Let’s Get In Formation /ˈlets git in fôrˈmāSH(ə)n/ phrase. – 1: a rallying cry to get together and fight for a cause (e.g., racial equity, social justice, women’s rights). 2: alternate meaning — get information. Suggesting an individual or group educate themselves about a topic or issue. See more. Formation by Beyoncé
I was born in Clearfield, Utah. Both of my parents were in the military and I was born on an air force base. And my mom and dad were one of the sort of early interracial couples, I would say, in the late 1970s, so I was born in 1981. My mom is African American, my dad is White Irish background and I lived in Utah for the first seven years or so of my life. And then moved to Columbus, Ohio where I grew up in Ohio for most of my childhood. And went to college, went to med school and eventually became a specialized type of pediatrician called a neonatologist. So I work in the newborn ICU. Now I’m 38. I have a wonderful husband, three little kids, and live in Kansas City, Missouri.
Well, I guess there’s two ways to think about it. I guess one definition could be sort of aesthetic beauty or what you can see with your eyes. And then I guess the second way I think about beauty is more, um, internal or emotional beauty. So experiences that you have, emotions that you feel that can also be interpreted as beautiful.
I think the thing I like and respect most about Black beauty, or really the beauty of any minority community, is it’s fearlessness. You know, by definition Black beauty is kind of going against what is considered mainstream or universally accepted as beautiful. And so, you know, celebrating different skin tones, celebrating different hair textures, celebrating…my favorite… bright, loud design clothing. I think it’s just amazing how that’s become more and more mainstream in the past decade. When I was a girl, there were not a ton of examples of especially professional women who really celebrated their Black beauty. But now there are a lot of professional women that dress the way they want to dress and wear their hair the way they want to wear it, wear the makeup that they want to wear and don’t try to assimilate with conventional, or what I’ll say is white beauty, in the United States. And so it’s actually just amazing to watch and to grow my professional career in that and then also raise my daughter in that.
There are not a lot of Black women in medicine, so there’s a lot of pressure to visually assimilate. Not just so that your colleagues feel comfortable around you, but so your patients accept you and respect you. And so for a long time I stressed a lot about wearing my hair in — I don’t know exactly even how to describe it, but you know — the least cultural way, you know, keeping it tame, keeping it straight, wearing it back in a ponytail. But as I’ve gotten more mature, I’ve totally flipped to the opposite. I just embrace like my big huge curls and let my hair be kind of wild and natural. And, you know, it’s funny cause there’s definitely nobody else in my division that looks like me. There’s nobody else in the ICU where I work that looks like me. But instead of being ashamed or afraid of that, now I’ve just come to embrace it. I still think about it a lot. Like for example, if I’m going to a big interview or giving a big international talk, I have to weigh the pros and cons of presenting myself as I naturally am versus kind of toning that down.
And there’s still things that I’m kind of intimidated to do. Like, when I go on vacation, sometimes I’ll get braids because you know, I’m going to be around my family, I know that’s not a big deal. But I’ve yet to be brave enough to wear braids to the hospital just because it is a thing of perception and it is a thing of how you treated and how you’re patients are going to treat you. So, there still are barriers that I’ve not completely broken through, but I’ve grown a lot in that regard.
You know, I think I’m not in a totally unique position because Black comes in all shades, but I think a lot of the pressures or stress stems from being a self-perceived Black woman that has incredibly light skin because I’m biracial. And so in the summer I get real Brown and it’s not as much of an issue, but in the winter when I’m extra pale, it’s interesting because, I guess when my hair is straight, maybe some people could think I could even pass as like Italian or you know, something Greek, who knows. But, there’s a little bit of discomfort with how I’m perceived versus how I perceive myself. And along the same lines, I’m acutely aware that I am probably accepted and allowed into spaces, into White spaces, that darker skinned Black women are not as easily allowed or accepted into. And so, you know, on one hand I capitalize on that and fight for equity and diversity in places that Blacks traditionally probably haven’t been allowed to fight for that. But then on the other hand, I feel some kind of guilt or shame about my privilege and advantages based on how light my skin is.
When I was a little kid, there was more overt racist discrimination among my peers. You know, the White children didn’t accept me because I clearly wasn’t White. Many of the Black children didn’t want to accept me cause I was bi-racial and light-skinned. And so I kind of lived in this strange in-between world, even as a child. The one thing that was unique to me was that I had a lot of bi-racial children in my family. It just so happened that my mom’s one of 12 and eight, or nine — I can never keep the numbers straight — of them were girls and a large majority of them, the Black women, married White men for whatever reason. It’s still kind of a strange fluke in my family. And so we have a humongous contingent of bi-racial cousins. And so in my household and in my family gatherings, I was totally normal. But when I went out into the world back in the early-‘80s, mid-’80s, there weren’t a lot of bi-racial kids the way there are today.
