In the US, people of color have long experienced inequalities in health care. In this special Charged episode we discuss these inequalities and racism in health care.
About the Episode
Nasrien Ibrahim, MD, cardiologist, has experienced firsthand the important role that mentorship plays in a person’s life and career. For Dr. Ibrahim, her approach to mentorship is built on transparency, vulnerability and a genuine belief in sharing her own challenges and mistakes in order to help other young woman and men of color who are considering careers in medicine know they are not alone.
In this episode of Charged, Dr. Ibrahim talks about her mission to eradicate disparities in medicine, how she overcame—though continues to struggle with—Imposter Syndrome and the story of what she describes as her “lowest point” in her career and life.
About the Guest
Nasrien Ibrahim, MD, is a cardiologist in the Advanced Heart Failure and Transplant Section within the Corrigan Minehan Heart Center at Massachusetts General Hospital. Dr. Ibrahim takes care of patients with advanced heart failure, left ventricular assist devices and heart transplants. With a research focus on heart failure, Dr. Ibrahim aims to improve the management and outcomes of patients with heart failure. Dr. Ibrahim completed her internal medicine residency and general cardiology fellowship at the University of Cincinnati Medical Center. She went on to complete a fellowship in advanced heart failure and cardiac transplant at the University of Colorado in Denver. Following that, she completed a fellowship in clinical research at Mass General.
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Q: Dr. Nasrien Ibrahim, a cardiologist at the Corrigan Minehan Heart Center at Mass General, recognizes the powerful role that mentors have played in her life, to help guide her career path. As a result, she now works hard to assume a similar role for young women and men of color considering careers in medicine, whether they are medical students pursuing careers in cardiology, or high school students learning about all of the opportunities available to them for the first time.
For Nasrien, whose clinical work focuses on advanced heart failure and heart transplantation, working to tackle disparities in medicine, both for patients and clinicians, has become a personal mission. And achieving leadership positions isn't just about building her résumé, it’s about opening doors and expanding the field for others to follow in her steps.
So welcome, Nasrien. It’s wonderful to have you here today.
I've heard you say that fighting disparities has been your personal mission. So I'm wondering if you can start by speaking just a little bit about that, and how that’s come up in your personal life, and your career.
A: So being a woman of color myself, I noticed, in every step of my training, starting in medical school, through residency, Fellowship, and even now as an attending, that there's a lot of work to do in diversifying, not just the workforce in healthcare, but also everything from who we’re recruiting into our medical schools, who we’re recruiting into our residencies, the nurses that work around us, ancillary staff in the hospital, and also at the top positions in hospitals and medicine and academia.
There's, quite the disparities, not just in the healthcare we provide, but also who is providing it. And so I think it’s important not just for patients to see doctors who look like them, but also for physicians when they look around the room, that they see people that look like them.
When you're sitting at the table, you look around the room and you say, “Who’s in here? Who’s making the big decisions?” When you're interviewing candidates, you're saying, “I want to bring in a diverse group of trainees, not just a diversity in cultural background, ethnicity, and race, but also diversity in life experiences, where they trained, where they're coming from. What kind of challenges has life thrown at them, that makes them different and unique?”
And so I just think it’s important to change the face of medicine, to change, who’s presenting big trials, who’s publishing big papers, who’s on TV talking about medicine. Because it’s important for young women and men of color, and from disadvantaged backgrounds, to say, “I can do this. This is possible. I see people who look like me that are at the top and doing these things.”
I would say it’s everybody’s responsibility to look around where they are, the institutions that they're at, and where they can actually make a difference in diversifying the workforce.
Q: And can you talk a little bit about how you’ve been working to increase diversity in the workforce?
A: So for me, it’s been mentoring, but also sponsoring. You get these opportunities where you get invited to go speak at middle schools, or high schools, or to talk to youth from disadvantaged and high risk neighborhoods and communities.
And it’s more so (a) the most important thing is, they're seeing somebody that’s telling them, “This is possible. And this is how you do it. And this is how you would have a career in medicine or in science.” But it’s also important to follow up and say, “Here are programs that we have at Mass General. Or here are programs at Harvard Medical School,” where we take students and say, “Mold them and teach them how to navigate the very difficult path to get into medicine.”
So I've mentored students. I've been invited to speak at different programs that cater to women and men of color that are interested in science. The most important thing is the follow-up. You give your email out, your phone number out, and you say, “Let’s touch base after this. And let’s see what sort of opportunities we have here at Mass General, or at Harvard Medical School, that can help you get to where you need to be.”
