared? Because I feel like
I'm terrified most.
Speaker 3 (00:12):
Of the day.
Speaker 1 (00:14):
Absolutely, there's biological difference. Is so like the nonchalance in
which we just sort of accepted and learned this information.
Speaker 4 (00:23):
I could they never felt like I truly belonged in medicine.
Speaker 3 (00:28):
Do they still want the ambience?
Speaker 1 (00:29):
I mean sometimes they still wanted and then you know,
we figure it out.
Speaker 3 (00:37):
I'm hurry, condibolu.
Speaker 1 (00:38):
I'm doctor Preanca Wally, and.
Speaker 3 (00:40):
This is health stuff.
Speaker 1 (00:43):
Hey Prianca, Hey Harry, how are you doing?
Speaker 3 (00:46):
Oh man?
Speaker 2 (00:47):
I uh as you know, I'm a touring stand up comedian.
Speaker 1 (00:51):
Yes, you are a Netflix special.
Speaker 2 (00:54):
With a Netflix special, which I like to mention whenever
I introduced myself to anyone, but especially cab drivers, because
I want them to know who they're driving around. But yeah,
I mean, I travel a lot, and it's getting harder,
you know, to do than it used to. You know,
(01:15):
it used to be a lot easier to take a
red eye and then get to the next place and
get on with my life and get stuff done. And
I just was in Oa Claire, Wisconsin, which is about
an hour and a half from the Minneapolis Airport, which
is where I had to take the flight from. So
I woke up at four am yesterday, got on that
flight at seven, got back around eleven something New York time,
(01:40):
and then back to my apartment by noon. And I
used to be able to do that and still have
a day of work, but I found myself just spent.
And what I don't understand is how does how does
flying make me so tired? Because I'm asleep the whole
time in the flight, so I just assume I'm catching
(02:00):
up on sleep while I'm there. Anyway, why does it
make me so tired?
Speaker 1 (02:05):
Well, I feel you your itinerary sounds exhausting. I'm just
tired just listening to it. I mean, I'm the same way.
You know, I used to be able to fly red
eyes like it was, you know, a bus ride, and
I can't do it now. You know, I have to
have a very justifiable reason to take a red eye flight,
but it still takes me several days to recalibrate. You know.
Speaker 3 (02:29):
Yeah, it's a lot.
Speaker 1 (02:31):
It's a lot, and there's so many little nuances about
flying from a health perspective, Like first of all the
pressurized air. It's so dry it really dries you out.
So there's a high chance that it's going you're gonna
need to be extra hydrated to survive the flight. Most
people don't hydrate. If anything, they do the opposite, Like
(02:53):
they'll have a glass of wine on a flight, which
dehydrates you. And so getting dehydrated, you're gonna feel like
crap right, no matter what else is going on. And
then you know you woke up at four in the morning.
Now your circadian rhythm is all off right, So anything
that affects your circadian rhythm is gonna make you feel lousy,
(03:17):
regardless of what direction time zone you're going. And also
little things like for me, when I when I'm on
an airplane, it's incredibly loud. I find flights to be
incredibly loud, so I always wear your plugs. I bring
your plugs with me, which has two purposes. One it
from a sensory perspective, it just simmers everything down, and
(03:41):
then like nobody will talk to me, which I really appreciate.
Speaker 3 (03:45):
Well, then you can't watch a movie or listen to anything.
Speaker 1 (03:48):
So if I have to watch a movie, then I'll
take them out and I'll put in the headphones or whatever,
but I do worry about that. You know, several hours
with headphones on, it's already a loud environment. You are
listening to them more loudly than if you were you
normally would you know in some other environment.
Speaker 2 (04:09):
I never thought about the sound effact because you're in
the you get so used to the sound inside an airplane.
It just becomes the white noise in the background. You
don't even think about it, and it's incredibly loud.
Speaker 3 (04:21):
Yeah. No.
Speaker 1 (04:24):
I once saw this thing on social media that went viral,
like people that were doing international flights and not watching
any movies. They would just sit there in silence and
watch the map, and they called it raw dogging the flight.
Speaker 3 (04:38):
That's what is that? What is the point of that?
I don't know.
Speaker 1 (04:44):
I don't know. I just think that's such a funny term.
Speaker 3 (04:49):
They don't even get into like a meditative.
Speaker 1 (04:51):
They don't read a book, they don't do mindfulness, they
don't watch.
Speaker 3 (04:57):
Your movies watching their time get wasted.
Speaker 4 (05:00):
To sit there.
Speaker 3 (05:01):
Yeah.
Speaker 1 (05:01):
Wow, some sort of like cheap sensory deprivation type experience.
Speaker 3 (05:07):
Do they ignore the flight attendance when they come around?
Speaker 1 (05:10):
I think they interact with humans. But the point being
like you're not inundating your yourself with you know, movies
and games and whatever people do on flights. And what
do you do on flights? Are you like a reader or.
Speaker 2 (05:24):
I try I try to pass out as quickly as
I can. I try to fall asleep. I'll watch a
movie every night. If it's especially if it's a cross
country flight, I'll probably watch a movie.
Speaker 3 (05:35):
Yeah, And I like to watch films. It's it's it should.
Speaker 2 (05:38):
Be when I catch up on the big films that
I've missed over the last year totally. But I always
end up watching some like independent film that Delta has
somehow and then or a foreign film and then watch
that for an hour and then go back to sleep.
Sleep is really what helps me get through it.
Speaker 1 (05:55):
Okay, Well, here's a little tip. There's a really great program.
It's called jet Lag Rooster, and what it does is
it helps you set your sleep schedule to minimize jetlag.
And you can find this online. It's a free website.
You put in your destination where you're ending up, what
(06:18):
time you're going to land, and then what time you're departing,
and it'll give you a sleep schedule for a couple
days before when to start resinking your sleep so that
you will minimize jet lag. And it's really helpful. I
use it for any kind of travel that's going to
(06:40):
affect my circadian rhythm, and I do find it to
be really, really helpful. The secret is, if you're taking
an international flight, the moment you get on the airplane,
you have to set your clock to your destination time,
and you have to eat, breathe, live, and operate as
if you're already in that new destination. So like, for example,
(07:06):
if I'm in LA and I'm traveling to Japan and
the flight is twelve or fourteen hours difference, you get
on the flight, and if it's nighttime in Japan when
you are in La, you the first thing you do
on the plane is you immediately go to sleep and
you start setting your clock to that. But this jetlag
(07:28):
Rooster device will help you change your sleep cycle like
several days prior so that the jet lag is minimized.
You could try that probably for you know, your cross
country flights, because you're going to be doing a lot
of that.
Speaker 3 (07:44):
How do you know all the things?
Speaker 1 (07:47):
I mean a lot of it's because like I've wanted
to work on that stuff for myself. But also like
people see me, you know, in my private practice or whatever,
and they're like, I have to travel, I get an ambient,
And I'm like, well, okay, what if we actually tried
like some more some less prescriptive options, like where you
(08:09):
might not necessarily need an ambient, you can, you know,
do it this way?
Speaker 3 (08:15):
Do they still want the ambien?
Speaker 1 (08:16):
I mean, sometimes they still want it, and then we
you know, we figure it out. But travel is so tricky, right,
It can bring up just a lot of anxiety for anyone,
not not just the passengers.
Speaker 4 (08:28):
You know.
Speaker 1 (08:28):
As a doctor, I also get anxiety when I travel
because every now and then there could be a medical
emergency mid air, and whenever I experience that, you know,
I'm always asking myself like, okay, am I the best
specialists for the job. There's fortunately only been one time
(08:49):
where someone was like, is there a doctor on the.
Speaker 3 (08:51):
Plane whoa that's happened?
Speaker 1 (08:54):
And my immediate reaction was like, oh, please, let this
not be like an infant or a baby, or or
is someone like outside of the scope of what I'm
comfortable with. Yeah, But fortunately it was just someone who
was essentially like dehydrated and had low blood pressure okay,
(09:14):
and was okay. It was like a very like mind,
Like we didn't have to turn the plane around. But
Alaska Airlines did give me like a little thank you
for your help certificate, which I really appreciated, just a certificate.
Speaker 3 (09:29):
Was like I think I.
Speaker 1 (09:30):
Got like I can't remember either, I think, like a
free meal on a plane or what. I can't I
honestly it was years ago, so I can't remember.
Speaker 3 (09:40):
Have you saved someone's life for a cheese plate.
Speaker 1 (09:43):
Well, it's not like I was doing like CPR on
the person. I mean, if I was doing CPR like,
it would have been nice to get like, you know,
I don't know, first class round trip tickets to TAP.
Speaker 3 (09:54):
Yeah, I'm just kidding.
Speaker 2 (09:56):
I mean yeah, actually no, I think if you save
somebody's life, you get to pick where you want to
go and get a free round trip on that airline.
Speaker 3 (10:03):
That's I think that's reasonable, you know.
Speaker 1 (10:06):
I mean if they made those kind of rules, you know,
people would set up like Ponsi schemes where people would
feign illness. They would turn into this whole like act,
you know, just to get the free tickets to Tahiti.
Speaker 2 (10:22):
And then he went to Tahiti with the patient. How
does that add up? Oh my goodness, more to come
on health stuff.
Speaker 1 (10:39):
Let's get to our episodes. Dam I'm super excited. We
have an interview with doctor Uchi Blackstock. Doctor Blackstock is
the founder and CEO of the organization Advancing Health Equity,
which works to close the racial gap in our healthcare system.
Doctor Blackstock has also worked as an emergency medicine physician
in New York City, so she is seen very clearly
(11:01):
how this issue plays out in real life. She's the
author of the memoir Legacy a Black physician reckons with
racism and medicine. But anyways, enough about us sort of
talking about the interview, Let's get to it. So here
is our conversation with doctor Uja Blackstock.
Speaker 2 (11:16):
Oocha again, thank you so much for joining us on
on health stuff. I'm gonna throw you a softball. This
is softball, Okay. To open this interview between the anti
DEI and anti science movement of this administration and RFK
Junior being the head of the Department of Health, how
(11:37):
do you stay hopeful?
Speaker 5 (11:39):
I stay hopeful because, like so the work I do,
I found it an organization called Advancing Health Equity about
six years ago, and so we actually are still able
to work with organizations that are doubling down on a
lot of these issues, that still want to stay true
to their core values. And then also because of the
book in my platform, I get to go to a
lot of events and actually being community with people who
(12:02):
are also still really committed to like making sure that
we're giving out accurate, irresponsible information and you know, still
proponents of health equity and d I and all on
all that comes with that. So I think it's my community,
like I think it's the people that I get to
be around that give me hope because now I'm like, no,
we're going to double down, like you are not going
(12:24):
to You're not going to scare us, You're not going
to intimidate us, like you know, we are here for
good and also we're going to be here when there's
a lot of repair to be done.
