Season 01: Episode 01: Dr. Valjean Bacot-Davis Transcript

Queer Diagnosis Podcast

Season 01: Episode 01: Dr. Valjean Bacot-Davis Transcript

[Theme music plays]

Interview

Zarya: Hey, welcome to Queer Diagnosis. My name is Zarya, and my pronouns are she/her/hers.

Srihita: My name is Srihita, and my pronouns are also she/her/hers. Our first guest today is Dr. Valjean Bacot-Davis who is a third-year medical student at the Renaissance School of Medicine at Stony Brook University. Zarya, do you remember how we met Valjean?

Zarya: Back in March, there was a meeting for a club that I wasn't a part of. I heard there was food, so I asked Srihita to go with me and wait outside. It turned out that I was the only person who represented the club along with nine medical students. Valjean was one of the medical students who witnessed me and Srihita kidnapping a family tray of eggplant parmesan in the meeting that turned out okay. Months later, I came across your website for LGBTQ+ Care at Stony Brook Medicine and saw Valjean featured and decided to reach out. Valjean, could you please introduce yourself with your preferred pronouns?

Valjean: Hi, my name is Valjean Bacot-Davis. I don't know if I'm technically a second or third-year medical student. Things have been weird with COVID with them keeping us going through the summer. But let's just say I'm starting my clinicals soon. And my preferred pronouns are he/him/his.

Zarya: Great, and you just mentioned that you're starting your surgery clerkship soon. I was wondering if you plan on asking fellow providers and patients for their preferred pronouns. I've met individuals who become apprehensive when asked for the pronouns as an Emergency Medical Technician (EMT). So I'm not really sure if it's socially acceptable yet to ask patients in particular, what do you think?

Valjean: That's a great question. And I feel two ways about it. I have pronoun pins. So I think wearing my pin as well as the rainbow sticker or a trans lanyard really helps open the door for conversation for people who want to have a conversation. But I also worked as an EMT, and I did confuse a lot of people by asking them their preferred pronouns. And I feel like that kind of interrupted our, I guess, care relationship. So I just hope that my pins are enough even though I would prefer to ask everyone.

Zarya: I think that's interesting when you say it affected your care relationship. In a poor way? In a good way?

Valjean: Okay, so I also volunteered on a needle exchange van in Albany where we would work with people using intravenous drugs and I would give them the needles, no questions. I remember they changed the form where we had to ask everyone their pronouns. And I asked this one older white gentleman his pronouns. He got, "Can't you see I'm a man," like I was questioning his masculinity, and I guess, part of patriarchy is virility to some extent, so he got really upset and just took the needles and left in a huff. So that was not the best time to ask someone their pronouns. And then yeah, I've had people open up about how they're more non-binary. And they're happy I asked them because no one else asked them. I was with a teenager, and their parents didn't really acknowledge their non-binariness. So I've had it work out both ways. There's some people that are happy, and some people who get angry.

Zarya: Okay, that's pretty good for me to know too because I've experienced that myself - when I ask a patient for their pronouns. They get very confused about what I'm asking for and then I have to explain what pronouns are, especially with some of the older population that I've met with. So do you recommend wearing your pronoun pins now as you're going into your clerkship?

Valjean: I plan to. It's a bit harder with surgery because everything has to be sterile and your scrubs. But, when I'm outside of the OR and say rounding on patients I plan on wearing my pronouns pins.

Zarya: And what about with providers? Have you ever had that conversation with them as well as to why you're wearing the pins?

Valjean: Not with providers, I would say. As far as the internal medicine pediatrics group, they have done a training on gender identity. And so they kind of understand why I'm wearing the pins. It's a hit or miss. Some of the newer residents from other institutions haven't had the training yet, so they're a bit more confused, especially about they/them pronouns. But I would say all the attendings, they also wear rainbow pins because they've had the training where they hand them out before. It's nice to have a lot of good allies and stuff.

Srihita: You mentioned that still on the forms, it has you ask the patient for pronouns and stuff. Do you feel like right now most forms kind of take into account different gender expressions?

Valjean: I know Stony Brook just changed their electronic health records to add they/them pronouns, or just leaving it blank. I think that happened over the summer, actually. So there's a way to go in. There's a way to go in and put someone's preferred name as well. The only thing I don't like about the system currently is all public paperwork is going to print out their legal name and on their wristband. So when they're being admitted, it's going to have their legal names. I wish there was a way to add their preferred name to that documentation.

Zarya: Okay, yeah. So is there another improvement along - how would you enforce that improvement? And how do you see that being implemented in the future?