So it’s, a lot of work to mentor and sponsor. And I think sometimes, people take these positions lightly. And it’s really important to say, not just maybe have a phone call here and there, and check in on them, but to create opportunities for them to find their path to medicine.
I remember I was speaking once at a program that MIT has. It’s called Upward Bound. And it’s for high school students from disadvantaged backgrounds. And in speaking to one of the students, she said, “You know, I talked to my high school counselor. And she seems to think the most important thing for me is just to graduate from high school.” And there was no encouragement and pushing the students to think about, “Okay, what's going to happen after high school? What are your plans? Are you going to vocational school? Are you going to college? Are you going to community college?”
So it’s important to actually provide resources and helpful tips and opportunities for students that may not have the same opportunities as students from, schools and high schools that are in higher socioeconomic cultures or statuses.
Q: Sure. And you talked about how that encouragement as a motivational tool for these students is really important. What are some of the other barriers that these students are facing to joining the medical field?
A: So medicine is expensive. And just the cost of the exams that you need to take, the MCAT exam, the cost of the books that you need to study for the MCAT, the cost of prep courses that a lot of students do take, in order to be competitive for med. school. So we’re talking about costs, and these are hundreds, sometimes thousands of dollars. So that’s a barrier. And it’s very challenging for students whose families may not be able to support them, to pay for these kinds of prep tests.
We look at things like grades, and how much research a student has done. But you have to remember, there are some students that, while they're also trying to work and maintain a high GPA, some of them have other responsibilities, whether it’s raising their siblings, because their parents are working two jobs, or whether they themselves have to have a job outside of school.
So we have to look at the big picture, and what everybody’s personal circumstances are, and a school in a certain neighborhood may not be as well connected as a school in a different neighborhood, where the students are connected and able to network with medical schools and colleges, and give those high school students opportunities to present research papers and abstracts.
So it’s very complicated, but medicine is not an easy or a cheap journey. And we have to think about how we can make the pipeline to get into medicine, easier. So there's a cost impediment. there are students whose, both of their parents are physicians. And so everything seems straightforward
But then, if you look at students who are first generation college students, or whose parents may not have the means, it becomes very challenging for them to get into medicine. So we have work to do in terms of identifying students that, don’t have all the luxuries that certain students have, and how we can approach them, sponsor them, and get them into medicine.
Q: And you mentioned, too, the follow-up being really critical in this process. And immediate follow-up being one of that. But just as far as retention goes, so what are the barriers for people of color in the medical field?
A: Yeah, because it also depends on where you go to school. So if you are a young black man or woman who starts in a medical school, and you are the only person of color, for example, in that medical school class, and you look around, and there's nobody that looks like you, you're afraid of asking for help or seeking support to continue your journey. That might be a barrier.
So you know, everything from the schools need to be diversified, to who’s teaching in the medical school, who’s the dean of the medical school. And then, medical school is tough for everybody. So not having people that you can connect with on a cultural level might be challenging. And you know, there's other things, that students have going on outside of school that might be an impediment. And then opportunities—and, like I keep mentioning, is cost.
Some students have the luxury of taking a year off, and doing research, and strengthening their application to residencies into the next steps. And some students just don’t have those sorts of luxuries. And I always say you want to do something where there's people that look like you around you, sitting at the table, and also leading you and teaching you.
Q: You mentioned earlier, being a patient, and having a doctor that looks like you. And you echoed that again here, of working with other people that look like you. How does all of this impact the patient, and make the care experience for them even better?
A: So if a doctor doesn’t necessarily look like the patient, do you understand their cultural background? Do you understand that they may have mistrust in the healthcare system, and rightfully so? How do you navigate that? Are you able to connect with a patient who grew up in a different neighborhood than the neighborhood you grew up in?
Are you able to understand the person fully? Are you able to understand their social circumstances? Are you able to understand that they may not be able to afford a $60 dollar medication that you think is a breakthrough drug? But do you know that that $60 dollars might be the money that they need to buy groceries?
So it’s not—It’s a matter of patients like to see doctors that look like them. And we know there's better outcomes when you have a diverse workforce. But also, if the doctors don’t necessarily look like their patients, do you understand the different circumstances where a patient’s coming from? What are the things, the ideas, and the beliefs that have changed how they view medicine, or what their belief systems are?