Speaker 2 (12:32):
Do you really not get scared because I feel like
I'm terrified most.
Speaker 3 (12:36):
Of the day.
Speaker 5 (12:37):
No, because I think, you know what is I also think,
you know, I try to speak to a lot of
our elders. They give me perspective like maybe we have
not been in this like this moment before, but we've
been in similar moments thout the history of this country
and we've gotten through it.
Speaker 4 (12:54):
And so I don't know.
Speaker 5 (12:55):
I just I think what I'm an optimist by by
nature and because and I think that also work I
do it makes me feel like I'm actually doing something,
like I'm doing something about it.
Speaker 4 (13:04):
So I think that makes me less scared.
Speaker 1 (13:07):
Wow, that's really inspiring. The work you do. This is
high energy lifting work. I mean you're spending a lot
of time in spaces dismantling inequities. I mean it takes
a lot of physical energy and emotional energy to do this.
What are your self care practices? I want to know, Like,
(13:29):
what what are the things that you do to stay
grounded and.
Speaker 5 (13:32):
To recharge listen. I mean it's yeah, it's not easy.
I have the best therapist in the world that has
held me down for the last like six seven years.
I don't know what I would do without her, Like
I love her, but like every time I have a
(13:52):
call with her and I get off the call and
like I feel like I'm floating on cloud nine, like
I could do everything, Like just helped me get through
both like professional and personal challenging times, and you know,
even now, like really it's all about like my my
my mental health because you know, I think sometimes I
(14:12):
forget how much of a loaded is to carry to
like talk about these issues publicly then also do the work.
And then also I'm a parent, so it's just like
it's it's a lot, and so she really helps me
be like intentional about what I say yes too when
I say no to, and so I don't always get
it right, Like there are times where I'm like I
(14:34):
text her, I'm like I have to talk to you.
Can we do like an emergency call because I literally
feel like I'm at capacity and splintering.
Speaker 4 (14:42):
Yeah, yeah, I know, I know.
Speaker 3 (14:45):
I think.
Speaker 5 (14:45):
Also I think also because I'm very you know, I've
always been like very high functioning. So sometimes I feel
like because I can do it. If I can do that,
I'm doing okay, and then let me hit a wall.
And the whole point is like to stop before I
hit that wall, right, absolutely, And so I try to
have like a rubric or an algorithm for being like
if I say yes to something, like it definitely has
(15:06):
to be a hell yes, Like it can't be like
it has to be oh, hell, yeah, I want to
do this and I have the time to do it,
you know, so so that helps. But then also, you know,
I definitely I was meditating this morning. I try to
make time to meditate. I work out a lot, so
and I go for like really long walks and listen
to my favorite podcasts. I live in Brooklyn and a
(15:29):
really beautiful neighborhood, so I love walking around. So it's
just like a combination of things. And then also one
thing I've done is I used to be that friend,
like a strong friend all the time, and I've really
tried to share with my friends, like when something is
going wrong, like just be like, hey, I'm not in
a good place, like and really just I'm vulnerable in general.
(15:51):
But I've never kind of used to like want to
ask for help to my friends. And I realized they
want to be there for you. Yeah, So I've been
asking them to show up when I need them to.
Speaker 4 (16:01):
And that was That's that's huge.
Speaker 5 (16:04):
Like the last few years I've been doing that and
saying like hey, I need you for this, I need
you for that, and the response is like amazing. No
One's ever like, oh, no, what are you talking about? Yes,
I'm here for you.
Speaker 1 (16:14):
What do you mean? Yeah, I mean you're bringing up
so many really critical points. The work you're doing is
part of calling out the flaws and the system so
that things can change. If you could snap your fingers
and change one thing right now about the medical system,
(16:35):
you know what would what would that change be for you?
Speaker 4 (16:39):
Okay, this is easy? I mean I would you know.
Speaker 5 (16:41):
I am a big proponent of single payer universal health care.
We know that in this country we spend more than
any other heigh income country on healthcare and we have
the worst health outcomes. Right.
Speaker 4 (16:56):
Part of that.
Speaker 5 (16:57):
Part of that is because we have a large proportion
of the population that is uninsured or under insured that
is not able to access just prevented services to care
for them. And they're disproportionately people of color. And so
I think that, I mean, that's it sounds so simple.
And you know, when you compare us to other he
income countries, most income countries have some form of universal
(17:20):
health care, right, and that contributes to why they have
longer life expectancy, a lower burden of chronic disease, et cetera.
Speaker 2 (17:29):
Both my parents worked in hospitals. My dad worked in
more of a community hospital as an eco cardiogram technician
a public hospital, and my mom worked in a cath
lab in a private hospital. And whenever I walked into
those two hospitals, I saw the stark differences between the
community hospital and this private hospital, both in terms of
(17:50):
maybe even the age of equipment, to who was you know,
who had insurance, who didn't, you know, the racial makeups
that I think makeups of both places. In the book,
you talk about your experiences both at Tish and Bellevue,
Can you talk about the differences of those two hospitals.
Speaker 5 (18:07):
Yeah, you know what was so interesting is that the faculty,
like we worked at both hospitals, so we were like
the only thing that was the same about both hospitals.
But obviously, like the resources that we had were very different.
The nursing shortage. We had only like two nurses versus
like six nurses per team at Tish. And then just
(18:29):
like in terms of the process, like patients would have
to wait so long in er at Bellevue just to
get all of their testing for us to figure out
what was going on, to you know, whether or not
we should send them home or admit them. So it
just was like night and day. And then at Tish,
where we have people come in, they're totally plugged in,
(18:49):
they have specialists who are actually dictating their care, or
even before they get there, we're getting called about VIP
patients coming in, you know that are on a board
of trustees we have to make sure we're paying special
attention to. And they're like, you know, three cat scans,
two MRIs, you know, there's never our weight. So it
just is like, how can this happen, like literally a
(19:11):
block apart, just because like one group of patients don't
have insurance and the other group of patients do have
insurance when it one is a public hospital and one is.
Speaker 4 (19:20):
A private hospital.
Speaker 5 (19:21):
And to see that, you know, even though the same
clinicians that work at both places, because the resources are different,
you know, the overall care, the care delivery is different,
and that affects outcomes.
Speaker 1 (19:35):
What I'm super curious about is if you felt in
your body a physical difference in the way you carried
yourself at the two hospitals.
Speaker 5 (19:47):
I would say that I think I mentioned this in
the book, Like at Tish, we were told we had
to wear we couldn't wear scrubs, we had to wear
you know, a nice shirt, pants or dress, and our
white coat. At Bellevue, you could wear your scrubs, you know,
scrubs are just really kind of casual, right, And I
think that affects like how you kind of move and
(20:09):
how you carry yourself. And then I also think even
like interactions with patients, like the way that I saw
patients being treated at Dellvu or even by e ands,
like they would just like come in and just like
dump the patients, you know, like just dump them.
Speaker 4 (20:26):
Yeah right, that would never.
Speaker 5 (20:27):
Happen at Tish, you know, so it just like it felt,
and I wrote about just like how I felt so
uncomfortable with this, and it actually was one of my residents,
this really wonderful young woman who still is very much
into social justice, who would actually talk and do a
lot of advocacy around the disparate care actually across the city.
(20:51):
She started as a medical student between the public and
private hospitals, but she sort of want someone that gave
me more confidence, but to speak up about it.
Speaker 1 (21:00):
Hmmm mm hmmm.
Speaker 2 (21:01):
It's clear that you know, the professional and the personal
for you are very deeply connected, and you talk about
that in your in your book. A great deal like
the fact that this is this is you know, a
family business, and so much of your inspiration comes from
your mother.
Speaker 3 (21:19):
Can you talk a little bit about that.
Speaker 5 (21:21):
Yeah, you know, I just feel you know, my mother,
now I call the original a doctor of black Stuff,
was such an incredible inspiration to both my twin sister
Oni and me. I mean, she was just a wonderful mom,
very loving, very attentive, and I think all of it
was because she grew up a public assistance had a
really really rough life and just managed to, through luck, fortune,
(21:43):
hard work, overcome all of these barriers, you know, to
end up first person in her family in college Brooklyn College,
then at Harvard Medical School, and they could have gone
anywhere after that. That's the other thing, Like literally could
have gone anywhere. Most of the most people who graduated
from Harvard Medical School, they usually go to some IV
associated residency program. Right she went to Harlem Hospital. She
(22:04):
went back to New York City to Harlem Hospital, trained there,
and then ended up working for many years in this
the same central Brooklyn neighborhood that.
Speaker 4 (22:12):
You grew up in.
Speaker 5 (22:12):
So like that's like that was my model of like
how you do it, Like you can go to these
really prestigious institutions and then come back and do really
good work in your community.
Speaker 4 (22:22):
And she was such a down to earth woman.
Speaker 5 (22:24):
But also because of her for a very long time,
and I thought most positions were black women because because
of her, because of you know, she led a local
organization of black women physicians. She's always taking my sister
knee like to every event, and so that was like
I was like.
Speaker 4 (22:41):
Oh, wow, like this is totally doable.
Speaker 5 (22:43):
I can do this, right, And then like getting older
and then going to college and the medical school have
been being like, oh, actually, we're less than three percent.
Speaker 4 (22:50):
Of all positions. Okay.
Speaker 5 (22:52):
I didn't realize that, you know, but I feel so
fortunate to have had that exposure growing up because it
made me know that I could, I could, I could.
Speaker 4 (23:00):
Do this, I could be this.
Speaker 2 (23:01):
You talk about the lack of black doctors in the
book and the historic reasons for that. Can you get
into the history of black medical schools and why we
have so few black doctors even today?
Speaker 5 (23:15):
Yeah, I thought it was so important for me to
put that history in the book because I think people
they make up observations, they say, okay, well, why are
less than six percent of all doctors black, what's wrong
with black people? And I think it's really important for
people to understand the history. And so, you know, one
of the organizational policies I talk about is the Fleksner
Report in nineteen ten, which was actually commissioned by the
(23:38):
American Medical Association, the largest and oldest organization of positions,
which has its own trouble past with racism and discrimination,
and the Carnegie Foundation, and they commissioned an educational specialist
named Abraham Flepsner to go around to all one hundred
and fifty five US and Canadian medical schools and to
hold them against the gold standards of Western European schools,
(23:59):
and in the Johns Hopkins in Baltimore, and you know
that the report actually led to the closure of a
good number of medical schools, not just historically black schools,
but at the time there were only seven historically black
medical schools, and by nineteen oh five they had trained
about sixteen hundred black physicians, and really they were the
(24:19):
only schools really educating black physicians because black positions weren't
allowed into predominantly white schools. But in nineteen ten, when
that report came out, it closed five out of seven
of those schools leaving behind Howard and Mahary, And I
will just say this, like some of the things they
were looking at were the admissions criteria, percentage of physician
(24:39):
scientists on faculty, the quality of the lab facilities, and yes,
like you know, because of the legacy of slavery, those
schools probably did not have the same resources as predominantly
white medical schools. But we don't know that they necessarily
were training underperforming doctors. Anyway, all that to say is fast.