Valjean: Yeah, so that's a good question, too. Whenever I was living in Wisconsin, my family doctor had my preferred name (this was before I legally changed my name) in parentheses and everyone just worked off that. And then also have the phonetic pronunciation so spelling out phonetic pronunciations. I would like to add that. So a system like that. Even though I prefer the legal name to be the one in parentheses instead of the preferred name because the parentheses is kind of where you can maybe call them this. And it's like, no, it should be bolded with someone's preferred name.

Zarya: I'm even thinking about the paperwork that we have. As an EMT, we have the physical copies of the paper, not really digital. And there's not even an option for preferred name. So I couldn't even ask that. I mean, I could ask that question and potentially have that miscommunication. But I really wish that there was a system for us to do that as well.

Valjean: We actually worked with electronic records in Albany when I was working for Mohawk Ambulance, but they didn't have a place for preferred name either. You could put it in parentheses if you want, but then you might confuse people later on. And then for gender, they have males/females and for "other genders" if you left them both blank, they were like, “We'll figure it out later.” But I mean, that was their workaround at the time. I think that newer systems have more options available which is good.

Zarya: So when you're filling out paperwork, do you ask? When you're filling out specifically gender? Do you do it based on apparent gender, or do you always ask for gender? Because I know you mentioned sometimes you might not ask but, with non-binary patients, you do somehow get that question in.

Valjean: I would say it depends. Normally I have a history of these patients, so you can go back to their charts and see what else has been entered. Whenever I was doing my immersion with pediatric endocrinology, I would specifically ask, but I would normally have to have some kind hints that it should be a question I ask. But I know Dr. Ellis asks all her patients their preferred name, preferred pronouns, and it takes like a second. And most of the youth know what you're getting at. It's not awkward for them to answer either way.

Zarya: So what does queer mean to you?

Valjean: To me personally, because I know it might - it means a different thing to pretty much everybody. But to me personally, it means that I'm some kind of minority whether it be gender, sexual orientation, or I don't fit neatly into a box. So to be LGBTQ, all that encompasses queer, but maybe I'm non-binary or maybe I'm pansexual. I don't really feel represented by those few letters. So then I have to either explain I'm pansexual, or that I'm queer, just like a minority of some kind, according to heterosexual patriarchal dominance.

Zarya: Do you use that term yourself (queer)?

Valjean: Yes, I identify as queer because I think it's the fastest way for people to know I'm a member of the LGBTQ community. Some people read me, before I transitioned, as a lesbian. After I transitioned, a lot of people read me as a gay man, which is hilarious to me. So I think a lot of people don't really know where I fit. If I just say I'm queer, then they know I'm one of those, but I don't want to put myself in a box most of the time.

Zarya: And for our audience who doesn't know what you mean by transitioning, would you mind explaining if you're comfortable?

Valjean: Sure. I was assigned female at birth. From a young age, people could kind of tell that I was more tomboyish, more drawn to traditionally masculine things. And then when I was an undergrad I came out as non-binary, and then later on, as a transgender male. I identify as a male. I started hormone replacement there for about two years, and I socially transitioned. Changed my name as well.

Zarya: I do want to note that - I was actually telling a friend that I was really excited about having you specifically as a guest because I remember that you were really great during that meeting in March when we were stealing eggplant parmesan. But just in general, my friend just had top surgery. And I was like, yeah, we're hosting someone who is also trans. And they're really excited to see that they're not alone in this.

Valjean: Yeah, sometimes it does feel very lonely because I just have to jump through so many medical hoops to be my authentic self. If you want to have surgery, if you want to start hormones, which can be isolating. It was nice to meet other trans older siblings who kind of helped me figure out the process along the way.

Zarya: How did you find those individuals?

Valjean: I was very involved in the LGBTQ Centers that I was at at the time. I went, I did my undergrad at Duke. So then I found my way there. And it took a lot of courage because I grew up in a very conservative family. So I was, "Oh, I don't know, who I'm gonna meet there, what they're gonna be like, who's gonna see me there." I was very nervous. But I'm glad I went, and I met people there. Then I did my graduate studies in Wisconsin and I found the LGBTQ Center there. And that's where I really met my first trans male friend. I basically figured out what it meant to be trans. I was like that really fits me more than anything else. So he kind of helped me embrace my identity and figure out the process to get what I wanted done.

Zarya: Yeah, I think that's pretty encouraging that at Stony Brook University, for instance, we do have the LGBTQ+ Center that they put out a lot of videos. And I'm surprised that I've heard about this pretty much in orientation and newsletters. We actually even had - I used to be in charge of our Hall Council - and we hosted a meeting for individuals who are misgendering because I heard that it was something that was happening pretty often. And also, as part of Hall Council, I used to spend a lot of time in our lounge, and I heard the word gay being thrown around pretty loosely. And I don't think that individuals really recognize that for some people, it may be out of good humor, but it doesn't register like that. So if you were in a situation where you're hearing the word gay being thrown around pretty loosely, and whether that be specifically in the workplace, what would you recommend? What would you do?