So I think it’s important to have a —culturally competent workforce. And that’s more than just training, doing online training, and listening to lectures. It’s really getting immersed in these different cultures, and meeting patients that don’t look like you, that didn’t grow up like you, that might have challenges that you’ve never encountered, to really provide the best care for our patients.
Q: Absolutely. And I'm curious, how has this work changed from the beginning of your career versus now?
A: Well, the more advanced I get in my career, the more resources I have in general to say, this is what I want to do. These are the changes that I want to make. So I would say becoming more vocal. When you're a first year attending, you're not as vocal. You're a little more reserved, because you're still learning the environment that you're in. You're learning what works and what doesn’t work.
But the more I progress in my career, the more I'm able to say, this is what we need to do. These are the changes we need to make. And then, just my, quote/unquote Tribe has grown in terms of the students that I mentor, the students that I sponsor, and then also the support that I've received from faculty about the work I want to do.
And again, you just gain this confidence, as you grow in your career, to be able to speak up at meetings, to speak up when things don’t seem like they're going the right way, to speak up in things like transplant selection meetings, which are very biased process. But the ability to have that confidence, to speak up and have that belief in, in your purpose, it gets easier, the older you get in your career.
Q: Can you talk a little bit more about that journey, finding your voice, what tools you found have been helpful in developing that within yourself?
A: So I would say the more you speak up, the easier it becomes. So I am somebody that had really bad anxiety when it came to public speaking. And, you know, I would get these opportunities from the ACC and Heart Failure Society of America, and be really excited. But then, when the day came, I would just freak out. So I would say gaining that confidence, and being able to speak up without being nervous just takes work.
And I would say you just have to keep doing it. for women and men who have this fear of public speaking, and just speaking out in general, you just start small. You start in smaller meetings, where there's maybe four people. And then you go to meetings where there's 15 and 20 people. And then you just keep doing it.
And then, every invite that you get to speak up in front of an audience—and it doesn’t necessarily mean you're giving a lecture. It can also just mean you're asking a question in front of a bigger audience, just keep doing it. It gets better. It gets easier. I also think that a little bit of anxiety is good, because that means, that you're really passionate about something. And it gives you a little bit of a push to do a really good job.
We have this fear as women, and I've read about it a lot, that we’re afraid to speak up. We’re afraid to ask questions. Because for fear of looking quote/unquote stupid. But a lot of times, everybody in the room is wondering the same thing and wants to ask the same question. I've noticed a lot of times, when I speak up, and I have a little bit of maybe a two-minute debate in my head, like should I ask this question? Should I not? And I end up asking it anyway, I get a flood of texts like, “I'm so glad you asked that. I'm so glad you brought up that point.”
So just keep doing it. Keep speaking up. Make sure to do things gracefully. My leadership coach has talked to me about this thing called the amygdala hijack, when somebody says something and you want to react, give yourself a little bit of time. And then speak up later, and just be graceful when you're bringing up something that might be considered controversial.
Q: And you talked about mentoring earlier. What mentors have you had along the way, that have sort of led you to this point, and been really beneficial for you?
A: So I have mentors in every part of my life, I have different types of mentors. But my academic mentors are two. There's Dr. Joanne Lindenfeld, who I met at the University of Colorado. She is the one that actually sent me to Mass General. I was doing my advanced heart failure and transplant Fellowship there. And she said, “Hey. Would you consider extending your training and going to Mass General, and doing a research Fellowship?”
And at that point, I thought she was crazy. And I was like, “I need to get a real job. I need to start getting paid. Does she really think I need to do more training?” So she ended up connecting me with Dr. Jim Januzzi, who is here at Mass General. He is my second academic mentor. And I call Dr. Lindenfeld my fairy godmother, and Dr. Januzzi is probably my fairy godfather.
But they’ve helped me with the confidence, with that self-doubt, with the not feeling like I'm good enough or smart enough to be here, seeing the potential in me. And especially with public speaking, I remember having to give different talks. And there was one that I had to give in Paris. And Dr. Januzzi sat down with me, and we practiced and practiced and practiced until I was comfortable and confident.
So they have helped me along the way. And I think you can have excellent mentors. But if you're not putting in the work yourself, you're really not going to get very far.
But mentors play a key role. They’ve played a key role in my career development. And I would say Dr. Lindenfeld and Dr. Januzzi are really sponsors, sponsors are the ones that put you in the positions that will help you succeed. And they’ve done that. And I try to pay it forward every chance that I get.