(25:00):
There was an article in twenty twenty in the Journal
of American Medical Association that estimated that if those five
schools had stayed open, they would have trained between twenty
five thousand and thirty five thousand black physicians.
Speaker 1 (25:14):
That's huge, I mean that is huge. It's huge.
Speaker 4 (25:18):
It's huge, it's huge.
Speaker 5 (25:19):
And when you think about the number of patients they
could have cared for or the research they could have done,
just just like that domino effect, right, And so what
we're what we see today is the legacy of that policy.
We also see the legacy of the racial wealth gap.
The people who do all the endcats they belong to
the highest of the economic SATs. That's a correlation, right,
people who have access.
Speaker 1 (25:40):
Yeah, And you know what what was so great about
reading in the book is because you go through so
many different historical points, like things we didn't learn in
medical training.
Speaker 4 (25:52):
You know.
Speaker 1 (25:52):
I there was a line in your book when you
talk about the race correction factor. This is uh, you know,
we were taught in medical school. When you look at
kidney function, you're if someone is African American, they're gonna
have a different set of quote unquote normal values compared
to someone who isn't black. And to me, you have
(26:16):
this line where you're like, yeah, I just wrote it
down and like thought, you know, I med high school,
like this is what we learned, you know. And then
later they pulled white medical students to ask them if
they thought that there were actual biological differences between African
Americans and non African Americans, and they were like, yeah, absolutely,
(26:36):
there's biological difference. Is so like the nonchalance in which
we just sort of accepted and learned this information, you know.
I there was like one iota of me that was like, huh,
that's weird because like what if you know, there's a
black person, they don't have a lot of mutuscle mass
then like they fall into the same category. But there
(26:59):
was so much pressure to just do well and excel
and just absorb the information that you never thought to
question it and in fact, if you did question it,
you would probably get penalized. And it's it's just mind blowing,
like the stuff that we just sort of observed and
(27:19):
took in. And you know, it took me years after
coming out of training to really accept like how I
was complicit in this process, you know, and there's so
much reckoning around that as a person of color, to
like sit with the fact that, like you also were
complicit I wonder if that resonates with you on some level.
Speaker 5 (27:42):
Yeah, no, totally, yeah, no, no, it totally does. And
to be honest with you, I know this sounds weird,
but I think they never felt like I truly belonged
in medicine, just because I always felt like, you know,
it's a very traditional environment, even though people I think
they're being innovative, but it just felt like, I don't know,
(28:02):
I don't know if this is for me.
Speaker 4 (28:05):
Like I love this, I love the patient part.
Speaker 5 (28:08):
I love interacting with patients, caring for them like that
is such a blessing and an honor, but just like
the way that the organization's function and the way that
like I could show up, I felt like I really
couldn't show up as my full self.
Speaker 4 (28:22):
But that's why.
Speaker 5 (28:23):
Like when I was in academic medicine at NYU, like
I always say it, I literally forgot that I was
someone who it gives to share because I felt really
just like taken for granted. I thought I was like
doing all this work and like it wasn't really appreciated
or recognized.
Speaker 1 (28:39):
Oh my gosh, can I just thank you for this
confession because I totally can resonate with this. I remember
when I graduated residency in internal medicine. I I remember
it was graduation ceremony and I just I felt like
(29:00):
I was just like, this is not like what I
thought it would be. And I had this attending she
was always a little quirky, and we got along and
she was quite lovely and charming, and she was a
white woman, and she at graduation ceremony. I remember she
pulled me aside and she's like, so, how are you?
And I was like, oh, I guess I'm okay. I mean,
(29:22):
I'm supposed to be happy that I've graduated, but it
just feels there's I don't know, I can't And then
she's like, oh, she tells me, Priyanka, these are not
your people. And I remember when she said that. I
was like what. She's like, yeah, these aren't your people,
Like go find your people, and that invitation like it,
(29:44):
I was like, it took me a long time. I
was like, she's right, and now, you know, leaving academic medicine,
leaving the system, like, I'm lucky that there's I'm able
to meet other physicians that are like me and they
get it and they're fighting the good fight and they're
doing the work. And it's a much smaller community, but
(30:06):
it's a richer community for me, for my soul. And
so I so appreciate that confession because I think the
more we can be really honest with ourselves about what
our experiences were like, the more we can then make
this a system that works for everyone.
Speaker 5 (30:22):
I know, because I'm like, you know, I always say,
I know this sounds horrible, but whenever I get a
lot of students approach me like premads a pre professional
and they're like, I really want to be a doctor,
Like okay, hold on one second, there are a lot
of different ways that you can help people.
Speaker 4 (30:37):
Because I'm like, I want to help people. Let's talk
about all the different ways you can help people.
Speaker 5 (30:41):
I want you, I want you to know all of
your options, right, I want you to know what the
process is.
Speaker 4 (30:45):
Like, I'm not trying to discourage them, but just like
you know.
Speaker 5 (30:48):
They're just they're different ways, different ways to help to
help society.
Speaker 1 (30:52):
Yeah. Yeah, being a doctor, yes, totally, totally. We will
see you right after the break.
Speaker 3 (31:05):
You talk a lot about.
Speaker 2 (31:07):
Racism and medicine, whether it's about what we discussed earlier
regarding the black medical schools closing, or just what we
also discussed earlier about the othering of black bodies. But
there's some really incredible and painful stories of black people
used for the scientific benefit of white people, and it's devastating.
(31:32):
And again, like Pianca said, this is stuff that we
should have learned. These are things that we should know,
and we should know the legacy of this racism. Can
you tell us the story of Henrietta.
Speaker 5 (31:44):
Lax Yes, yes, And I have to say I felt
so honored. I was actually able to meet her family
a few years ago. I think it was on her
on her hundredth birthday. But they are really wonderful people,
you know, Harietta Lax. You know again I talk about
in the book, how you know we used her cells
in our histology class first year of medical school, that
(32:06):
he was cells and we were I was, we were
never told like where these cells were from. And it
wasn't until I was a practicing physician that I was like, oh,
my goodness, these cells were from this thirty four year
old impoverished I mean black women from impoverished Baltimore who
you know, several children are just trying to survive and
presented to Johns Hopkins with some you know, with pelvic
(32:27):
symptoms and her the cancer tissue was removed from her
without her consent, and then you know, what they found
was that the cells were they were able to replicate, right,
replicate really quickly. And so her cells have been used
by pharmaceutical companies, biomedical companies that had made lots of money,
(32:48):
and also they were used for good for for polio research,
and they were actually involved in the COVID vaccine. So
it's this dissonance where it's like, yes, like here she
was totally betrayed and exploited, right, and then her family
didn't receive any sort of compensation for it. And then
also these really wonderful discoveries were made but based on
(33:10):
you know, this this betrayal, right, And I think it's
like this idea of like how do you like, how
do we really reconcile but to you And I think
part of it is like is talking like publicly one
talk cooking publicly, making sure that everyone knows about these
the history, right, And then the other part is, you know,
I actually I think her family in the last few
years there was a settlement and they started receiving some
(33:32):
funds from all of the benefits that have come out
of research being done using herself. But you know, it's
like Henrietta Lacks, her story is like one of many
stories of how you know, I talk about today how
you know people say, oh, people of color don't trust
healthcare systems. I don't trust you know, clinicians, and they
(33:53):
put it the burden on people. But it's like, no, hey,
like there's like this history. It's not just just ee,
it's not just Henriette, Like there is a history that
has been built in this country on exploitation of black bodies.
And so I actually turned it around from like from
medical mistrust to institutional untrustworthiness, where it's like institutions should
(34:17):
have to prove themselves trustworthy to our community, say this
is what we're doing to engender your trust. These are
the programs we're doing, this is what this is who
we're employing, like you know, and not turn it the
other way around, being like, yeah, you should take that vaccine,
you know, just because right like give people the information
they need, like that's crucial.
Speaker 1 (34:38):
So, speaking of the spread of information you talk about
in the book, how things like it seems like everything
sort of changed after this tweet of yours that went
viral that the institution like wasn't too happy about, and
that like this sort of like changed everything.
Speaker 5 (34:58):
Yeah, this tweet and looking back and like they should
have been so proud that I was giving this history lesson.
But yeah, the infamous tweet was actually so the former
HMS dean who posted on Twitter an article I think
was from the Boston Globe that talked about how Brigham
and Women's Hospital had taken down portraits in the Bornstein Amphitheater.
(35:21):
This is like the ampitheater where you go to for
all of our lectures because they didn't represent you know,
the diversity of our current you.
Speaker 4 (35:29):
Know, workforce.
Speaker 5 (35:29):
And literally I remember going into that auditorium as a
medical student being like lily, porches of white men looking
down at me, right, And so he goes, it's such
a shame, and.
Speaker 4 (35:40):
I just like, sir, wait a minute.
Speaker 5 (35:42):
That ball represents like white supremacy, it represents like sexism, racism.
Speaker 4 (35:49):
There are so many people who would have been on
that wall, but.
Speaker 5 (35:51):
They weren't allowed into medical school, right, and so like
who are we glorifying?
Speaker 4 (35:56):
And what does that look like?
Speaker 5 (35:57):
So anyway, and I gave it the history of the
flex and the report and then actually it was a
response to a tweet and then someone told the head
of the med school and they were just like, we
have a problem. Yeah, so I'm not sure like how
they wanted me. I felt very silenced and muzzled and
like I am a grown adult. I can respond. And
(36:17):
it wasn't in.
Speaker 4 (36:18):
A disrespectful way.
Speaker 5 (36:20):
It was literally like, okay, these are the facts, yeah
right yeah, And so that kind of like I was like,
you know what, this is ridiculous, Like I just need
to be you know, part of having my own consulting
firm is like I get to just do what I
want to do, Like I don't have to worry about
folks saying thinking what I'm doing is somehow radical when
(36:40):
it's it's actually not radical.
Speaker 4 (36:43):
But they made me feel like it was.
Speaker 1 (36:45):
Yeah, and that were the radical. I mean, it was
a real radical moment. But it also led to the
birth of advancing health equity, which is so important. I
too had a moment in medical training where I basic
spoke up out of line. The story was there was
a patient actually that was dnr DNI do not resuscitate,
(37:06):
do not intubate, and so the you know the rules
are you should not run a code on this patient. Well,
it was a very large team, and long story short,
the head attending what wanted to run a code and
wanted to sort of see if he could. The person
(37:29):
had a lot of fluid in her heart and he
wanted to make sure that he could try and do it.