Valjean: I read a good article about how patients might also be using language that's derogatory, to how you identify. And the paper had like three or four different ways to approach it. But the method [that] I think fits better with my personality is to just say, "Oh, I'm surprised you feel comfortable. You think it's appropriate to use that language around me." Just to let them know that I don't feel comfortable with it and that there are probably other people who also don't feel comfortable with using it that way. And it's a nice way to kind of make them just think about it, instead of just saying you're a horrible mean person by using that language.

Zarya: What's usually their response?

Valjean: Usually, it's just “Oh.” And then they kind of say, “Oh, I didn't mean it that way.” They always kind of rationalize it. But then at least you've set that boundary that even if they think it's okay, when they're around you to think twice about using it.

Zarya: I'm actually in a similar position right now in the workplace where I'm at. It's so many people who use it, and I feel like I'm the odd one out who would say something of that sort. I really want to, so I think that's really encouraging to me that there is a way. I'm definitely gonna use that in the future. So can you tell me about a patient that you chose to disclose your identity with, and tell me about a patient who you felt would change their opinion of you for the worse if you did?

Valjean: Sure. So, I'm in a three-year program. We had an 8 to 10-week immersion in our specialty choice, and I'm medicine and pediatrics combined. I did have to go half-pediatrics. Whenever I was with pediatric endocrinology, I was with an attending who loves to work with trans youth. Whenever I was with her, she was working with a trans male adolescent who was just starting hormone replacement therapy, which is super exciting to me. Still remember how exciting my first shot was. So we were running about an hour and a half behind - a lot of people are upset. So I was like, “Oh, can I just go in with him and just chat with them about what to expect?” because he was there to learn how to give himself a shot and do it for the first time. I went in there and disclosed basically the reason that I was in there and asked him if he had any questions just about non-medical things or medical things like what to expect that certain providers might not know about. So that was fun. And he really appreciated it. He was there with his dad. His dad appreciated it. It felt really great to help. And as far as a patient that it would change their opinion of me: I would also say on the pediatric side, some parents will disclose that they're not really comfortable with the LGBTQ community. And in that way - you know I go in with a rainbow pin on. So in a way, they're already kind of telling me to be wary of them. That's always kind of awkward, too. You just go in there, you do your exam, do everything you have to but you say, “I’m probably not going to make a personal connection” like I do with some other patients for this particular patient and their family.

Zarya: I think it's pretty bold that somebody would see that pin and then still tell you that. That's a very uncomfortable position to be in. I don't understand. Has there ever been a parent who asked to switch providers because of that?

Valjean: There have been people who have just asked me to wait outside because as a medical student the attendings like getting you in there. But, the patient has a choice as to if you’re there or not. So if they feel more comfortable without me in there, they'll ask me to wait outside. And then normally the attending I'm with will apologize and say, “Wait outside, and we'll talk about the case later.” And that's the best you can get out of that situation.

Zarya: Yeah, and I also know in general, too - as a medical student - I'm sure some people in general just, they're like, “Ah well, they're medical students. So maybe we'll put them outside.”

Valjean: Yeah, that’s true, too. You’ll just get a patient who doesn't want to deal with medical students at all. And, yeah, you have to take that gracefully as well.

Zarya: So are there any blind spots that you see in medicine that your peers may not as it relates to being transgender?

Valjean: Well, it has definitely. So for my class, we do these live practice patients, and one of the scenarios is that the patient was trans. And I picked up on it right away; they had their preferred name, and their legal name back-to-back. There are some students in my class who didn't really get the premise that the patient was trans. I believe the patient was a trans woman. So they were confusing a trans woman with a trans man. They didn't really know the difference, and they didn't know any of the terminology for the surgery. I was just surprised that in 2020-2021, there could be young adults, old adults who didn't know more about the community. That's definitely a blind spot. And I'm glad they had us go through that process to hopefully remediate some people's lack of knowledge as far as that goes. And as far as providers go, I have an eight-month-old, and we're raising them non-binary. One of the pediatrician residents didn't really understand that we’re using they/them pronouns and kept misgendering our baby. Then, when we came back, three months later, he was using them. So I'm glad that he actually took the time to probably practice to help. And that was nice to see some changes happening. But that was another blind spot.

Zarya: Congratulations!