Q: So I'm wondering if you can talk a little bit about how the confidence has played a role in the current stage of your career. Is this something that you're still working on, and you still find present at times in your life, and have to continuously work on?
A: Yes. So we talk about imposter syndrome. The biggest challenge in my life was coming to Boston. And I really understood what what imposter syndrome meant when I came here. I had no Ivy League training. I went to University of Cincinnati for undergrad and med. school. I did most of my training there. Then I went to University of Colorado.
And then I'm here now at Harvard, at Mass General, surrounded by people who have incredible track records, and have all come from Ivy League Schools, trained in Ivy League residencies. And I just felt that sense of I'm not good enough to be here. I'm not smart enough to be here. Did they make a mistake when they took me? So it was a very difficult time. And I just had to work on that.
And my mentors played a huge part. And I know it’s cheesy to say, people believing in me more than I believed in myself. But I really needed that. I really needed that encouragement from Dr. Januzzi and Dr. Lindenfeld, to say, yes, I'm good enough to be here. I'm smart enough to be here. There's a reason that I came here. Everybody can tell you that, “You're awesome. You're amazing. We’re so glad to have you here. We love the work that you're doing.” But I had to work on that myself.
And I remember reading a book called The Confidence Code. And I was blown away. I didn’t realize that all these women in high-powered positions had those same feelings of imposter syndrome. And recently, I read that Maya Angelou had imposter syndrome as well, and was nervous that one day, people would find out she was a fraud. So it’s something that’s real. It happens to women and men, but nobody talks about it.
So for me, it was realizing what it was, understanding that I had to work on my own confidence. but also talking to people about—especially my parents, and saying, “I don’t feel like I'm good enough to be here,” and getting that encouragement to say, “Look at what I've done. Look at the objective things that I've done.”
I was born in Saudi Arabia to a Sudanese father and an Egyptian mother. We grew up there as expatriates. We immigrated to the U.S. My parents wanted us to get the best possible education that they could provide us, and then did all of this training, and ended up here. So I have to look at the objective things.
And I remember winning this Excellence in Education Award by the Mass General Fellows, by the Cardiology Fellows. And I kept saying, “Are you guys serious? Like I really got this award?” Even that moment I couldn’t believe it. Again, it was an imposter syndrome.So it creeps up in a lot of times, but it’s gotten better the more advanced in my career I've become, the more I've worked on my confidence and knowing, yes, I deserve to be here. I belong here, regardless of what my background training was, there's a reason that I'm here.
And so it’s really changed how I look at the world. Because when I'm interviewing candidates, I say, this sounds like somebody like me, somebody that maybe didn’t have all the research experience coming in to Harvard and Mass General. But they have potential. And I would love to help them grow into that potential. And it’s a continuous process.
I talk to people that are full professors at Harvard, and they're world-renowned experts in their fields. And they still say they have imposter syndrome, or sometimes they feel less confident. So it’s a continuous journey to keep trying and making yourself better and more confident and more secure in everything that you're doing, while also remaining humble.
Q: And I know there must be moments, and I think we all can relate to this, where you just, you remember the things where something, accomplishment happens. You get acknowledged for something, and your mind automatically goes to that sort of, “Do I deserve this?” Are there any moments in your career where you found that your reaction was more of a, “Yes, I deserve to be here”?
A: I recently got invited to speak at the Heart Failure Society of America. And I said, “Yes, I deserve to be here. Let me look at the other panelists that are there. Let me look at what they’ve accomplished, what kind of papers they’ve written.”
And I said, “You know, I've worked hard, even though I have to get this out of my head. I keep saying, I'm only in my fourth year as an attending.” It doesn’t matter. I've worked my butt off. And I continue to work my butt off. So yes, I deserve a seat at the table. And it’s not just because I came from Mass General, that I'm getting these opportunities, because there's many people, from many Ivy League institutions.
But I do get that feeling, yes I deserve this. A big one was when I got promoted from instructor to assistant professor. And it happened very quickly. The system at Harvard is almost impossible when you're going through the promotions process. It’s very challenging. And I just felt like, wow. I've put in all this work. I published, a bunch of papers. And I got to speak at meetings. So I do deserve to get this promotion. And I'm working on getting my next one.
Q: And with your mentees, how do you have this conversation? How do you start it with them? And do you sort of relay a lot of your own experiences? Or do you have a way of approaching it with the people that you mentor?