This code ended up running for about forty five minutes.
It was horrific. I mean, my intern was in tears.
In the middle of the code. I basically said to
my attending like, what is our endpoint here? Why are
(37:49):
we doing this? And that pretty much was like the
wrong thing to say, because I got in so much
trouble for speaking up. You know, I was reported as insubordinate,
as not a team player, and you know, all I
was trying to do was advocate for this patient who
(38:11):
the family actually wasn't medically literate enough to say, like,
please don't code this family member. Yeah, and so I
remember for me, that was a real turning point as
well after that, Like, to me, suddenly I could see
that I was just this pawn in this system and
the system runs. And I also felt like, you know,
(38:34):
I'm gonna have to sort of break away in order
to be myself. And fortunately I had started to perform
stand up comedy, and stand up comedy in so many
ways saved me, and it allowed me to develop my
voice and to play and to be an artist, and
you know, it saved me in so many ways. So
it's funny because we both arrived at the same place
(38:57):
but very different ways.
Speaker 4 (38:59):
Yeah.
Speaker 5 (39:00):
Actually, that experience reminds me of this idea, and we
work on it in my with my consulting firm of
psychological safety and making sure that people, you know, especially
in different settings, not just in healthcare, but in healthcare,
you know, the stakes are higher because you know, we
have our patients being able to speak up right when
(39:20):
you see something that shouldn't be happening, right, and so
just because you were you were a resident then right
as it's because you're attending, when you attending, was doing
something they shouldn't have done, shouldn't be doing, and for
you to just say in a respectable way, like what's
your end point? And in fact that that became an issue,
that says like there was no there was there wasn't
psychological safety in that environment for you. And that's why,
(39:41):
like now, like a lot of work that we do
is making sure like within organizations people feel comfortable speaking
up because we know that when people don't speak up,
actually bad things happen to patients, and that that didn't happen.
Speaker 1 (39:53):
Yeah, yeah, totally. I want to just hop a little
back because this this was so dear to meet, Like,
there were so many points in reading your book that
I actually I put the book down and just like
sat with like a full heart, especially around some of
the lines that you wrote about your your dear mother. Yes,
(40:13):
I feel like we all had the same mom in
so many ways. So like also had. You know, my
mom's a physician, very driven all of the above. And
when you talked about you had friends over for sleepovers,
and then your mom would cue up the movie and
then when the movie was over, she'd announced that it
was time to do math worksheets that I was like, oh, yeah,
(40:37):
that's here we go. We're family, Like hello.
Speaker 5 (40:40):
My mom was so intense about just like our academics, Like,
I mean, the amount of work that we would have
outside of school. I shouldn't I want you to write
an essay about being young gefted in black, you know,
like everything was a learning experience. Like we walk around
the neighborhood, we thought about the different flowers, Like our
weekends were full, like Saturday morning was like music, very violin, piano, gymnastics,
(41:04):
modern dance. I will tell you this, I am not
that parent. I have the total opposite. I'm like, that
was exhausting. I've been so exhausting for her. But also
I think, just like this generation, I think how I
parent is a little bit different, and just you know,
I just want my kids to be like happy, well
adjusted kids. And if they they don't need to get
(41:26):
like straight a's, I'm okay with I'm okay with that.
I just want them to enjoy learning. But yeah, I
just I'm like, whoa, We're gonna take it a step down.
Speaker 4 (41:35):
Yeah, totally.
Speaker 1 (41:37):
When I would have people over for sleepovers, my dad
would go around and make sure that they were studying
for the SATs that he was. He would be like,
are you studying for the SATs? Have you done a
practice test? It's like, we didn't. I didn't have that
many friends after.
Speaker 3 (41:53):
That, obviously in the time we have.
Speaker 2 (41:56):
I feel like sickle cell is something that you talk
about and is a great example of the inequality in
the medical system. There's the scene in the show The
Pit like ca.
Speaker 5 (42:11):
I don't watch medical shows, but people tell me, I
actually watch that that one.
Speaker 3 (42:15):
It's a good one.
Speaker 2 (42:15):
I like it, and I don't watch medical shows generally,
but you know, there's a scene where the patient comes
in yelling and screaming, asking for pain medication, and you know,
the the paramedics that bring her in assume that like
she's fiending and that's sickle Celt's completely not the case.
So can you talk about like how sickle cell disproportionately
(42:37):
affects black people and also kind of how it's it
is an example of what's wrong with our system.
Speaker 5 (42:44):
Yeah, and like there's so many layers to it. So
sickle cell disease, it's inherited disease, like you inherit it
from you know, your parents, and it's actually a disease
that it fliics people like all around the world, not
just in Sub Saharan Africa, but in like the subcontinent
India in the east. But the fact is is that
most people in the United States who have sickle cell
(43:04):
disease are black. So it's been like racialized as a
black disease. And so it's interesting because even though it
was first described over one hundred years ago, up until
very recently, there were only like one or two treatments
for it compared to other, you know, other inherited diseases
like cystic fibrosis, where they have multiple treatments, where there
are centers of excellence, you know, there's there are very
(43:27):
few for sickle cell disease. And so a lot of
that is because of that racialization of the diseases. And
when you look at like the amount of federal funding
that's gone to sickle cell disease and research, right, it's
it's much less than other inherited diseases that afflict mostly
white Americans. And so, you know, I tell about in
the book my patient Jordan, who's a composite of patients.
(43:49):
But how I was wondering why in residency in Central
Brooklyn I would see so many patients with sickle cell
disease in the ARC, because when I was in Boston
at the Harvard Hospitals, I would rarely see, you know,
any patients with sickle cell disease. Also, there are fewer
black patients, and I realized it's because the system is
not set up in a way to care for patients
with sickle cell disease as outpatients, right, so they actually
(44:13):
end up coming to the er all the time with
pain crises. And when they have pain crises, you know,
you treat that with pain medication, but you also look
for any underlying causes infection, whether they have of the pneumonia,
because they actually are more likely to get very, very
sick and get sick quickly. But the other piece is
like you know, they're sigmatized, and like you talk about
(44:35):
that episode of the Pit where you know, she was
assumed to be like a drug fiend, but actually she
was having sickle cell pain. There's this whole idea that
you know, people get addicted to the pain medication. And
I remember in my residency, I had some of my
senior residents and attending say, wait, are you sure that
person has sickle cell disease? I want you to send
(44:56):
a hemoglobin screen, which is like a test to check
for it. You know, there's a lot of like doubting,
a lot of suspicion, a lot of stigmatization, and it's
a black disease.
Speaker 4 (45:08):
I've never seen that with any other disease before.
Speaker 5 (45:11):
You know, just a note in the last year or two,
there is a type of therapy that came out to
treat sickle cell disease. It was at the year proof.
But you actually have to be gene therapy. Gene therapy,
you have to be hospitalized to get it. It costs
millions of dollars, right, So that's the other issue, you know.
I know the Biden administration was working on Medicaid covering
(45:32):
it for people, but so it's a million dollars, So
that's an access issue and you have to be actually
hospitalized for.
Speaker 4 (45:38):
Several months to get it. But it actually could cure
sickle cell disease. I know.
Speaker 5 (45:43):
So there's amazing, amazing treatments that are there now, but
then again, thinking about access and affordability for people who
are afflictive to it, who most likely don't have the
resources to pay for it.
Speaker 1 (45:57):
It's so great, like we're bringing attention to it, but
there's still just so much work that needs to be
done around this. I want to just open the floor
to you chay about like, is there anything else that
you want to like share with us today or anything
else that you want to say?
Speaker 5 (46:14):
Yeah, I think the only end up being we talk
about maternal mortality. We'd hear up about a lot in
the mainstream press, and I just want like people to
realize that, like when we look at maternal mortality rates
for all racial demographics in this country, it is abysmal.
Speaker 4 (46:29):
Yeah, compared to other high income countries.
Speaker 5 (46:31):
It's most abysmal for people of color, but even white
women it's abysmal for it. It's like our rates are
similar to countries that are like low to middle income, right,
And so a lot of that So, yes, I talked
about universal health care, but a lot of it also
is because the process of getting birth has been medicalized
in this country because there is financial incentive to medicalizing it,
(46:53):
and a lot of the countries that are doing really
really well in maternal health outcomes, they center midwif free care,
so mid midwife, their nurse. Midwise right, because if you
give birth using a midwife, complications are less likely to
happen when you're in the hospital. So that's like at
a birthing center or at home. But at a hospital
you are more likely to have to have a c section,
(47:14):
You're more likely to have to have other interventions. So
I would love just for people to understand what like
their options are that like at in hospital birth may
not necessarily be the case for everyone, and maybe if
you have some chronic disease issues or you're more high risk,
that's the case. But we also need to think about
what explant communities to understand, like what their options are,
(47:35):
that there is an option to be birth at home,
which I think I'd probably in retrospect, would have really
wanted to do.
Speaker 4 (47:40):
I know, I know, I know it sounds crazy coming
from a doctor, I feel you yeah, or a birthing center.
You know, I think a lot of times.
Speaker 5 (47:49):
In the er would see like the very worst outcomes
of home births, right, but we don't see all the
good ones, you know, So I just wanted to put
that out there for people to know that there are
all of these different options and they're Jewela and really
a lot of support like birth workers that can help
people have a more positive birthing experience in its country.
Speaker 1 (48:07):
Yeah, I think doula cares really do improve birth outcomes.
That's actually had an opportunity to undergo a doula training
just for curiosity and spend a couple of weekends just understanding,
you know, what goes on around the application of doula care,
and it was it was great, Like I really enjoyed it.
(48:29):
So I'm so super pro doula And I think that's
really important because a lot of people don't know. In
California actually medical covers doul us. That's part of the
Medicaid in the state of California, So it improves birth outcomes.
So I hope, you know, listeners who are looking into
pregnancy care can can look into that. A lot of
(48:52):
private payers don't cover them, but Medicaid does. So this
is lovely, like, yeah, thank you for having me.
Speaker 4 (48:59):
You know, we're not worth When I got the invite.
Speaker 1 (49:04):
I was like, oh my goodness, how much fun.
Speaker 4 (49:06):
Yes, this is this is the highlight of my day.
Speaker 3 (49:08):
Oh thank you. All right, everybody, that's our show for today.
Thanks so much for listening. I'm Hurrykindebolu, and.
Speaker 1 (49:15):
I'm doctor Prianca. This is health Stuff.
Speaker 2 (49:23):
Health Stuff is a production of iHeart Podcasts. Don't forget
to send us your voice memos with all those pesky
health questions that keep you up at night. Email us
at health Stuff podcast at gmail dot com and go
and subscribe to health Stuff wherever you get your podcasts.
Speaker 3 (49:39):
Talk to you soon.
This podcast is for information purposes only and should not
be considered professional medical advice.