[Laughter]

Srihita: Do you feel like the curriculum that you’ve been studying adequately kind of covers different sexualities and different gender expressions so that the generation of providers are going to be better prepared?

Valjean: Unfortunately, no. I would say our class is trying and the class before us is trying, especially for our endocrine and reproductive course where they didn't even have us - I would say it starts with anatomy. First day starts with anatomy where I would prefer a slide to say that, you know, gender is a spectrum. But for the sake of anatomy, we're going to call this male and this female. We know that there's a wide range out there, but there was nothing there. You just come in this and “this is a male and this is a female.” It’s surprising to me. A lot of other students drafted proposal changes about how to change their course to be more inclusive. So hopefully, it’s a fact that we have to take seriously and make some changes. We'll see.

Zarya: It's encouraging that you guys are proactive about this. I'm actually surprised that you mentioned just having a patient who was a trans woman, and people weren't understanding that. Personally, when I was in high school - that was my first exposure to the LGBT community in general. I’m from New York, so I imagine that for people who are from states that maybe aren't - well, I shouldn't say states - but from places that are more conservative and don't have that exposure, I'm sure it would be a transition for them as well. But not one that can't be amended by reading up on the topic.

Valjean: Definitely. In our ethics course, we read a paper about how exposure to the community makes people more understanding. And, as a member of the community, it seems like extra work that I don't always want to do. But it's nice to know that seeing more people like us does help some people come around. Maybe they grew up a certain way, and that's all they knew. It's really just something different that can change their mind, which is promising.

Zarya: You said it feels like work that you have to do. Why does it feel like it falls on to you?

Valjean: [Laughter] I said it's like I sometimes don't want to do work that falls on me. I just feel like being a member of the community, I know so many stories. You have a specialized knowledge that you can either share with people or teach yourself. And for me, I feel like I personally need to share what the best way to get through the day is, so that maybe people don't have to go through what I went through. Because, you know, I want to “leave the world a better place.” It’s really authentic for me where I don't want people to jump through the same hoops that I had to get to where I'm from.

Zarya: So what is something that people tend to misunderstand about you as a medical student? And when you see that people are perhaps being mistreated because they don't understand that identity?

Valjean: Sorry, repeat the question one more time.

Zarya: [Laughter] What’s something that your fellow medical students misunderstand about you while you are trying to explain to them this is the best approach for a patient who is transgender, for instance.

Valjean: I would say I was surprised by people who just don't understand respecting pronouns. I don’t think it would be a discussion to say this person’s preferred pronouns are female, so use them. But it has been. Some people don't get it. And then I explained to them, “How would you feel if someone kept misgendering you?” And then they normally fall into two categories: They say, “Oh, it wouldn't affect me at all.” For those people, I might just start misgendering them on purpose. Then they realize it really does affect them, it is important, and then they change their behavior later. And other people, they get it automatically, right away. And they’re like, “Yeah I wouldn't like that at all.” It's a person-to-person-dependent thing. But I would say that's the main thing that also surprised me because it's not hard to use someone's preferred pronouns or at least try to practice it. But some people don't want to.

Zarya: I'm in a class right now called Gender Theory or actually Feminist Theory. My professor has pronouns they/them. I’m in the class with my younger brother, [for] who this is his first exposure to someone with pronouns they/them. He's really struggling with the grammar of it. So he's trying his best. I see my friends, for instance, identify as they/them so I've had that exposure for close to two or three years now. And for me, it's not something odd to do. But I see that my brother, who I guess his school didn't really have as many individuals who identify as trans or really just don't have as visible a queer community, he's not really sure how to approach [pronouns], and he feels really bad about misgendering. I see that he's making that effort, and I don't think I've met somebody who's ever been opposed to using the correct pronouns. But I also think it goes back to that conversation of “Do you ask for preferred pronouns?” because as soon as you do, for instance, with those people who are throwing around the word gay around the workplace, they feel like they're being seen. And you could see that there's a change in their behavior. So I definitely see what you're saying. So when it comes back to disclosing your identity with certain patients, what does physician privacy mean to you?

Valjean: Physician privacy means to me personally that it's your choice (how much you disclose). It means to me that it's your choice who you're gonna disclose to, how open you're going to be with your patients. I had a family physician, who identified as a gay man, but basically didn't tell any of his patients unless he knew you're also a part of the LGBT community. So I thought that was interesting. Other people don't come out at all to their patients. And I want to say that I observed it to be a generational thing. Whereas normally, like, the older providers who identify as gay men, normally aren't as open, and a lot of the younger providers are completely open about it. And I guess it depends on how out you are to your family. Because not everyone's completely out to their family. Yeah, there's so many different factors. But for me - this is an interesting thing I don't tell most people - I lived in what's called stealth for about a year. After I transitioned, I didn’t tell anybody. I got a new job, I moved to Canada, a completely different country, totally different network. No one knew. And I won't get into what basically forced me to come out besides to say some sexist stuff, obviously. But for a year, I lived without telling anyone, and it was very different. People saw me differently, but I prefer my life being out in the open. Because it is a big part of who I am, and what I want to do. I want to work with the LGBTQ community. So I'm glad I'm out again.