So I still kind of have…scars seems like an extreme,exaggerated word…you know…still kind of remembrances of that feeling of growing up that way. And then as you go through college, med school, residency, becoming a practicing physician, things are not usually so overt. But there’s a lot of… there’s controversy about using this word “microaggression” because it minimizes the daily traumas that minorities face…but a lot of small instances all along the way that you just feel like people are doubting your competence or your intelligence or subtly kind of putting you where they perceive your place to be. And just having to be twice as amazing, perform twice as well, as some of your colleagues to even get a seat at the table or be taken seriously. So that’s really something that’s ongoing and I kind of struggle with. And that’s internal as well. You know, imposter syndrome. You know, White women face imposter syndrome for sure, but I think for minority women, there’s layers of self doubt that you have to kind of contend with continually. And I’m getting a lot better at — I’ll say half jokingly — accepting my brilliance and knowing in my heart that I belong and knowing in my heart that I am a leader and that I will be a preeminent researcher, all of these things. But it’s a work in progress for sure.
Well, I’m reading a really amazing book right now called “The Well-Read Black Girl.” It is a remarkable book because it’s a bunch of different, successful, and impactful Black females. Each chapter is one of them talking about a book that affected them or transformed them. And so not only have I read a lot of the books they’re talking about, but I’m hearing these Black women describe their lives and their life experience as it relates to these books. I mean, it’s incredible. I don’t know how I discovered it, but it’s called “The Well-Read Black” Girl and it is an incredible book that I’m reading right now.
Other people that I really admire…One is Tracee Ellis Ross. I just appreciate her authenticity and how she’s really followed her dreams and her career and work to lift other people up. I really admire Ava DuVernay. You know, she’s giving voice to the voiceless in the world of media in a way that I kind of aspire to do in the world of medicine. So she’s somebody that I follow and admire a lot. Those are a few that come to mind immediately.
I think the primary word is resilient. I just think, despite all the odds, really incredible things are done on a day to day basis. And that could be something as mundane as a single mom getting clothes on her kid’s back and food in her kids’ bellies. Or it can be someone like me who is serving on the board of directors for national medical societies and presenting cutting edge research internationally. You know, we’re the same. We each have had to show and maintain a type of resilience that is really remarkable, if you think about it.
It’s complex. As a society we just don’t see value and worth in Black women. I mean, that’s the honest truth. At least, those with power just don’t see it. So you’re starting at a tremendous disadvantage. Tremendous. Any Black woman that wants to achieve great things knows that going into the game and has to continually contend with that and overcome it. So why is it important? If there are more of us in those positions of power, any person coming up under us doesn’t have to contend with that anymore because they know I see her and I know her and her value and her brilliance intrinsically because I know my value in my brilliance. And so imagine the weight that that lifts off of somebody. Imagine how transformative an experience that is.
For example, a Black female mentor of mine, you know, she gravitated towards me immediately as soon as she met me in the ICU because then you’ve removed layers of disadvantage if you can find a mentor that looks like you. Because you know, they love people that look like you. They respect people that look like you. They know there’s value and excellence and brilliance in people that look like you. That’s why it’s important for more of us to be in those leadership and upper echelon roles because right now there are so few. And so anybody that’s coming up behind us is dealing with all those layers of bias and intrinsic value placement and all of those things that…it’s hard to describe them in words, but everybody has felt those things.
There’s definitely this sense that if you have reached this echelon of achievement — however that’s defined in our society — that you’ve kind of “broken the mold.” So by definition, that implies that the mold is a lack of success. And I don’t in any way want to perpetuate that assumption. You know, a little-third-grade-Black-girl is just as smart as a little-third-grade-White-boy. But the two are nurtured in very different ways. The two are encouraged in very different ways. When the two children leave the classroom, they have very different lives in America.
And so that is why there are not more Black female physicians. It’s not because Black females are not as smart. It’s not because they’re not as ambitious. It’s because they are systematically not given the same opportunities to reach that what I’ll call “upper echelon of success”. Once that is acknowledged and once we take concrete steps to fix that, there could be an equal proportion of Black women physicians as there are (Black women) in our society instead of this gross overrepresentation of non-minority physicians. And so, I hate to think that my achievement would in any way block or minimize the achievement of other people. If anything, I hope that me giving voice to the currently relatively voiceless and talking about these issues would give others the same opportunities.