A: Oh, I'm very transparent. I talk about everything. I talk about the good times. I talk about the bad times. And I talk about like some of my lowest moments. I think people look at us and expect us to be super heroes, expect us to be robots, to never fail, to never make mistakes, to never, you know, break. But it’s such a bad way to look at us. We’re just human beings. And we have some of the toughest jobs in the world.
So I make sure, first of all, when I'm deciding who I'm going to mentee or mentor and be able to work with, you have to make sure that your personalities align. We can have similar research interests. We can have similar social interests. But if our personalities don’t vibe, I find it very difficult to mentor. So usually just starts with a meeting, introducing ourselves to each other, making sure that we vibe personality-wise.
And then, I'm very transparent with the struggles I've had in academia, with the struggles I've had even outside of medicine, with my dating life, with, friendships, with any really sort of thing that I've gone through. And sometimes, people are afraid to speak up. Because in medicine, again. Nothing is supposed to affect you, which is a really convoluted way of looking at things.
And so, when I start to notice the signs, whether it’s anxiety, depression, lack of interest in what they're doing, I just make sure to reach out, make sure to sit down and have these transparent conversations. I also blog about challenges that physicians face, especially with physician wellness, depression. I talk about suicide and things that we normally don’t talk about.
So I like to teach people by telling them, “Learn from my mistakes. Learn from my struggles. Learn from my challenges. That’s what I'm here to do, to tell you this is normal. I've been through it. Let me tell you how how I survived these challenges, whether it was sexism, discrimination in any other form, in medicine, or just the feelings of inadequacy and anxiety and depression, because all of those are normal for people who take care of really sick patients like we do.”
Q: And it sounds like you're really good at recognizing things within yourself when this imposter syndrome arises. And you mentioned that you can notice this in your mentees as well. But what are some of the manifestations of this, that you notice in your mentees, that help you sort of initiate this conversation with them?
A: So sometimes, it’s that they're hiding from me. I notice that they're canceling meetings. They're not showing up to meetings. And then, just their demeanor has changed when I run into them in the hallway. They're not reaching out. They're canceling when we set up dinners outside the hospital, to just check in and go over things. So that’s when I know somebody is struggling.
Usually, they try to avoid the conversations. But it’s easy to get them back on track by saying, “Hey, let’s meet up. Let’s talk about your career.” And so that’s how I frame it. I say, “Let’s talk about your career. Let’s talk about what the next step is for you.” And then I get them to sit down with me, and I end up talking about everything but career. “Tell me what's going on in your life. How are you sleeping? How are you doing? How’s your social life? Have you made friends in Boston? Have you seen your family? When have you taken a vacation?”
So—And usually, you just see a sign of relief. Like they’ve been waiting for somebody to ask them like, “Hey, how are you actually doing?” Not, “How are you doing?” “Oh, things are fine. And work is fine. And I'm doing okay,” but really I'm on the verge of a breakdown. I just notice the things that I have been through myself, and the way I've tried to trick people into thinking I was doing okay, and just calling it like it is.
And use my voice, and use my platform.
Q: And you talked before about this perception of being a super hero, and that you have to be able to do it all. So how have you been able to maintain just your overall wellness, and also help your mentees do the same?
A: So let me tell you about my lowest point. Because I think when I reached rock bottom, is when I said, “It’s time to really take care of myself.” Because I thought I was doing awesome. I have an amazing social life. I exercise. I'm eating right. Life is so good. But my lowest point happened in the fall of 2015. That was the summer I moved to Boston.
I was moving here from Denver. And this city is outrageously expensive. So I'm living in a small apartment, on a Fellow’s salary. Everything’s expensive. I don’t have any friends. I broke up with my boyfriend at the time, because he didn’t want to move to Boston. And I wanted to come here. And, you know, you don’t always get a chance to come to Harvard. So I chose Boston over the relationship. And it ended very badly.
I remember, 2015, that summer was fine, because people were visiting me. The beaches are amazing. Then the fall comes, and now less people are visiting. It’s cold. The days are short and dark. It’s dark when you go to work. It’s dark when you come home. It was starting to become winter. And I was just so depressed.
I didn’t have friends here. I was at Harvard, and I didn’t feel like I was smart enough or good enough to be there. Imposter syndrome was at an all-time high. And I knew I was depressed, I slept all the time on my days off. I was miserable here. I was, re-considering my decision to come here. I was crying all the time.