Zarya: Thank you for sharing that with us. I think that that's so important, even just hearing about -. Well, of course, it's your preference to come out. But the fact that you feel you're happier being out, is that a good way to phrase it? That you feel more comfortable being out?

Valjean: Yeah, I was gonna say it's definitely less than mental work. Whenever you go stealth, you have to change bits of your past. Because you're raised as a different gender, you probably had experiences based on being raised that gender. So when people ask you later on, you have to change a lot of the bad history, which for me it felt like lying or manipulating the truth. And I just didn't like doing that after a point because it was too much mental effort to do all that.

Zarya: When you say that you moved - I'm trying to imagine this - like uprooting everything from Al- You said you’re from Albany originally?

Valjean: I'm from Atlanta, Georgia originally. Atlanta to North Carolina to Wisconsin then to Canada then to Albany. So I bounced all over.

Zarya: Wow. Okay. Well, when you were in Canada and no one, I guess, that when you presented as male to the general population or general public I should say, did anybody really understand that you were transgender? Was it something that you just were like “I'm male and owning this”? Or was it more like you felt like you had to explain the transition period?

Valjean: Whenever I was in Canada and I was presenting as male, most people thought that I was gay or bisexual. Then when I told them I wasn't, they would lump me with people like Prince. And they would make all kinds of inappropriate jokes about gayness and bisexuality because I guess an ironic way they thought that I was in the closet by living stealth. It was an interesting experience, to say the least. I would say for the most part people thought I might be a closeted gay now, which is hilarious to me on the inside.

Zarya: Yeah, I remember earlier you mentioned that people thought that you were a lesbian. And then when you came out as trans, they thought that you were gay. So I think the transition is - I remember that when I was in high school too two of my friends came out as male. And that was really - I remember that just listening to people's conversations in the halls about their sexual orientation and guessing [their orientation], I was like, “Do you guys not understand that?" It's not th- they're not even talking about their sexual orientation right now. They're talking about who they are, in terms of gender. So I think that people's lack of knowledge is so surprising sometimes. And especially that within - again in my school, there was a big queer community - our school didn't really do much to educate others of my class who maybe didn't take the time to learn about, you know, what do these identities mean? And even in college, I think that some people stand away from the LGBTQ+ Center, and they're like, “Well, that's that community. It doesn't really affect us. They're their own thing,” when in reality, there's people who identify as queer who maybe might not do so in a public setting. Because they're afraid of people like that, who, they're just kind of like “They're in their own place right now, it doesn't really matter what we say apart from them.” I think it's really encouraging that I saw that Stony Brook has an "Out & Proud List" that's coming up, and I was really excited to see that. I think the funny thing part of that is - for the audience who doesn't know what I'm referring to - on the website for LGBTQ+ Medicine at Stony Brook, there's a video where Valjean is if you want to see him in person. I noticed that there was no one was on the list, so at first I was really surprised. I was like, "Wow, this is... I guess no one is out, then." And I thought that was surprising because Stanford, on the other hand, has quite a few providers listed on theirs. So I was like, "Wow, this is quite a statement to make from a university."

Srihita: Yeah.

Valjean: It's true. So I was on the board. We call it the E-board. It's a student club - MSPA, Medical Student Pride Alliance. I was one of the community outreach chairs for that group at Stony Brook, and finding faculty advisors was difficult. And finding *out* faculty advisors, I would say is even more difficult because there are a lot of allies, like, say, have family or friends who identifies with the LGBTQ community. But finding LGBTQ providers, I know of about two or three. I'm sure there are more. But I was also surprised by that, and it's a big reason why I also wanted to go in and help Eric because I really saw myself represented whether that be my racial ethnic identity, or my sexual orientation, or gender identity. I just never saw myself anywhere, so I wanted to be part of a change to make health care more diverse, more representative of the communities that are part of it.

Zarya: Has any physician come out to when you disclose your identity? I know that might be a rare chance, but just wondering.

Valjean: No, besides the family physician, I told the nurse practitioner that I was trans during my first meeting with her and she was like, "Oh, you know, that doctor actually identifies as gay, and he would love for you to come shadow." Like once I told her and then I was like, "Oh, great, they're gonna be very supportive." But that was the only instance. It's never happened after that or before that.