Well, I’m proud of different facets. One thing I’ll say is that I’m really proud of my family. I have a wonderful stay-at-home husband. Three very well adjusted children that are little social justice warriors, just cause of all the indoctrination we do at my house. Which I’m actually not ashamed of, I’m very proud of.
You know, less than 2% of physicians in the United States are Black females. So I’m very proud of being part of that less than 2%, because I bring a very unique perspective to any table I’m at, at the hospital. I bring a very comforting and unique experience to my minority patients in the ICU. And I also shine as a beacon of hope for minority trainees that want to become a physician one day. I’m very proud of that and really have stepped into that role. Sometimes it’s stressful cause it feels like the weight of the world on your shoulders, but most of the time it just feels like a hugely privileged position and I’m really proud of that accomplishment.
The third thing I would say is that I’m really proud of bringing voice to the importance of racial diversity in medicine and really working hard to improve racial diversity among medical students, residents, fellows, physicians. We’ve got a long way to go, but we’re definitely making strides. And a more racially diverse physician population is undoubtedly a better physician population. So, I’m proud of that too.
Well, I want to retire and have grandkids. I’m way too young to be dreaming about that already, but that is what I look forward to when I’m like 65. But in the next 20 years or so…My research is in neonatal pharmacology, or new born pharmacology, so one of my aspirations is to really change the way we think about using drugs in sick newborns and do high-impact research. Present my research at impactful meetings and really kinda change the field when it comes to newborn drug therapy. One of my other aspirations is just to become a leader in the medical field, pediatrics in particular. A leader in discussing racial health inequity, the experience of minority patients, the experience of minority physicians, and really keeping the importance of that in the forefront of medicine so that things can continue to improve for minority healthcare providers and patients.
I think the best description, at least in medicine, for the experience of Black women physicians and especially as an academic working in research and teaching, it’s just really isolating. You just feel very isolated because, you know… I’m collegial with a lot of people, but I don’t think it’s as natural to forge really deep meaningful relationships at work. And part of it is that I am “other” and even if superficially we act like we’re all the same, under the surface everybody holds biases. You know, it’s an ever present fact that I’m not quite the same as the other people in my division. I think part of the reason that you feel isolated is because you can’t be your real authentic self at work. That is just the honest truth.
My colleagues don’t want to hear me rave about Black men getting killed by police and racial inequity day in and day out. Even though those are things that I think about and those are things that I stress about, I have to really hide that at work. Sometimes it comes out, mostly as it has to do with health equity and the experience of minority patients, but there’s so much injustice in the world that I think about and talk about at home and with my friends that I just can’t discuss in the workplace. I think that is one of the reasons why it’s hard to forge real deep, meaningful relationships at work when it’s a majority White workspace — you’re only presenting a part of your authentic self. And I think that one of the most difficult things about it is that no one perceives this except me.If you asked any of my colleagues, they would never perceive that I’m kind of policing myself in this way because they’ve never had to really do that. I think that’s also part of the unusual experience of being a minority in academic medicine and being in all these spaces that are really all White spaces. It’s very interesting experience.
So, there’s increasing research and data that document again and again that Black patients are having worse health outcomes. They die more frequently and earlier of cancer, of heart disease. They have worse controlled diabetes. They have worse controlled asthma, higher mortality from asthma. And you know, there’s a new drug that’s an HIV prophylaxis drug called PrEP, where if you are in a high risk sexual relationship and you take PrEP, then you’re protected from getting HIV like 99.5% of the time. And there’s data that PrEP is used almost exclusively by Whites, that Black patients do not have access to it and are not using it, even though they’re the highest risk patient population. So, there’s research study after research study that documents these profound racial health inequities, but there’s very little research being done and very little resources being put towards how do you fix it?
One of the major underlying root causes is racism and apathy about the outcomes of minority patients. And I don’t believe that’s malicious, but it’s that for all of the history of medicine, the people in the seats of power have decided that this is not something that deserves research funding and this is not something that deserves the resources to fix it. And so I do think we’re at a kind of a precipice of a paradigm shift of there being such accumulated data and enough minorities in medicine that are saying, This is not okay. This must change. We must look this ugly truth in the eye in order to fix it. But we’re just now getting to that point. And so the honest truth is that from this day, and all the way in the past, on average a minority patient is going to have a worse outcome than a White patient. That’s with access to care. That’s with control of their chronic disease. And that’s with the risk of death. That’s just a really sad and hard thing to think about.