And I just remember specifically, there was one day I was walking to work, and I was in the middle of a big intersection. I said, you know, like what if I just stepped out into traffic and got hit by this truck? Then I wouldn’t have to feel how I'm feeling right now. Like that’s how much pain I was in. And then I said, I have to rescue myself. I have to save myself.
And I had already looked up counseling services at Mass General, because I knew I needed help. But I was just so terrified of getting help. And I didn’t want to tell my parents. They live overseas. So I didn’t want them to freak out. And I didn’t want to scare my siblings.
So the first thing I did, after I walked through the intersection, of course I'm still here. So I didn’t do it. I didn’t walk into traffic. I just went straight to employee assistance. They were super helpful. They helped me navigate the situation with my ex, who ended up leaving me alone. I got connected with a therapist, who’s still my therapist. I think everybody should get a therapist. I love her to death. We work together. I talk to her maybe like once a month now.
But it was just a wake-up call for me to say, I have to take care of myself. I have to save myself. Nobody is going to save me. And that was my lowest moment. It took me maybe two to three months. For me to feel like myself again.
And it was tough. I've never really publicly talked about that incident of walking into the intersection, and thinking, like, I would rather get hit by a truck than be here. So it’s hard for me to share that. But I think sharing it helps other people say, “This is normal. We’re just human beings. We are trying to do the best that we can. And we take care,” especially in advanced heart failure and transplant, we take care of the sickest patients.
So it was a lot of things. It all kind of hit me at once. And so that was my cue to say, I'm taking care of myself. So wellness has always played a big part.
And the way I look at it is, if I'm not well, I can't take care of patients well. I can't write good papers. I can't do the things that I love to do, and you know, be kind and nice to my parents and my brothers, and just everybody around me. So if I'm not doing well, everything else falls apart. And so other than therapy, that I think everybody should take, I always say, make sure to have a life outside of medicine.
Most of my friends are not physicians, are not in healthcare. When I leave the hospital, I don’t want to talk about medicine. So my friends tend to be artists, lawyers, educators. I do have medical friends as well. And then having things that you just love doing.
I'm in a business academy to learn about all the things they don’t teach us in medicine about business. And then, really just having a core group of family and friends that I can count on, so when I do have my low points.
And then another thing, with wellness, too, is being your authentic self. So bringing your whole self to work. I can't imagine trying to be somebody else or putting on a show every time you come to work, whether it’s braiding your hair, or keeping your hair curly, or speaking a certain way, I just feel like putting on a show like that is just exhausting. So making sure you're in an environment where you're able to be yourself, speak up, feel comfortable, that’s part of wellness.
And then, I also look at things, like what am I going to say yes to? Because when you're a junior faculty member, you get all of these opportunities. And people want you to do everything. So you have to decide. What are you going to say yes to? So I look at it in five ways. I say, is it going to pay me? Is it going to promote me? Is it going to push me to learn something that I'm not good at? Am I passionate about it? Or does it align with my purpose?
So I think about all those things whenever I'm asked to do something. And that’s part of wellness, too, creating these boundaries for yourself, what you're willing to put up with, the type of work that you want to do, and what kind of energy you want to put out in the world. So you just have to make sure the most important person in this whole journey is you.
So it’s always, like, we have to make sure to take care of ourselves, and to speak up about things that we’re going through. Because more often than not, somebody else is experiencing the same thing. And we saw that with COVID. You know, doctors are suffering depression and anxiety. And, we’ve heard of suicides, with physicians taking care of patients that had COVID. And again, we are placed in an environment, and in a workplace that we weren’t used to before.
So just speak up. I don’t think there's any shame in opening up about how we’re doing, and the steps we’re taking, to protect ourselves.
Q: First, thank you so much for sharing your story, truly. I just think so many people can relate to that. So thank you so much. And you started to touch on COVID. So I would love to hear a little bit more about wellness during the past few months, and what you’ve seen in yourself, and what you’ve seen in your colleagues.
A: So I'm lucky I work at a place like Mass General, because they had a lot of resources, for free counseling, they had group sessions that you could attend to debrief about things that were going on around us. We had lots of free food delivered to us. The pandemic was especially challenging for me, personally, because I live alone. I live in a one-bedroom apartment, the usual single Boston living.
And so I felt really trapped. I felt better coming into work, even though everybody was concerned about exposure. And I ended up getting a health coach. She helped me with setting up at-home fitness, at-home classes. And we checked in once a week to make sure that I was doing what I was supposed to do. Connected with people as much as I could via Facetime. Going out, taking walks.