Speaker 2 (00:08):
Do you really not get scared? Because I feel like
I'm terrified most.
Speaker 3 (00:12):
Of the day.
Speaker 1 (00:14):
Absolutely, there's biological difference. Is so like the nonchalance in
which we just sort of accepted and learned this information.
Speaker 4 (00:23):
I could they never felt like I truly belonged in medicine.
Speaker 3 (00:28):
Do they still want the ambience?
Speaker 1 (00:29):
I mean sometimes they still wanted and then you know,
we figure it out.
Speaker 3 (00:37):
I'm hurry, condibolu.
Speaker 1 (00:38):
I'm doctor Preanca Wally, and.
Speaker 3 (00:40):
This is health stuff.
Speaker 1 (00:43):
Hey Prianca, Hey Harry, how are you doing?
Speaker 3 (00:46):
Oh man?
Speaker 2 (00:47):
I uh as you know, I'm a touring stand up comedian.
Speaker 1 (00:51):
Yes, you are a Netflix special.
Speaker 2 (00:54):
With a Netflix special, which I like to mention whenever
I introduced myself to anyone, but especially cab drivers, because
I want them to know who they're driving around. But yeah,
I mean, I travel a lot, and it's getting harder,
you know, to do than it used to. You know,
(01:15):
it used to be a lot easier to take a
red eye and then get to the next place and
get on with my life and get stuff done. And
I just was in Oa Claire, Wisconsin, which is about
an hour and a half from the Minneapolis Airport, which
is where I had to take the flight from. So
I woke up at four am yesterday, got on that
flight at seven, got back around eleven something New York time,
(01:40):
and then back to my apartment by noon. And I
used to be able to do that and still have
a day of work, but I found myself just spent.
And what I don't understand is how does how does
flying make me so tired? Because I'm asleep the whole
time in the flight, so I just assume I'm catching
(02:00):
up on sleep while I'm there. Anyway, why does it
make me so tired?
Speaker 1 (02:05):
Well, I feel you your itinerary sounds exhausting. I'm just
tired just listening to it. I mean, I'm the same way.
You know, I used to be able to fly red
eyes like it was, you know, a bus ride, and
I can't do it now. You know, I have to
have a very justifiable reason to take a red eye flight,
but it still takes me several days to recalibrate. You know.
Speaker 3 (02:29):
Yeah, it's a lot.
Speaker 1 (02:31):
It's a lot, and there's so many little nuances about
flying from a health perspective, Like first of all the
pressurized air. It's so dry it really dries you out.
So there's a high chance that it's going you're gonna
need to be extra hydrated to survive the flight. Most
people don't hydrate. If anything, they do the opposite, Like
(02:53):
they'll have a glass of wine on a flight, which
dehydrates you. And so getting dehydrated, you're gonna feel like
crap right, no matter what else is going on. And
then you know you woke up at four in the morning.
Now your circadian rhythm is all off right, So anything
that affects your circadian rhythm is gonna make you feel lousy,
(03:17):
regardless of what direction time zone you're going. And also
little things like for me, when I when I'm on
an airplane, it's incredibly loud. I find flights to be
incredibly loud, so I always wear your plugs. I bring
your plugs with me, which has two purposes. One it
from a sensory perspective, it just simmers everything down, and
(03:41):
then like nobody will talk to me, which I really appreciate.
Speaker 3 (03:45):
Well, then you can't watch a movie or listen to anything.
Speaker 1 (03:48):
So if I have to watch a movie, then I'll
take them out and I'll put in the headphones or whatever,
but I do worry about that. You know, several hours
with headphones on, it's already a loud environment. You are
listening to them more loudly than if you were you
normally would you know in some other environment.
Speaker 2 (04:09):
I never thought about the sound effact because you're in
the you get so used to the sound inside an airplane.
It just becomes the white noise in the background. You
don't even think about it, and it's incredibly loud.
Speaker 3 (04:21):
Yeah. No.
Speaker 1 (04:24):
I once saw this thing on social media that went viral,
like people that were doing international flights and not watching
any movies. They would just sit there in silence and
watch the map, and they called it raw dogging the flight.
Speaker 3 (04:38):
That's what is that? What is the point of that?
I don't know.
Speaker 1 (04:44):
I don't know. I just think that's such a funny term.
Speaker 3 (04:49):
They don't even get into like a meditative.
Speaker 1 (04:51):
They don't read a book, they don't do mindfulness, they
don't watch.
Speaker 3 (04:57):
Your movies watching their time get wasted.
Speaker 4 (05:00):
To sit there.
Speaker 3 (05:01):
Yeah.
Speaker 1 (05:01):
Wow, some sort of like cheap sensory deprivation type experience.
Speaker 3 (05:07):
Do they ignore the flight attendance when they come around?
Speaker 1 (05:10):
I think they interact with humans. But the point being
like you're not inundating your yourself with you know, movies
and games and whatever people do on flights. And what
do you do on flights? Are you like a reader or.
Speaker 2 (05:24):
I try I try to pass out as quickly as
I can. I try to fall asleep. I'll watch a
movie every night. If it's especially if it's a cross
country flight, I'll probably watch a movie.
Speaker 3 (05:35):
Yeah, And I like to watch films. It's it's it should.
Speaker 2 (05:38):
Be when I catch up on the big films that
I've missed over the last year totally. But I always
end up watching some like independent film that Delta has
somehow and then or a foreign film and then watch
that for an hour and then go back to sleep.
Sleep is really what helps me get through it.
Speaker 1 (05:55):
Okay, Well, here's a little tip. There's a really great program.
It's called jet Lag Rooster, and what it does is
it helps you set your sleep schedule to minimize jetlag.
And you can find this online. It's a free website.
You put in your destination where you're ending up, what
(06:18):
time you're going to land, and then what time you're departing,
and it'll give you a sleep schedule for a couple
days before when to start resinking your sleep so that
you will minimize jet lag. And it's really helpful. I
use it for any kind of travel that's going to
(06:40):
affect my circadian rhythm, and I do find it to
be really, really helpful. The secret is, if you're taking
an international flight, the moment you get on the airplane,
you have to set your clock to your destination time,
and you have to eat, breathe, live, and operate as
if you're already in that new destination. So like, for example,
(07:06):
if I'm in LA and I'm traveling to Japan and
the flight is twelve or fourteen hours difference, you get
on the flight, and if it's nighttime in Japan when
you are in La, you the first thing you do
on the plane is you immediately go to sleep and
you start setting your clock to that. But this jetlag
(07:28):
Rooster device will help you change your sleep cycle like
several days prior so that the jet lag is minimized.
You could try that probably for you know, your cross
country flights, because you're going to be doing a lot
of that.
Speaker 3 (07:44):
How do you know all the things?
Speaker 1 (07:47):
I mean a lot of it's because like I've wanted
to work on that stuff for myself. But also like
people see me, you know, in my private practice or whatever,
and they're like, I have to travel, I get an ambient,
And I'm like, well, okay, what if we actually tried
like some more some less prescriptive options, like where you
(08:09):
might not necessarily need an ambient, you can, you know,
do it this way?
Speaker 3 (08:15):
Do they still want the ambien?
Speaker 1 (08:16):
I mean, sometimes they still want it, and then we
you know, we figure it out. But travel is so tricky, right,
It can bring up just a lot of anxiety for anyone,
not not just the passengers.
Speaker 4 (08:28):
You know.
Speaker 1 (08:28):
As a doctor, I also get anxiety when I travel
because every now and then there could be a medical
emergency mid air, and whenever I experience that, you know,
I'm always asking myself like, okay, am I the best
specialists for the job. There's fortunately only been one time
(08:49):
where someone was like, is there a doctor on the.
Speaker 3 (08:51):
Plane whoa that's happened?
Speaker 1 (08:54):
And my immediate reaction was like, oh, please, let this
not be like an infant or a baby, or or
is someone like outside of the scope of what I'm
comfortable with. Yeah, But fortunately it was just someone who
was essentially like dehydrated and had low blood pressure okay,
(09:14):
and was okay. It was like a very like mind,
Like we didn't have to turn the plane around. But
Alaska Airlines did give me like a little thank you
for your help certificate, which I really appreciated, just a certificate.
Speaker 3 (09:29):
Was like I think I.
Speaker 1 (09:30):
Got like I can't remember either, I think, like a
free meal on a plane or what. I can't I
honestly it was years ago, so I can't remember.
Speaker 3 (09:40):
Have you saved someone's life for a cheese plate.
Speaker 1 (09:43):
Well, it's not like I was doing like CPR on
the person. I mean, if I was doing CPR like,
it would have been nice to get like, you know,
I don't know, first class round trip tickets to TAP.
Speaker 3 (09:54):
Yeah, I'm just kidding.
Speaker 2 (09:56):
I mean yeah, actually no, I think if you save
somebody's life, you get to pick where you want to
go and get a free round trip on that airline.
Speaker 3 (10:03):
That's I think that's reasonable, you know.
Speaker 1 (10:06):
I mean if they made those kind of rules, you know,
people would set up like Ponsi schemes where people would
feign illness. They would turn into this whole like act,
you know, just to get the free tickets to Tahiti.
Speaker 2 (10:22):
And then he went to Tahiti with the patient. How
does that add up? Oh my goodness, more to come
on health stuff.
Speaker 1 (10:39):
Let's get to our episodes. Dam I'm super excited. We
have an interview with doctor Uchi Blackstock. Doctor Blackstock is
the founder and CEO of the organization Advancing Health Equity,
which works to close the racial gap in our healthcare system.
Doctor Blackstock has also worked as an emergency medicine physician
in New York City, so she is seen very clearly
(11:01):
how this issue plays out in real life. She's the
author of the memoir Legacy a Black physician reckons with
racism and medicine. But anyways, enough about us sort of
talking about the interview, Let's get to it. So here
is our conversation with doctor Uja Blackstock.
Speaker 2 (11:16):
Oocha again, thank you so much for joining us on
on health stuff. I'm gonna throw you a softball. This
is softball, Okay. To open this interview between the anti
DEI and anti science movement of this administration and RFK
Junior being the head of the Department of Health, how
(11:37):
do you stay hopeful?
Speaker 5 (11:39):
I stay hopeful because, like so the work I do,
I found it an organization called Advancing Health Equity about
six years ago, and so we actually are still able
to work with organizations that are doubling down on a
lot of these issues, that still want to stay true
to their core values. And then also because of the
book in my platform, I get to go to a
lot of events and actually being community with people who
(12:02):
are also still really committed to like making sure that
we're giving out accurate, irresponsible information and you know, still
proponents of health equity and d I and all on
all that comes with that. So I think it's my community,
like I think it's the people that I get to
be around that give me hope because now I'm like, no,
we're going to double down, like you are not going
(12:24):
to You're not going to scare us, You're not going
to intimidate us, like you know, we are here for
good and also we're going to be here when there's
a lot of repair to be done.
