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  • Writer's pictureDr A Bashir

41 Twice as Hard

Our summer hiatus is officially over, which means we’re back with four more episodes to close out 2023! Our 41st episode features Jasmine Brown, a fourth-year medical student at the Perelman School of Medicine at the University of Pennsylvania. After completing a Bachelor's in Neuroscience at Washington University in St. Louis, she then obtained a Master of Philosophy at Oxford University. During our chat, we discussed her phenomenal book—Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century—why she decided to write it, and her book’s major take-aways. Importantly, we also chatted about how she actively prevents burning out as a medical student. Jasmine and I hope you enjoy our conversation, aptly titled Twice as Hard, in homage to her beautiful book.

You'll find the audio version of this episode on our website, Apple Podcasts, Google Podcasts, Soundcloud, Spotify, and more.

The transcript of our conversation has been prepared for accessibility purposes, with minor edits for clarity and brevity.

Jasmine Brown: Listen to yourself and don't be afraid to set boundaries because it can really help you in the long run.

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Dr Asma Bashir: Hello world, and welcome to Her Royal Science. Thank you so much for joining us for today's episode. Today, we'll be chatting with Jasmine Brown, a medical student at the Perelman School of Medicine at the University of Pennsylvania. She previously completed a Bachelor's in Neuroscience at Washington University in St. Louis, and she also obtained a Master of Philosophy at Oxford University, during which she carried out in-depth research and organised oral histories that were synthesised into her book, Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century. I am over the moon to be chatting with Jasmine today about her amazing new book, but let's start from the very beginning—Jasmine, what's your story?

JB: I first started thinking about medicine when I was in high school. I felt like I needed to know what I was going to major in in college, so I started thinking more about my different interests. The big thing that stood out to me was that I wanted to understand why we are the way that we are, and that kind of made me think about psychology. At the time, I wasn't able to take psychology classes at my high school, so I started taking online courses from different universities. One professor in those classes introduced the concept of neuroscience as this marriage between biology and psychology, and that felt like a perfect fit for me because, throughout school, I enjoyed my science classes and [it] felt like that fit the bigger picture idea that I was interested in. [I] started exploring neuroscience more. I actually did a neuroscience competition in high school that really cemented my interests, so decided to major in neuroscience in undergrad at WashU and found out that research was an option. As I was going through undergrad, I actually started to think about doing an MD-PhD but was really drawn to medicine, using this knowledge that I was interested in to help people when they're really most vulnerable.

AB: Mm-Hmm <affirmative>. And where are you in the medical stage? Obviously, as I mentioned in the introduction, you're in the midst of acquiring your medical degree. Could you tell our audience a little bit more about that process? I know it differs from country to country.

JB: Yeah. I know, in the UK, people go from high school straight into medical school, but in the US you have to do an undergraduate degree first, so it was four years. It can be any topic, but you have to do the pre-medical basic science classes, then we do medical school after, which is another four years. I, as you mentioned, took two years in between when I did my Master's at Oxford because I got the Rhodes Scholarship. That was a great opportunity to kind of take a detour, explore something new. But now, in medical school, I'm actually in my fourth year, my final year, starting to finish things out. So yeah! I'm excited to be almost done with this stage of the training.

AB: And you have quite a few things going on in parallel! Not only are you finishing medical school, you've also written an amazing book, Twice as Hard. One of the things that I really appreciate about the book that you wrote is the fact that there is an emphasis on Black American women. Oftentimes, the people that we spotlight without even really realising it are the descendants of recent immigrants from the African continent. Though that's not to say that the experience of having that particular identity doesn't come with its own set of challenges, I do think that it's not particularly fair to exclude or to seldom represent individuals who are the descendants of enslaved individuals in the United States, because that experience is in and of itself one that deserves its own spotlight and its own space for conversation. I know you talk about this also in your book and some of the conversations that you've had with classmates about this topic. Can we chat a little bit more about that?

JB: Yeah. One big thing that I found in my research and looking at how it changed over time was, in the early 1900s, there were specific efforts to make medicine a more elite space. They were trying to elevate the overall perception of medicine because in the 1800s, they weren't viewed as highly as they are now, so they tried to get rid of people who are from lower socioeconomic backgrounds by making it harder to get in, more expensive to go through this training process. That discrepancy has persisted to today. The vast majority of medical students come from families who are from middle class, upper middle class, or wealthy backgrounds. The vast majority have parents with high-earning professions. When you look at that background, the longer legacy not just the individual, because of racism as it pertains to immigration, most of the Black immigrants that are able to get into the US typically have parents who have higher-earning careers compared to African Americans in the US who have been persistently excluded from those spaces.