And again, remembering why we went into medicine in the first place, and it’s to heal, to help patients, to help people. I think we had that opportunity during the pandemic, more so than ever. It was all about, how do we take care of ourselves, and also of patients? So I just had to pivot.
The things that I was used to doing for fun, going to the gym at five a.m., going out with my friends, going to Galas, going to events, and going to restaurants and bars, all that was shut down. So I just had to think of different ways to do things. Go outdoors, take a walk, Facetime people that I hadn’t talked to in a really long time. And just try to get through it.
And I think a learning lesson for all of us, for what's actually important in life. And that is human connections. And how we take care of each other, and how we look out for each other.
Q: And I wonder if we can kind of go back to where we were in the beginning a little, too, just talking about your work fighting disparities in medicine. In the setting of COVID, how the pandemic really impacted your work in that regard.
A: I think COVID just opened up our eyes to how bad the inequities are. So the work I'm doing hasn’t changed at all, I think my role and my goal is to be the pipeline to identify high school students, middle school students, college students that are interested in medicine, and help them navigate that journey into getting into and staying in medicine.
I've also been researching ways that we can improve transplant equity. Because if you look at heart transplant specifically, there's lots of inequities in organ allocation, meaning black and Hispanic patients are less likely to receive heart transplant than white patients. And so back to work that I've been doing and working on, how we can actually make changes to improve those inequities.
Because of COVID, I would say more people are listening. More people are willing to put resources to research, to reduce inequities in healthcare. In the heart transplant world, we are looking to build outreach clinics. So basically, these would be advanced heart failure clinics in black and Hispanic communities, places where we have not had advanced heart failure clinics before, to identify patients in those communities that do need evaluations for transplant.
So we would see the patients in their communities, optimize their medications. And if their hearts still don’t improve, then we would bring them to Boston and do a formal evaluation for heart transplant. So that’s an actionable thing that we have been speaking with Dr. Bettencourt and others, to get funding to do. And there seems to be interest there.
And so my work hasn’t changed. It’s more so that people are willing to listen, and people are noticing. I think the people that have been advocating are just speaking louder, or I would say screaming louder. I wrote a blog recently. And it said “Black Lives Matter. Doctors, we need to talk.” And I don’t think anybody would have agreed to publish that, especially in these big medical societies, if it weren’t for the current states of the pandemic, and then also recent racial disparities, in terms of police brutality, and everything else going on around us.
The pandemic brought out the inequities. And also, at the same time, we had several instances of police brutality against black men, and that people started listening and talking more so than they had. But it’s not just important to create committees, and create positions and titles, it’s important to say, “So what are we going to do about it?”
It’s amazing to stand in front of the hospital, and kneel, and hold a sign that says “Black Lives Matter,” or “White Coats for Black Lives.” That’s amazing. But what do you do next? Are you creating a program where we’re bringing high school students from black and brown communities that are interested in medicine? For me, I'm doing my part by saying, okay, I'm going to establish these heart failure clinics. And we’re at the stage where we’ve already presented the proposals. And there's interest.
So we’re going to build these clinics so we can find black and Hispanic patients that have end stage heart failure, that need to be evaluated for transplant. So it’s more so what each of us is doing. We each have a role to play in our respective fields, whether you're a teacher, whether you're a lawyer. And especially if you're a physician, look around you. What can you do? We each have a responsibility to say, “This is wrong. This is how we've been doing it. But how can we do it better? And what small step can I take to make things better?”
Q: And what do you think needs to happen to sort of keep that momentum, keep that conversation going?
A: I’d say keep speaking up every opportunity you get. Especially people that have the platforms, whether it’s social media, whether you're speaking up, in a big meeting, where your audience is huge, or you're in a small meeting, and somebody said something, doesn’t quite sit right with you. Make sure to speak up. I would say we need the societies to give us money to do this work.
And we don’t have to keep publishing. We don’t have to keep publishing data that shows us, oh, there's inequities in heart transplant. There's inequities in hypertension management. Now we need the funding to say, what are we doing to fix that? We need people to stay engaged. We need people to continue to speak up every opportunity you get. And I would say it’s all of our responsibilities.
So I don’t want this hype with racial disparities and health inequities to just be, oh, everybody’s excited about it now. We have to continue to carry that message forward. And I think it’s everybody’s responsibility.
Q: And working with the types of patients that you do, they're experiencing very challenging medical situations and conditions, I'm just wondering how has that sort of changed your own perspective?