Speaker 2 (12:32):
Do you really not get scared because I feel like
I'm terrified most.
Speaker 3 (12:36):
Of the day.
Speaker 5 (12:37):
No, because I think, you know what is I also think,
you know, I try to speak to a lot of
our elders. They give me perspective like maybe we have
not been in this like this moment before, but we've
been in similar moments thout the history of this country
and we've gotten through it.
Speaker 4 (12:54):
And so I don't know.
Speaker 5 (12:55):
I just I think what I'm an optimist by by
nature and because and I think that also work I
do it makes me feel like I'm actually doing something,
like I'm doing something about it.
Speaker 4 (13:04):
So I think that makes me less scared.
Speaker 1 (13:07):
Wow, that's really inspiring. The work you do. This is
high energy lifting work. I mean you're spending a lot
of time in spaces dismantling inequities. I mean it takes
a lot of physical energy and emotional energy to do this.
What are your self care practices? I want to know, Like,
(13:29):
what what are the things that you do to stay
grounded and.
Speaker 5 (13:32):
To recharge listen. I mean it's yeah, it's not easy.
I have the best therapist in the world that has
held me down for the last like six seven years.
I don't know what I would do without her, Like
I love her, but like every time I have a
(13:52):
call with her and I get off the call and
like I feel like I'm floating on cloud nine, like
I could do everything, Like just helped me get through
both like professional and personal challenging times, and you know,
even now, like really it's all about like my my
my mental health because you know, I think sometimes I
(14:12):
forget how much of a loaded is to carry to
like talk about these issues publicly then also do the work.
And then also I'm a parent, so it's just like
it's it's a lot, and so she really helps me
be like intentional about what I say yes too when
I say no to, and so I don't always get
it right, Like there are times where I'm like I
(14:34):
text her, I'm like I have to talk to you.
Can we do like an emergency call because I literally
feel like I'm at capacity and splintering.
Speaker 4 (14:42):
Yeah, yeah, I know, I know.
Speaker 3 (14:45):
I think.
Speaker 5 (14:45):
Also I think also because I'm very you know, I've
always been like very high functioning. So sometimes I feel
like because I can do it. If I can do that,
I'm doing okay, and then let me hit a wall.
And the whole point is like to stop before I
hit that wall, right, absolutely, And so I try to
have like a rubric or an algorithm for being like
if I say yes to something, like it definitely has
(15:06):
to be a hell yes, Like it can't be like
it has to be oh, hell, yeah, I want to
do this and I have the time to do it,
you know, so so that helps. But then also, you know,
I definitely I was meditating this morning. I try to
make time to meditate. I work out a lot, so
and I go for like really long walks and listen
to my favorite podcasts. I live in Brooklyn and a
(15:29):
really beautiful neighborhood, so I love walking around. So it's
just like a combination of things. And then also one
thing I've done is I used to be that friend,
like a strong friend all the time, and I've really
tried to share with my friends, like when something is
going wrong, like just be like, hey, I'm not in
a good place, like and really just I'm vulnerable in general.
(15:51):
But I've never kind of used to like want to
ask for help to my friends. And I realized they
want to be there for you. Yeah, So I've been
asking them to show up when I need them to.
Speaker 4 (16:01):
And that was That's that's huge.
Speaker 5 (16:04):
Like the last few years I've been doing that and
saying like hey, I need you for this, I need
you for that, and the response is like amazing. No
One's ever like, oh, no, what are you talking about? Yes,
I'm here for you.
Speaker 1 (16:14):
What do you mean? Yeah, I mean you're bringing up
so many really critical points. The work you're doing is
part of calling out the flaws and the system so
that things can change. If you could snap your fingers
and change one thing right now about the medical system,
(16:35):
you know what would what would that change be for you?
Speaker 4 (16:39):
Okay, this is easy? I mean I would you know.
Speaker 5 (16:41):
I am a big proponent of single payer universal health care.
We know that in this country we spend more than
any other heigh income country on healthcare and we have
the worst health outcomes. Right.
Speaker 4 (16:56):
Part of that.
Speaker 5 (16:57):
Part of that is because we have a large proportion
of the population that is uninsured or under insured that
is not able to access just prevented services to care
for them. And they're disproportionately people of color. And so
I think that, I mean, that's it sounds so simple.
And you know, when you compare us to other he
income countries, most income countries have some form of universal
(17:20):
health care, right, and that contributes to why they have
longer life expectancy, a lower burden of chronic disease, et cetera.
Speaker 2 (17:29):
Both my parents worked in hospitals. My dad worked in
more of a community hospital as an eco cardiogram technician
a public hospital, and my mom worked in a cath
lab in a private hospital. And whenever I walked into
those two hospitals, I saw the stark differences between the
community hospital and this private hospital, both in terms of
(17:50):
maybe even the age of equipment, to who was you know,
who had insurance, who didn't, you know, the racial makeups
that I think makeups of both places. In the book,
you talk about your experiences both at Tish and Bellevue,
Can you talk about the differences of those two hospitals.
Speaker 5 (18:07):
Yeah, you know what was so interesting is that the faculty,
like we worked at both hospitals, so we were like
the only thing that was the same about both hospitals.
But obviously, like the resources that we had were very different.
The nursing shortage. We had only like two nurses versus
like six nurses per team at Tish. And then just
(18:29):
like in terms of the process, like patients would have
to wait so long in er at Bellevue just to
get all of their testing for us to figure out
what was going on, to you know, whether or not
we should send them home or admit them. So it
just was like night and day. And then at Tish,
where we have people come in, they're totally plugged in,
(18:49):
they have specialists who are actually dictating their care, or
even before they get there, we're getting called about VIP
patients coming in, you know that are on a board
of trustees we have to make sure we're paying special
attention to. And they're like, you know, three cat scans,
two MRIs, you know, there's never our weight. So it
just is like, how can this happen, like literally a
(19:11):
block apart, just because like one group of patients don't
have insurance and the other group of patients do have
insurance when it one is a public hospital and one is.
Speaker 4 (19:20):
A private hospital.
Speaker 5 (19:21):
And to see that, you know, even though the same
clinicians that work at both places, because the resources are different,
you know, the overall care, the care delivery is different,
and that affects outcomes.
Speaker 1 (19:35):
What I'm super curious about is if you felt in
your body a physical difference in the way you carried
yourself at the two hospitals.
Speaker 5 (19:47):
I would say that I think I mentioned this in
the book, Like at Tish, we were told we had
to wear we couldn't wear scrubs, we had to wear
you know, a nice shirt, pants or dress, and our
white coat. At Bellevue, you could wear your scrubs, you know,
scrubs are just really kind of casual, right, And I
think that affects like how you kind of move and
(20:09):
how you carry yourself. And then I also think even
like interactions with patients, like the way that I saw
patients being treated at Dellvu or even by e ands,
like they would just like come in and just like
dump the patients, you know, like just dump them.
Speaker 4 (20:26):
Yeah right, that would never.
Speaker 5 (20:27):
Happen at Tish, you know, so it just like it felt,
and I wrote about just like how I felt so
uncomfortable with this, and it actually was one of my residents,
this really wonderful young woman who still is very much
into social justice, who would actually talk and do a
lot of advocacy around the disparate care actually across the city.
(20:51):
She started as a medical student between the public and
private hospitals, but she sort of want someone that gave
me more confidence, but to speak up about it.
Speaker 1 (21:00):
Hmmm mm hmmm.
Speaker 2 (21:01):
It's clear that you know, the professional and the personal
for you are very deeply connected, and you talk about
that in your in your book. A great deal like
the fact that this is this is you know, a
family business, and so much of your inspiration comes from
your mother.
Speaker 3 (21:19):
Can you talk a little bit about that.
Speaker 5 (21:21):
Yeah, you know, I just feel you know, my mother,
now I call the original a doctor of black Stuff,
was such an incredible inspiration to both my twin sister
Oni and me. I mean, she was just a wonderful mom,
very loving, very attentive, and I think all of it
was because she grew up a public assistance had a
really really rough life and just managed to, through luck, fortune,
(21:43):
hard work, overcome all of these barriers, you know, to
end up first person in her family in college Brooklyn College,
then at Harvard Medical School, and they could have gone
anywhere after that. That's the other thing, Like literally could
have gone anywhere. Most of the most people who graduated
from Harvard Medical School, they usually go to some IV
associated residency program. Right she went to Harlem Hospital. She
(22:04):
went back to New York City to Harlem Hospital, trained there,
and then ended up working for many years in this
the same central Brooklyn neighborhood that.
Speaker 4 (22:12):
You grew up in.
Speaker 5 (22:12):
So like that's like that was my model of like
how you do it, Like you can go to these
really prestigious institutions and then come back and do really
good work in your community.
Speaker 4 (22:22):
And she was such a down to earth woman.
Speaker 5 (22:24):
But also because of her for a very long time,
and I thought most positions were black women because because
of her, because of you know, she led a local
organization of black women physicians. She's always taking my sister
knee like to every event, and so that was like
I was like.
Speaker 4 (22:41):
Oh, wow, like this is totally doable.
Speaker 5 (22:43):
I can do this, right, And then like getting older
and then going to college and the medical school have
been being like, oh, actually, we're less than three percent.
Speaker 4 (22:50):
Of all positions. Okay.
Speaker 5 (22:52):
I didn't realize that, you know, but I feel so
fortunate to have had that exposure growing up because it
made me know that I could, I could, I could.
Speaker 4 (23:00):
Do this, I could be this.
Speaker 2 (23:01):
You talk about the lack of black doctors in the
book and the historic reasons for that. Can you get
into the history of black medical schools and why we
have so few black doctors even today?
Speaker 5 (23:15):
Yeah, I thought it was so important for me to
put that history in the book because I think people
they make up observations, they say, okay, well, why are
less than six percent of all doctors black, what's wrong
with black people? And I think it's really important for
people to understand the history. And so, you know, one
of the organizational policies I talk about is the Fleksner
Report in nineteen ten, which was actually commissioned by the
(23:38):
American Medical Association, the largest and oldest organization of positions,
which has its own trouble past with racism and discrimination,
and the Carnegie Foundation, and they commissioned an educational specialist
named Abraham Flepsner to go around to all one hundred
and fifty five US and Canadian medical schools and to
hold them against the gold standards of Western European schools,
(23:59):
and in the Johns Hopkins in Baltimore, and you know
that the report actually led to the closure of a
good number of medical schools, not just historically black schools,
but at the time there were only seven historically black
medical schools, and by nineteen oh five they had trained
about sixteen hundred black physicians, and really they were the
(24:19):
only schools really educating black physicians because black positions weren't
allowed into predominantly white schools. But in nineteen ten, when
that report came out, it closed five out of seven
of those schools leaving behind Howard and Mahary, And I
will just say this, like some of the things they
were looking at were the admissions criteria, percentage of physician
(24:39):
scientists on faculty, the quality of the lab facilities, and yes,
like you know, because of the legacy of slavery, those
schools probably did not have the same resources as predominantly
white medical schools. But we don't know that they necessarily
were training underperforming doctors. Anyway, all that to say is fast.