Zarya: Do feel like that affects your - have you ever met any physicians who are conservative and might treat you differently because of that identity? Because I know that we kind of hit upon it a few different times before, but specifically that a provider doesn't feel comfortable with you?

Valjean: Yes. I was recently looking for another endocrinologist because I changed my health care. And the first endocrinologist that I was referred to - I scheduled my appointment, I got the referral from my primary care doctor. The day I was supposed to be there, maybe an hour before I was going to drive out there, I get a call from one of their receptionist, and she's like, "Oh, I see - why do you want to see this doctor?" I tell her because it was already documented in the referral. She's like, "Oh, that doctor doesn't actually see trans patients." I was like, "You mean there's an endocrinologist, she doesn't see trans patients?" The last I checked, a lot of hormones have to do with the endocrine system. I was a bit snarky over the phone, but she said that provider didn't feel comfortable with seeing me. That day I had to change my endocrinologist to another one who, luckily, I saw about an hour or two after my original time for my appointment. But I was just super shocked that in this day and age, there can be endocrinologists who are still not comfortable with treating trans patients. There's a standard of care that you can find online and just read it. You can talk to other endocrinologists who do it more regularly. It's not rocket science, and you have your medical degree. It's lifelong learning. But it's like some people just refuse to want to pretend - it just “makes them uncomfortable and they don't want to work with a certain community.”

Zarya: I'm really sorry that you had that experience. And also, I'm really glad that you were snarky on the phone because they deserve that and so much more.

[Laughter]

I think that's kind of - I feel like if there's an "Out & Proud List" there should be an opposite list where it's like, these people are [on the] "We Do Not Interact List”. And I think that's such a scary experience. My friend that I mentioned earlier, who is also transgender, they were telling me about how they had to change their - pretty much all their doctors - because the physicians that they were seeing originally were pretty unaccepting. And they just didn't really understand that they had transitioned, then they refused to adjust their approach even though they had been their pediatrician from birth. So, it's very difficult to see. Yeah, but they're happier now! They're a lot happier now. Because I think that once you start to see people in your community - and that's partially why I wanted to do the podcast as well - you start to realize, like, "Oh, I'm not alone in this. And there's other people that I can reach out to." I was actually kind of worried for this first episode too of “How am I even gonna find people who are comfortable talking about this?” and the fact that you are an individual who does identify as trans but you're also such a baller in terms of medical school, you're on this website, and I remember meeting you for the first time too. I was like, "You are so composed, and you seem like you're so on top of your game," and I'm sure that you are. I'm really excited for your surgical clerkship for you, but also just in general it's nice to know that there's other people. So if you were to go back to your pre-med self, what would you tell them?

Valjean: I would probably tell myself to get more healthcare experience in any way I could. Now, back then, I was all about just being in the library, reading a lot of science books, which of course is great. But a big part of medicine is interacting with people, conversing with people. And if it's not a skill you have naturally, you can develop it over time. So I would just say to get out there, maybe talk to people I don't know so well, figure out what makes them tick, what brings them joy, what makes them sad, because that's going to be a good path of providing medical care, connecting enough for people to tell you what's going on. Some more practice with that probably.

Zarya: You said that you were an EMT as well, when you were a pre-med student, doo you feel like that's one of-

Valjean: No, that was afterward.

Zarya: Oh, that was after? Oh okay.

Valjean: Right. So I was basically doing a lot of things where I was in science. I got my PhD in microbiology, so less patient-related care. And then I was like, I really miss interacting with people. I don't want to be in the lab 12 hours a day. So I started working as an EMT to get more hands-on experience in healthcare and with people.

Zarya: As an EMT, myself, too, it's hard to find time to talk to the patient, especially depending on the emergency. I'm trying to find ways to make connections with patients because I used to work as a medical scribe about a year ago and it was, you know, you stop by their room and you say, "Hi," you talk to patients. And one thing that came up is actually - in addition to preferred pronouns - I noticed that some providers - they were a bit hesitant to not only ask for the patient's gender but also [ask about the relationship to the patient] when you see two people in a room who don't look like each other, for instance. Like, if you see a white male and a white female who are a bit older you might assume that they're married and not have to ask, "What's their relationship?", but when you see two people who [are] a black patient and a white patient, for instance, I saw then those questions were coming up of, "Can you explain your relationship to us?" Have you ever come across that as well, where you've seen that change, it's not like a consistent question throughout?