Having discrimination in the work environment and the education system, that has prevented our community’s ascent socioeconomically. And so, if you have one population who on average has a higher household income, i.e., recent immigrant populations compared to African Americans, then that wealth disparity that persists within the medical education system also persists within those demographics. The community that has a higher earning family background are going to be more well-represented than the community that doesn't.

It's just unfortunate that then it creates tensions within our community as a whole because I think it hurts us more than it helps us. I think I wanted to speak to my experience. This book, as much as it was an effort to help other people, was also a process of healing for myself and the different traumas or challenges I've experienced. Writing resilience and the victories that have happened in my community have been a way to work through that.

AB: Mm-Hmm <affirmative>. How often do you then go back to your book in the toughest of times through this process of pursuing a medical degree? Is it a source of joy and a source of inspiration even now that it's published and you’ve finished working on it?

JB: Definitely. Even though I did most of my research at Oxford, I was doing the writing process about half the time that I was in medical school. Even going back over some of my research as I was writing about these women, reinforced that. And then, even since the book has come out, I've also definitely gone back to different portions of the book for my own inspiration.

One example was having an advisor tell me that they weren't sure if I could be competitive enough for a surgical specialty and me really taking that to heart because it's like, 'Okay, they're the advisor, they have this insight.' But then I was going through my book, reading about some of the women, one of whom was Dr Marilyn Gaston, who when she was in high school, she had her school advisor tell her she couldn't become a doctor at all because she was Black, she was a woman, and she was poor. Thankfully, she persisted and not only did she become a physician, but she became a physician who made a huge impact. Her research on sickle cell disease has helped to extend the life expectancy of people with sickle cell disease. Had she listened to that advisor back when she was younger, she might not have gone on this path. And so, me referencing that as I'm going through my journey is just a reminder that these negative experiences that I might have, it helps to take away, I would say, feeling like an individual issue, like 'maybe this is something wrong with me,' seeing how my individual experience fits into the larger social context basically.

Another example: people telling me that, 'Oh, you only got into medical school or whatever successful thing,' similar [to what] I heard when I was getting into college, like, 'you only got in because of affirmative action.' I knew my grades. I knew I was one of the highest performing students at my school, but still it hurt. But then when I saw other women, one example in that case from my book is Dr Lavizzo-Mourey, she was told similar thing and she was literally the highest scoring student in her class. Making that realization that, 'Okay, people are reusing the same tropes, the same messaging, to prevent us from going after what we're capable of achieving.' [That] helped me to refocus on people who are supportive of me, who don't hold those biases, and reminding me that I have to believe in myself.

AB: Mm-Hmm <affirmative>, I'm so glad that you believe in yourself the way that the rest of us do. And seeing all the amazing things that you're doing out in the world, we're so inspired by you. I'm wondering if there's anyone whose story you were surprised by, [where] you got to someone's story and you went, 'Oh my goodness!’ That could be, 'Oh my goodness, I can't believe it,' in an amazing way or in a shocking way. Is there anyone that comes to mind when I say that?

JB: Yeah! I would say Dr May Chinn. She went to medical school in the 1920s. She went to medical school at NYU and a few things [surprised me]. So, one, in terms of her medical training, because of racism along this training journey, her along with many other Black physicians were not allowed to do residency, which is the next step of training after medical school that is necessary for a physician to be able to practice well in their specialty of choice, and even in medicine in general. Right now, as a medical student, I'm learning the science behind it or the clinical decision-making, but as a resident, that's when we get much more practical experience. And so, she wasn't allowed to do residency because of racial segregation of hospitals. She wasn't hired at hospitals, same as Black patients were not being accepted at these hospitals, so she actually did a kind of apprenticeship-style training working with other physicians after medical school.

Then, she partnered up with a Black surgeon and they would go to people's houses to perform surgeries when those patients had been turned away from hospitals because of their race. It was really incredible imagining the scene. She would talk about using either the patient's bed or an ironing board as an operating table, or sterilising some of the surgical tools in the oven or in the washroom, where they washed their clothes. It's really incredible, the ingenuity they used to overcome the significant health disparity, also turning the discrimination that they experienced in their own careers to make a really significant impact in people who were being discriminated against on the patient side.