(25:00):
There was an article in twenty twenty in the Journal
of American Medical Association that estimated that if those five
schools had stayed open, they would have trained between twenty
five thousand and thirty five thousand black physicians.
Speaker 1 (25:14):
That's huge, I mean that is huge. It's huge.
Speaker 4 (25:18):
It's huge, it's huge.
Speaker 5 (25:19):
And when you think about the number of patients they
could have cared for or the research they could have done,
just just like that domino effect, right, And so what
we're what we see today is the legacy of that policy.
We also see the legacy of the racial wealth gap.
The people who do all the endcats they belong to
the highest of the economic SATs. That's a correlation, right,
people who have access.
Speaker 1 (25:40):
Yeah, And you know what what was so great about
reading in the book is because you go through so
many different historical points, like things we didn't learn in
medical training.
Speaker 4 (25:52):
You know.
Speaker 1 (25:52):
I there was a line in your book when you
talk about the race correction factor. This is uh, you know,
we were taught in medical school. When you look at
kidney function, you're if someone is African American, they're gonna
have a different set of quote unquote normal values compared
to someone who isn't black. And to me, you have
(26:16):
this line where you're like, yeah, I just wrote it
down and like thought, you know, I med high school,
like this is what we learned, you know. And then
later they pulled white medical students to ask them if
they thought that there were actual biological differences between African
Americans and non African Americans, and they were like, yeah, absolutely,
(26:36):
there's biological difference. Is so like the nonchalance in which
we just sort of accepted and learned this information, you know.
I there was like one iota of me that was like, huh,
that's weird because like what if you know, there's a
black person, they don't have a lot of mutuscle mass
then like they fall into the same category. But there
(26:59):
was so much pressure to just do well and excel
and just absorb the information that you never thought to
question it and in fact, if you did question it,
you would probably get penalized. And it's it's just mind blowing,
like the stuff that we just sort of observed and
(27:19):
took in. And you know, it took me years after
coming out of training to really accept like how I
was complicit in this process, you know, and there's so
much reckoning around that as a person of color, to
like sit with the fact that, like you also were
complicit I wonder if that resonates with you on some level.
Speaker 5 (27:42):
Yeah, no, totally, yeah, no, no, it totally does. And
to be honest with you, I know this sounds weird,
but I think they never felt like I truly belonged
in medicine, just because I always felt like, you know,
it's a very traditional environment, even though people I think
they're being innovative, but it just felt like, I don't know,
(28:02):
I don't know if this is for me.
Speaker 4 (28:05):
Like I love this, I love the patient part.
Speaker 5 (28:08):
I love interacting with patients, caring for them like that
is such a blessing and an honor, but just like
the way that the organization's function and the way that
like I could show up, I felt like I really
couldn't show up as my full self.
Speaker 4 (28:22):
But that's why.
Speaker 5 (28:23):
Like when I was in academic medicine at NYU, like
I always say it, I literally forgot that I was
someone who it gives to share because I felt really
just like taken for granted. I thought I was like
doing all this work and like it wasn't really appreciated
or recognized.
Speaker 1 (28:39):
Oh my gosh, can I just thank you for this
confession because I totally can resonate with this. I remember
when I graduated residency in internal medicine. I I remember
it was graduation ceremony and I just I felt like
(29:00):
I was just like, this is not like what I
thought it would be. And I had this attending she
was always a little quirky, and we got along and
she was quite lovely and charming, and she was a
white woman, and she at graduation ceremony. I remember she
pulled me aside and she's like, so, how are you?
And I was like, oh, I guess I'm okay. I mean,
(29:22):
I'm supposed to be happy that I've graduated, but it
just feels there's I don't know, I can't And then
she's like, oh, she tells me, Priyanka, these are not
your people. And I remember when she said that. I
was like what. She's like, yeah, these aren't your people,
Like go find your people, and that invitation like it,
(29:44):
I was like, it took me a long time. I
was like, she's right, and now, you know, leaving academic medicine,
leaving the system, like, I'm lucky that there's I'm able
to meet other physicians that are like me and they
get it and they're fighting the good fight and they're
doing the work. And it's a much smaller community, but
(30:06):
it's a richer community for me, for my soul. And
so I so appreciate that confession because I think the
more we can be really honest with ourselves about what
our experiences were like, the more we can then make
this a system that works for everyone.
Speaker 5 (30:22):
I know, because I'm like, you know, I always say,
I know this sounds horrible, but whenever I get a
lot of students approach me like premads a pre professional
and they're like, I really want to be a doctor,
Like okay, hold on one second, there are a lot
of different ways that you can help people.
Speaker 4 (30:37):
Because I'm like, I want to help people. Let's talk
about all the different ways you can help people.
Speaker 5 (30:41):
I want you, I want you to know all of
your options, right, I want you to know what the
process is.
Speaker 4 (30:45):
Like, I'm not trying to discourage them, but just like
you know.
Speaker 5 (30:48):
They're just they're different ways, different ways to help to
help society.
Speaker 1 (30:52):
Yeah. Yeah, being a doctor, yes, totally, totally. We will
see you right after the break.
Speaker 3 (31:05):
You talk a lot about.
Speaker 2 (31:07):
Racism and medicine, whether it's about what we discussed earlier
regarding the black medical schools closing, or just what we
also discussed earlier about the othering of black bodies. But
there's some really incredible and painful stories of black people
used for the scientific benefit of white people, and it's devastating.
(31:32):
And again, like Pianca said, this is stuff that we
should have learned. These are things that we should know,
and we should know the legacy of this racism. Can
you tell us the story of Henrietta.
Speaker 5 (31:44):
Lax Yes, yes, And I have to say I felt
so honored. I was actually able to meet her family
a few years ago. I think it was on her
on her hundredth birthday. But they are really wonderful people,
you know, Harietta Lax. You know again I talk about
in the book, how you know we used her cells
in our histology class first year of medical school, that
(32:06):
he was cells and we were I was, we were
never told like where these cells were from. And it
wasn't until I was a practicing physician that I was like, oh,
my goodness, these cells were from this thirty four year
old impoverished I mean black women from impoverished Baltimore who
you know, several children are just trying to survive and
presented to Johns Hopkins with some you know, with pelvic
(32:27):
symptoms and her the cancer tissue was removed from her
without her consent, and then you know, what they found
was that the cells were they were able to replicate, right,
replicate really quickly. And so her cells have been used
by pharmaceutical companies, biomedical companies that had made lots of money,
(32:48):
and also they were used for good for for polio research,
and they were actually involved in the COVID vaccine. So
it's this dissonance where it's like, yes, like here she
was totally betrayed and exploited, right, and then her family
didn't receive any sort of compensation for it. And then
also these really wonderful discoveries were made but based on
(33:10):
you know, this this betrayal, right, And I think it's
like this idea of like how do you like, how
do we really reconcile but to you And I think
part of it is like is talking like publicly one
talk cooking publicly, making sure that everyone knows about these
the history, right, And then the other part is, you know,
I actually I think her family in the last few
years there was a settlement and they started receiving some
(33:32):
funds from all of the benefits that have come out
of research being done using herself. But you know, it's
like Henrietta Lacks, her story is like one of many
stories of how you know, I talk about today how
you know people say, oh, people of color don't trust
healthcare systems. I don't trust you know, clinicians, and they
(33:53):
put it the burden on people. But it's like, no, hey,
like there's like this history. It's not just just ee,
it's not just Henriette, Like there is a history that
has been built in this country on exploitation of black bodies.
And so I actually turned it around from like from
medical mistrust to institutional untrustworthiness, where it's like institutions should
(34:17):
have to prove themselves trustworthy to our community, say this
is what we're doing to engender your trust. These are
the programs we're doing, this is what this is who
we're employing, like you know, and not turn it the
other way around, being like, yeah, you should take that vaccine,
you know, just because right like give people the information
they need, like that's crucial.
Speaker 1 (34:38):
So, speaking of the spread of information you talk about
in the book, how things like it seems like everything
sort of changed after this tweet of yours that went
viral that the institution like wasn't too happy about, and
that like this sort of like changed everything.
Speaker 5 (34:58):
Yeah, this tweet and looking back and like they should
have been so proud that I was giving this history lesson.
But yeah, the infamous tweet was actually so the former
HMS dean who posted on Twitter an article I think
was from the Boston Globe that talked about how Brigham
and Women's Hospital had taken down portraits in the Bornstein Amphitheater.
(35:21):
This is like the ampitheater where you go to for
all of our lectures because they didn't represent you know,
the diversity of our current you.
Speaker 4 (35:29):
Know, workforce.
Speaker 5 (35:29):
And literally I remember going into that auditorium as a
medical student being like lily, porches of white men looking
down at me, right, And so he goes, it's such
a shame, and.
Speaker 4 (35:40):
I just like, sir, wait a minute.
Speaker 5 (35:42):
That ball represents like white supremacy, it represents like sexism, racism.
Speaker 4 (35:49):
There are so many people who would have been on
that wall, but.
Speaker 5 (35:51):
They weren't allowed into medical school, right, and so like
who are we glorifying?
Speaker 4 (35:56):
And what does that look like?
Speaker 5 (35:57):
So anyway, and I gave it the history of the
flex and the report and then actually it was a
response to a tweet and then someone told the head
of the med school and they were just like, we
have a problem. Yeah, so I'm not sure like how
they wanted me. I felt very silenced and muzzled and
like I am a grown adult. I can respond. And
(36:17):
it wasn't in.
Speaker 4 (36:18):
A disrespectful way.
Speaker 5 (36:20):
It was literally like, okay, these are the facts, yeah
right yeah, And so that kind of like I was like,
you know what, this is ridiculous, Like I just need
to be you know, part of having my own consulting
firm is like I get to just do what I
want to do, Like I don't have to worry about
folks saying thinking what I'm doing is somehow radical when
(36:40):
it's it's actually not radical.
Speaker 4 (36:43):
But they made me feel like it was.
Speaker 1 (36:45):
Yeah, and that were the radical. I mean, it was
a real radical moment. But it also led to the
birth of advancing health equity, which is so important. I
too had a moment in medical training where I basic
spoke up out of line. The story was there was
a patient actually that was dnr DNI do not resuscitate,
(37:06):
do not intubate, and so the you know the rules
are you should not run a code on this patient. Well,
it was a very large team, and long story short,
the head attending what wanted to run a code and
wanted to sort of see if he could. The person
(37:29):
had a lot of fluid in her heart and he
wanted to make sure that he could try and do it.