A: So for me, heart transplant is the most amazing thing. And I remember, when I got to the University of Colorado, on the first day of Fellowship, my program director said, “This year is going to change your life.” And then I didn’t understand what he meant. And by the end of that year, I totally understood, because transplant is something so incredible. So you see,the two extremes. We see life, and we see death, up close and personal.
So when you're on heart transplant calls, or you're on donor call, you receive a call in the middle of the night, it’s always in the middle of the night. And they say, “Oh, there's a heart in New Hampshire, or there's a heart in Vermont.” And so you end up, up out of bed, and getting your laptop out. And you're looking up the details of all these donor hearts. And then most of the time, these are unexpected deaths. And they're young patients, and they're young people.
And you're thinking, you know, who is this? Where did they go to school? What kind of work they did? And so you're forming this picture in your mind about who this person is that, that lost their life. How is their family coping with this? So you're dealing with death up close and personal.
We’re dealing with death on a very personal basis, on a very up close and personal basis.
But then, on the other end of it, we get to call one of our patients that has end stage heart failure, and is essentially dying. And the only way that they’ll live is if they get a heart transplant. So it’s the two extremes. We’re dealing with death on the one hand, and you're thinking, they weren’t expecting this. What a tragic loss.”
And then, on the other end, you get to call a patient and say, “Guess what. We found a heart. And it’s suitable. And we think this is going to work out. Come into the hospital.” And then you're getting these reactions, sometimes they're crying, sometimes they're just dead silence. Sometimes they can't believe it. But they have their bags packed, and they're ready to come in. So it’s seeing the extremes of life and death.
And I always tell my transplant patients, they get to celebrate two birthdays now. So when they were actually born, and then, when they got their heart transplant. Because now they have a second chance at life. So you know, being on both of these extremes, you just look at life very different. And that’s how I would say what I do changed my life.
You stop sweating the small stuff. You realize what's important in life. You're really less worried about the materialistic things, and more so the connections that you make with other human beings. And that your happiness is of the utmost importance. And, just to make sure that you're actually doing what you want to do in life. You're not just doing it because somebody expects that of you. Make sure that you're actually living your life how you truly want to live it.
Q: Great. Thank you. And then I just have my final five questions. So the first one, what's the best advice you’ve ever gotten?
A: Never change. Always be your authentic self.
Q: What rituals help you have a successful day?
A: I have a power hour in the morning, where I meditate for 20 minutes. I journal for five minutes. And that’s just free journaling. I open my notebook, and I just write whatever comes into my head for the next five minutes. And then I work out for 30 minutes. Now that I'm not able to go to the gym, it’s just a home workout. Listen to music, and then I come to work.
Q: Great. If you weren’t a doctor, what would you be?
A: My dream job is to be a talk show host. And I always say, I want to be a combination of Oprah, Sanjay Gupta, and Charlemagne tha God, all in one person. [laughter] And so, in October, my brother and I are going to do a show, a weekly show on Instagram, where we’re going to be talking about everything from medicine to basketball to hip hop to whatever. So doing things that you really love.
Q: What advice would you give your younger self?
A: Be confident. You deserve to be where you are. You belong where you are. Believe in yourself more than anybody else believes in you.
Q: What's the best decision you’ve ever made?
A: Coming to Boston. Agreeing to extend my Fellowship training by two more years. It completely changed the trajectory of my life and my career.
Q: Do you have any guilty pleasures?
A: Reality TV shows. I say I watch mindless reality TV shows. I have watched Selling Sunsets, and I dream about owning one of those homes that they have on the show. I watch Real Housewives of Atlanta. And I listen to trap music. People always say it’s not real music, and it’s just a bunch of garbage. But it motivates me. And I love listening to trap music.
Q: That’s awesome. My last question. What do you consider your super power to be?
A: Intuition. I'm really intuitive. And my first thoughts about a situation and a person, or whatever it is, are always the right one. And I need to learn how to trust them. I really, you know, I can tell, right away, when I meet somebody, whether or not that relationship is going to continue as a friendship, or a partnership. I'm just a very intuitive person. And we always look back and laugh. And we say, “You knew it. You said exactly what that person ended up to be like. We should have just listened to you.” So I think that’s my secret super power.
Q: That’s awesome. Thank you so much, Nasrien. It was such a pleasure having you today. Really appreciate your time. Thank you so much.
A: Thank you. This was awesome. This was very awesome. And I can't wait to hear it.
Q: Thank you.
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