And then, the other cool side about her story: she also was a musician. She was a pianist and had been trained in piano growing up. While being a physician, she actually was an accompanist for Paul Robeson, who was a leader in the Harlem Renaissance, and that's where she practiced medicine. This is the 1920s, 1930s. This is during the Harlem Renaissance. She would talk about stories where she was playing at parties for Madam CJ Walker, who was the first self-made female [millionaire] I believe in the US, who was a Black woman. Or other times, where she would be in coffee shops and writers who were leaders in the Harlem Renaissance would all come together and they would read some of the stuff they're working on. She, along with others, would tell them what they think as they're doing their work in progress. It was really cool learning about her connection to this other significant moment in history that I had learned about growing up.

AB: I wanted to kind of go back to someone that you mentioned, I want to say one question ago: Dr Lavizzo-Mourey. She shared in the book, 'You're going to have to make sacrifices to do something bigger than yourself, and that's always the case. But you've also got to make sure that you take all of those parts of your life and weave it together.' I'm wondering if we could talk about the different important aspects of your life. You have a lot going on; that's very, very clear, but what do you do to prevent burning out? And what advice would you give to younger you about making sure that you're kind to yourself and you show yourself grace? You are exceptional, but I don't want you to be exceptionally burnt out either, you know what I mean?

JB: Yeah. Preventing burnout... That is… a challenge. I think within medicine itself, the training is very intense. Some of the expectations, I don't think are the best. For example, one of my friends I just saw yesterday, he was talking about how he has a 38-hour shift starting today, which means it ends tomorrow. Just the expectations for us to stay up for long hours, to sacrifice significant personal moments in our lives like going to weddings, going to funerals. These are things that I've learned of medical students having to deal with and definitely hearing about residents also. There is a really high rate of depression, high rate of physicians taking their own lives. I've read that in terms of physicians taking their own lives, [it's] twice as high as the national average in the US. That is difficult and it's... It's sad to see that in a lot of places within medicine, the culture towards the trainees or the physicians goes against the advice that we would give our own patients.

AB: Of course.

For me, how I try to prevent burnout, for one, doing other things is a way that I cope with that. I really love writing. I love trying to make an impact in this different way that taps into my creativity. It's something that along the path, especially before the book was actually published, people within medicine told me maybe I should put it off, 'Just focus on medicine. Don't do the book.' I would say ironically, but also unsurprisingly, once it actually came out, a lot of people changed their tune! But with writing the book, that was one example where I had to learn the boundaries that I was going to set. It's not fully rigid. There were times where I really did need to hunker down and focus on my medical training, but there were times when I could balance it and make it a priority.

Throughout this journey, it's constant reassessment, looking at, How do I feel right now? What are the things that I'm spending time on? What are the things that I have kind of neglected? And am I okay with that? And then trying to reassess like, okay, now I'm going to focus more on... One example is wanting to cook more. That's something I hope to do soon. I've been working on exercising more, just focusing more on my own health. So yeah, I think just the constant reassessment, because medicine is very demanding. I do have a lot of other things going on and I think learning how to say no or, 'Can we wait to do this later?' is something that I've been working on. Especially when the book first came out, it was pretty intense, all the book events plus studying for a big exam, so I think the reassessment helped me say, 'Okay, I'm feeling overwhelmed right now. What do I need to do to make things better for myself?'

AB: Okay, so that's the advice that you'd pass along: reassess, reconfigure, and just listen to what's going on in your own heart, your own mind. Make the best choices for yourself as an individual.

JB: Yeah. Listen to yourself and realize that setting... Don't be afraid to set boundaries because it can really help you in the long run.

AB: Hmm, I love that. What do you think the takeaway message is from your book, Twice as Hard?

JB: For me, the takeaway is that one, some of these systemic and social issues that were a hundred plus years old still persist today. Some may be in a slightly different form, but they still persist. But also, as someone who's going through that journey and that environment, you can still thrive despite that.

AB: All that's left to say now is thank you. Thank you so much, Future Dr Brown, for joining me today and having this conversation with me and for sending me your beautiful book. I hope everyone picks up a copy.

JB: Thank you!

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