Valjean: I'll say I've seen that where, like you said, if people look alike, people make the assumption. And if they don't, then people ask those clarifying questions. I will say that pediatrics here at Stony Brook asks everyone, which is kind of annoying for me, because I'm like, you should just know, but I get it. Because it's more equitable since they're asking everyone. So like my relationship with my kid, they'll say, "So what's your relationship?" And I’m like, "Oh, I'm the father." And it's good that they don't assume, because, maybe I know, some trans people who identify as ma/pa that are both and neither, like mother and father. So I'm glad that they're asking because you never know. I guess the moral of the story is that you never know.

Zarya: I haven't heard that term - ma/pa. So is that something that you can write on the form, going back to writing down preferred pronouns - is that something else as well?

Valjean: I guess I'll figure it out when I'm doing my pediatrics officially. I would note it in the chart probably. Like, you know, “Patient is here with their ma/pa.” And then make a note about how their parent identifies. But I don't think there's a button you can click. You can add anything to the note so that people know in the future, but as far as a clickable thing? No.

Zarya: Okay. Well, definitely keep us updated on how your clerkship goes, and everything else that follows. Do you have any questions for us, and, Srihita, do you want to add anything on?

Valjean: I'm really excited that you're doing this podcast. And I hope that you find other great people to interview going forward. And, since I was on the E-board for MSPA, I can also give you the names of other people who might be interested in doing interviews. This is very exciting, and thanks for inviting me.

Zarya: Of course, it's a good sign. Because if you're telling us that you might want to invite other people that means that we did a great job, too. Did you guys hear that, audience?

[Laughter]

Srihita: I don't want to put too much pressure on a closing question. In general, do you normally feel really positive about the way the healthcare field is moving on a daily basis? How do you feel?

Valjean: I would say overall - optimistic. So I'm more optimistic, there's just general talk more about healthcare disparities, you know, George Floyd, Black Lives Matter. And that's kind of started with racial ethnicity, and it's kind of spread out to also include gender identity, which I love in the LGBTQ community. So, I think things are a bit static for a while. And then we're onto the next big push. There are people always writing memos that they care. If they're actually trying to change the system? I don't know.

Srihita: Do you feel because this year has been such a big one, in terms of, obviously, just everything that we've gone through in the medical world, and also how we've gone through social progress, that it's kind of kick-started that next push after a little bit of status?

Valjean: I think so. I think 2020 will be remembered for many things, but I hope that’s one of the positive things that come out of it.

Zarya: You mentioned Black Lives Matter. This show stands for Black Lives Matter, in case anybody didn't know. That's definitely something important. And I think this, not to get too deep into it, but especially with COVID and everything and talking about presentation of symptoms on different patients who are not all white, for instance, do you have any recommendations of how a pre-med student like myself could learn more about the different factors that go into healthcare and like making those decisions? To be more considerate of them?

Valjean: Yeah, I would say, what I've really learned over time is: some people get this label that they're a difficult patient or they don't take their meds, they're not adherent to their meds. And normally med students or EMTs, you tend to - I guess maybe not in an emergency situation - but if you have time to actually sit down with them, ask them why they're not doing these things. In more detail, you can figure out a lot that maybe doctors and nurses don't have time for. For example, whenever I was an EMT in Albany, there was an older black male who kept coming into the ER for high or low blood sugar that was either in the 400s or it was 20. He had no in-between. And then supposedly, he was taking his insulin. I asked him, "Number One: What's going on? Number Two: Do you have an endocrinologist or primary care doctor to kind of help you figure this out so you're not in the ER every day?" He basically said he didn't have a primary care doc. So then I found the social worker in the ER and said, "This person needs help finding a primary care doctor so he's not here every day." I didn't see him after that. It just takes time for someone to connect the dots to actually help patients because not everyone has health literacy. Not everyone knows the steps to go through to get what they need. So if you can help with that, in a way, I think that's a positive thing.

Zarya: I think that's a really great story to share. I think that's so important that you made a direct impact on someone's health care. I mean, hopefully, that's what happened - a positive health outcome since you said that you didn't see the patient ever again. I think that's great that you took that initiative, and you reached out to the social worker and said, “Hey, this person needs help in this way.” And I think especially taking the time to talk to the patient and figuring out what's going on on a deeper level, that can mean so much more than just writing it off and saying, “This person's just not being competent at the moment.” So thank you for that.

Srihita: I'm not in the medical field. Do you feel like there's enough focus, in the process of becoming a provider, on patient care and how to talk to patients? Because both of you very instinctually seem like empathetic and considerate human beings, but in the case that those are skills that need to be fostered in other people, do think enough opportunities are almost mandated that people have to learn those skills before they start really interacting with patients and have that power?