This code ended up running for about forty five minutes.
It was horrific. I mean, my intern was in tears.
In the middle of the code. I basically said to
my attending like, what is our endpoint here? Why are
(37:49):
we doing this? And that pretty much was like the
wrong thing to say, because I got in so much
trouble for speaking up. You know, I was reported as insubordinate,
as not a team player, and you know, all I
was trying to do was advocate for this patient who
(38:11):
the family actually wasn't medically literate enough to say, like,
please don't code this family member. Yeah, and so I
remember for me, that was a real turning point as
well after that, Like, to me, suddenly I could see
that I was just this pawn in this system and
the system runs. And I also felt like, you know,
(38:34):
I'm gonna have to sort of break away in order
to be myself. And fortunately I had started to perform
stand up comedy, and stand up comedy in so many
ways saved me, and it allowed me to develop my
voice and to play and to be an artist, and
you know, it saved me in so many ways. So
it's funny because we both arrived at the same place
(38:57):
but very different ways.
Speaker 4 (38:59):
Yeah.
Speaker 5 (39:00):
Actually, that experience reminds me of this idea, and we
work on it in my with my consulting firm of
psychological safety and making sure that people, you know, especially
in different settings, not just in healthcare, but in healthcare,
you know, the stakes are higher because you know, we
have our patients being able to speak up right when
(39:20):
you see something that shouldn't be happening, right, and so
just because you were you were a resident then right
as it's because you're attending, when you attending, was doing
something they shouldn't have done, shouldn't be doing, and for
you to just say in a respectable way, like what's
your end point? And in fact that that became an issue,
that says like there was no there was there wasn't
psychological safety in that environment for you. And that's why,
(39:41):
like now, like a lot of work that we do
is making sure like within organizations people feel comfortable speaking
up because we know that when people don't speak up,
actually bad things happen to patients, and that that didn't happen.
Speaker 1 (39:53):
Yeah, yeah, totally. I want to just hop a little
back because this this was so dear to meet, Like,
there were so many points in reading your book that
I actually I put the book down and just like
sat with like a full heart, especially around some of
the lines that you wrote about your your dear mother. Yes,
(40:13):
I feel like we all had the same mom in
so many ways. So like also had. You know, my
mom's a physician, very driven all of the above. And
when you talked about you had friends over for sleepovers,
and then your mom would cue up the movie and
then when the movie was over, she'd announced that it
was time to do math worksheets that I was like, oh, yeah,
(40:37):
that's here we go. We're family, Like hello.
Speaker 5 (40:40):
My mom was so intense about just like our academics, Like,
I mean, the amount of work that we would have
outside of school. I shouldn't I want you to write
an essay about being young gefted in black, you know,
like everything was a learning experience. Like we walk around
the neighborhood, we thought about the different flowers, Like our
weekends were full, like Saturday morning was like music, very violin, piano, gymnastics,
(41:04):
modern dance. I will tell you this, I am not
that parent. I have the total opposite. I'm like, that
was exhausting. I've been so exhausting for her. But also
I think, just like this generation, I think how I
parent is a little bit different, and just you know,
I just want my kids to be like happy, well
adjusted kids. And if they they don't need to get
(41:26):
like straight a's, I'm okay with I'm okay with that.
I just want them to enjoy learning. But yeah, I
just I'm like, whoa, We're gonna take it a step down.
Speaker 4 (41:35):
Yeah, totally.
Speaker 1 (41:37):
When I would have people over for sleepovers, my dad
would go around and make sure that they were studying
for the SATs that he was. He would be like,
are you studying for the SATs? Have you done a
practice test? It's like, we didn't. I didn't have that
many friends after.
Speaker 3 (41:53):
That, obviously in the time we have.
Speaker 2 (41:56):
I feel like sickle cell is something that you talk
about and is a great example of the inequality in
the medical system. There's the scene in the show The
Pit like ca.
Speaker 5 (42:11):
I don't watch medical shows, but people tell me, I
actually watch that that one.
Speaker 3 (42:15):
It's a good one.
Speaker 2 (42:15):
I like it, and I don't watch medical shows generally,
but you know, there's a scene where the patient comes
in yelling and screaming, asking for pain medication, and you know,
the the paramedics that bring her in assume that like
she's fiending and that's sickle Celt's completely not the case.
So can you talk about like how sickle cell disproportionately
(42:37):
affects black people and also kind of how it's it
is an example of what's wrong with our system.
Speaker 5 (42:44):
Yeah, and like there's so many layers to it. So
sickle cell disease, it's inherited disease, like you inherit it
from you know, your parents, and it's actually a disease
that it fliics people like all around the world, not
just in Sub Saharan Africa, but in like the subcontinent
India in the east. But the fact is is that
most people in the United States who have sickle cell
(43:04):
disease are black. So it's been like racialized as a
black disease. And so it's interesting because even though it
was first described over one hundred years ago, up until
very recently, there were only like one or two treatments
for it compared to other, you know, other inherited diseases
like cystic fibrosis, where they have multiple treatments, where there
are centers of excellence, you know, there's there are very
(43:27):
few for sickle cell disease. And so a lot of
that is because of that racialization of the diseases. And
when you look at like the amount of federal funding
that's gone to sickle cell disease and research, right, it's
it's much less than other inherited diseases that afflict mostly
white Americans. And so, you know, I tell about in
the book my patient Jordan, who's a composite of patients.
(43:49):
But how I was wondering why in residency in Central
Brooklyn I would see so many patients with sickle cell
disease in the ARC, because when I was in Boston
at the Harvard Hospitals, I would rarely see, you know,
any patients with sickle cell disease. Also, there are fewer
black patients, and I realized it's because the system is
not set up in a way to care for patients
with sickle cell disease as outpatients, right, so they actually
(44:13):
end up coming to the er all the time with
pain crises. And when they have pain crises, you know,
you treat that with pain medication, but you also look
for any underlying causes infection, whether they have of the pneumonia,
because they actually are more likely to get very, very
sick and get sick quickly. But the other piece is
like you know, they're sigmatized, and like you talk about
(44:35):
that episode of the Pit where you know, she was
assumed to be like a drug fiend, but actually she
was having sickle cell pain. There's this whole idea that
you know, people get addicted to the pain medication. And
I remember in my residency, I had some of my
senior residents and attending say, wait, are you sure that
person has sickle cell disease? I want you to send
(44:56):
a hemoglobin screen, which is like a test to check
for it. You know, there's a lot of like doubting,
a lot of suspicion, a lot of stigmatization, and it's
a black disease.
Speaker 4 (45:08):
I've never seen that with any other disease before.
Speaker 5 (45:11):
You know, just a note in the last year or two,
there is a type of therapy that came out to
treat sickle cell disease. It was at the year proof.
But you actually have to be gene therapy. Gene therapy,
you have to be hospitalized to get it. It costs
millions of dollars, right, So that's the other issue, you know.
I know the Biden administration was working on Medicaid covering
(45:32):
it for people, but so it's a million dollars, So
that's an access issue and you have to be actually
hospitalized for.
Speaker 4 (45:38):
Several months to get it. But it actually could cure
sickle cell disease. I know.
Speaker 5 (45:43):
So there's amazing, amazing treatments that are there now, but
then again, thinking about access and affordability for people who
are afflictive to it, who most likely don't have the
resources to pay for it.
Speaker 1 (45:57):
It's so great, like we're bringing attention to it, but
there's still just so much work that needs to be
done around this. I want to just open the floor
to you chay about like, is there anything else that
you want to like share with us today or anything
else that you want to say?
Speaker 5 (46:14):
Yeah, I think the only end up being we talk
about maternal mortality. We'd hear up about a lot in
the mainstream press, and I just want like people to
realize that, like when we look at maternal mortality rates
for all racial demographics in this country, it is abysmal.
Speaker 4 (46:29):
Yeah, compared to other high income countries.
Speaker 5 (46:31):
It's most abysmal for people of color, but even white
women it's abysmal for it. It's like our rates are
similar to countries that are like low to middle income, right,
And so a lot of that So, yes, I talked
about universal health care, but a lot of it also
is because the process of getting birth has been medicalized
in this country because there is financial incentive to medicalizing it,
(46:53):
and a lot of the countries that are doing really
really well in maternal health outcomes, they center midwif free care,
so mid midwife, their nurse. Midwise right, because if you
give birth using a midwife, complications are less likely to
happen when you're in the hospital. So that's like at
a birthing center or at home. But at a hospital
you are more likely to have to have a c section,
(47:14):
You're more likely to have to have other interventions. So
I would love just for people to understand what like
their options are that like at in hospital birth may
not necessarily be the case for everyone, and maybe if
you have some chronic disease issues or you're more high risk,
that's the case. But we also need to think about
what explant communities to understand, like what their options are,
(47:35):
that there is an option to be birth at home,
which I think I'd probably in retrospect, would have really
wanted to do.
Speaker 4 (47:40):
I know, I know, I know it sounds crazy coming
from a doctor, I feel you yeah, or a birthing center.
You know, I think a lot of times.
Speaker 5 (47:49):
In the er would see like the very worst outcomes
of home births, right, but we don't see all the
good ones, you know, So I just wanted to put
that out there for people to know that there are
all of these different options and they're Jewela and really
a lot of support like birth workers that can help
people have a more positive birthing experience in its country.
Speaker 1 (48:07):
Yeah, I think doula cares really do improve birth outcomes.
That's actually had an opportunity to undergo a doula training
just for curiosity and spend a couple of weekends just understanding,
you know, what goes on around the application of doula care,
and it was it was great, Like I really enjoyed it.
(48:29):
So I'm so super pro doula And I think that's
really important because a lot of people don't know. In
California actually medical covers doul us. That's part of the
Medicaid in the state of California, So it improves birth outcomes.
So I hope, you know, listeners who are looking into
pregnancy care can can look into that. A lot of
(48:52):
private payers don't cover them, but Medicaid does. So this
is lovely, like, yeah, thank you for having me.
Speaker 4 (48:59):
You know, we're not worth When I got the invite.
Speaker 1 (49:04):
I was like, oh my goodness, how much fun.
Speaker 4 (49:06):
Yes, this is this is the highlight of my day.
Speaker 3 (49:08):
Oh thank you. All right, everybody, that's our show for today.
Thanks so much for listening. I'm Hurrykindebolu, and.
Speaker 1 (49:15):
I'm doctor Prianca. This is health Stuff.
Speaker 2 (49:23):
Health Stuff is a production of iHeart Podcasts. Don't forget
to send us your voice memos with all those pesky
health questions that keep you up at night. Email us
at health Stuff podcast at gmail dot com and go
and subscribe to health Stuff wherever you get your podcasts.
Speaker 3 (49:39):
Talk to you soon.
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