In medical school and residency you learn that some diseases occur more frequently in some racial groups. So a good example is lupus. You know, lupus is much more common in African American women than it is in White women. And it is real. There are certain diseases that are more prevalent in certain racial groups, but you also learn things like African Americans have different baseline kidney function than White Americans. There is a lot of controversy in medicine about if that kind of race based understanding of disease is valid or not.
Because we know that genetically Blacks and Whites are almost identical. And so really race is something that’s a social construct. You know, calling someone different based on the color of their skin is not based in biology, it’s based in power structures and how this country and other countries around the world have been built societally. And so in medicine right now, there’s a big outcry, especially from minority physicians that we need to stop teaching race-based-medicine or race-based organ function because there’s no good heart research and data that backs up these facts that students and residents are learning.
The honest truth is that minority patients who distrust the medical system or distrust research have completely valid concerns and their distrust is completely reasonable. Historically, medicine hasn’t gone out of the way to prioritize the wellbeing of those patient populations. It’s just the honest truth. And in the research realm, there have been some very unethical things done in the past. And so, those things are all true. And the first step of the medical community is acknowledging those things, even though you can imagine it’s very hard to acknowledge those things for many physicians and researchers.
But the next thing to move forward is to A) increase the number of minority researchers and physicians. Because there’s nothing like race concordance that can make people feel more comfortable and more trusting, there’s data that shows that. And B) make sure that we’re interacting with these communities and educating these communities in a culturally competent way. And what do I mean by that? I mean, don’t ask Black patients to come get their care in the “ivory tower of hospital X” where it’s totally intimidating and they’re scared that they’re getting suboptimal care or that people are judging them.
But, take those physicians and researchers out into the community and have them meet people where they are. Educate people. For example, talk about the importance of participating in diabetes trials. You know, we know that diabetes is disproportionately affecting and killing certain minority populations, but those populations are not represented in the research studies. So, you have to have a team of people going into those communities, talking to people where they are, educating, and saying, Look, we can’t make this disease better in your population if we can’t get you into the research studies. But you know, that’s a much harder and much more inconvenient approach to research. And so it’s really only certain groups that take that approach, but if that approach was taken more universally, we could improve the number of minorities that participate in research and we could improve the number of minorities that are coming in for health care. But it’s a labor intensive, resource intensive, more arduous approach.
Well, I think, honestly, the root of a lot of racial health inequity is wealth inequity.The thing that we don’t like to talk about in this country, at least in the circles I run in, is how your fate is almost entirely determined at birth. It’s based on your race in this country and where you’re born, and what your parents have had access to, and your geography, and how segregated your neighborhood is, and what you are going to have access to as a child. And so, I think if we were to, really in a serious way, take on a problem that affects Blacks in America, really in a serious way, it would be reparations. Really acknowledging the historical disadvantage and doing something tangible to correct that historic disadvantage.
You have to face the reality of generations of violence and oppression. In modern days it’s kind of more settled, but the disadvantage of most minority families in this country, you basically have to admit, is compounded over generations. There’s good data. You know, there’s research that looks at the median wealth of different racial groups, different families from different racial groups… and if you’re born in neighborhood A that’s five miles from neighborhood B, your life expectancy is 10 years less. And so there’s good data and anybody that wants to say, That was a different time, those effects don’t carry over is just ignorant and honestly not even worth my time.
I just think one of my biggest dreams is that we could have open and honest and hard conversations. Except for a small group of people that are willing to sit in discomfort, a lot of the time many people in our society don’t want to have open and honest and hard conversations. And I think that those conversations can really be transformative. So I think that’s one of my biggest wishes.
It’s tough. A lot of the conversations that I want to have… kind of forced upon people… they are not personally affected by the things I’m passionate about. So it’s tough. You know, I rack my brain on a daily basis of how to get these things to seem important to people who could very well just go their entire life, their entire profession without thinking about it or without having those conversations. That’s easier for sure. So, how do you get people to walk into discomfort that they don’t have to walk into? It’s really a challenge and I’m still figuring that out, honestly.
Never let perceptions of other people limit your aspirations. In any situation that you can, dream bigger than what others have dreamed for you. And know that there are role models out there and there are people that are willing to help you along that path. They’re hard to find and they’re rare, but that they exist.
Probably the best advice would be to 1) embrace discomfort and 2) be open to really having to face shifts in who you believe you are and who you believe this country to be. Because for many non-minorities there are so many realities that they have not really stared at in the face and thought about and it is crushingly difficult for them to do that. And so just to really cultivate that skill and learn to sit in discomfort and be open to learning hard things.
Interview Date: November 9, 2019
Day 10 — Story posted on February 9, 2020
Personal links: Read Dr. Lewis’ article The Burden of Having Ears That Can Hear