Valjean: I would say they're getting better now. They have standardized patients. All medical students have to do certain exams and have to do interviews with. They say empathy can be developed over time. I think some people need more work than others. I think that's the job of the faculty to kind of figure out those students and kinda help guide them to be more empathetic. So I'd say there are opportunities. Just some people need more help than others.

Zarya: And hopefully they'll- That is a different cool thing to learn though. I’m thinking about people who are in my own class at Stony Brook. And I've heard some really interesting things being said in light of the past events over the past year, I suppose. But there's so much I think ignorance that maybe people don't realize is being fostered and harbored. And that really needs to be addressed. But there has to be somebody who's there to tell them, "Hey, you need to start here and start looking into resources to work on this." Because I think that it's a bit scary too, I think, to think that some people who are might be going to med school. And these are people who could potentially affect lives [in a negative way] in the long run. And I'm glad that there's people like you, Valjean, who are there and hopefully that's not something that only falls to you. And there's other people like allies who are there along with you to make that difference in a positive way.

Valjean: Definitely.

Zarya: So on that note, thank you so much for coming out. This really means a lot to us. I think coming out in two ways... coming out to our podcast - sorry, that was a really bad one. Thank you so much. It really does mean a lot. Yeah, thank you. We appreciate it.

Srihita: Thank you so much for taking the time.

Valjean: Sure. Thanks for inviting me.

Reflection

Zarya: Thanks again to Valjean for joining us. At the end of each episode, Srihita and I want to go through some interesting topics in further detail for those of you who may not be as familiar or who simply want more detail. On that note, Srihita will start.

Srihita: Okay, so I'm not a bio major. So could you explain what an EMT is and exactly does?

Zarya: Yeah, I mean you don't have to be a bio major to understand what an EMT is. Personally, I'm a biochemistry major but that's totally fine - I forgive you.

Srihita: I'm graduating in three years so...

Zarya: Okay. Well! Some of us have school for the next five years. Well hopefully if we into med school. I mean - well, you know what I mean. Anyway, so EMT stands for Emergency Medical Technician. When you call 911, EMTs like me and Valjean show up and are responsible for treating the patient and also transporting them. Fun fact: My parents are more likely to trust me with an ambulance than a car. Anyway, I think I might buy the pins that Valejan mentioned. What do you think?

Srihita: Oh yeah so the pins. We actually had a meeting last year, when we were part of Hall Council, and they had a presentation. The pins are essentially what they sound like. They're pins with your preferred pronouns, and Valjean mentioned that he wears them when he's doing rounds in the hospital. Is that the correct medical term?

Zarya: Yeah.

Srihita: But yeah, it's a way of making people feel more comfortable in whatever their gender expressions are and just accommodating the idea that gender is a spectrum and kind of going away from this binary idea that we've been taught.

Zarya: Yeah, so it's kind of interesting because after we interviewed with Valjean, our editor Jameson said that he went for his vaccine (first dose). And on the forms that he had to fill out, they asked for his preferred name, pronoun, sex assigned at birth, and gender identity. I thought that was pretty cool because we had just touched upon that in the interview, and it's cool to see that the changes Valjean is looking forward to is kind of already in progress in some ways. So there was actually something else that Valjean mentioned that I personally hadn't heard of before. It was stealth, can you go into what that is?

Srihita: Right, so I searched up stealth on the internet and its definition technically is, "The term stealth in its most extreme sense refers to a person who passes as their desired sex or gender at all times and who has broken contact with everybody who knew their gender history." So I actually kind of started to read articles about people's experiences - and it is what it sounds like. When someone normally is transitioning or is done transitioning, they move away from everyone they know and knew their previous gender history and assume a life where they were their preferred gender their whole life. And the article I was reading actually talked about something really interesting where it was so much easier to do [stealth] before social media because your circle was just the people that you knew. And now it's a lot more complicated because you also have an internet persona that you kind of have to redo. So I thought that was pretty interesting.

Zarya: Yeah, I was looking into, specifically for publications, if somebody - for instance, Valjean has a PhD. While we didn't get the chance to ask him about it, he does have some publications because he is a PhD. So I thought that was interesting that maybe somebody's deadname could appear on their publications but when you look Valjean up, you wouldn't know that that's his publication, because the name is different. Do you know what a deadname is?

Srihita: Oh yeah, it's like your name before you transition.

Zarya: Yeah. So that's our brief run-through for today. Thanks for listening. You can find us on Twitter at @queerdiagnosis, which also has our website. We'll see you next time!

Srihita: Bye!

[Theme music plays]

This transcript has been edited for clarity. This text may not be in its final form and may be updated or revised in the future.