Season 01: Episode 02: Laurel Hiatt Transcript

Queer Diagnosis Podcast

Season 01: Episode 02: Laurel Hiatt Transcript

[Theme music plays]

Interview

Zarya: Welcome to another episode of Queer Diagnosis, a podcast that aims to increase LGBTQ+ visibility in the medical field. I'm Zarya, and my pronouns are she/her/hers.

Srihita: I'm Srihita, and my pronouns are also she/her/hers. Our guest today is Laurel Hiatt, a second-year medical student at the University of Utah School of Medicine.

Zarya: Hi, Laurel, could you please introduce yourself with your preferred pronouns?

Laurel: Hi, my name is Laurel. I use he/they pronouns interchangeably.

Zarya: So most people are familiar with he/him pronouns and may have heard of they/them pronouns, too. What does that combination of he/they pronouns mean?

Laurel: I think that there's a bit of a misconception that pronouns correspond one to one with gender, whereas they're more reflections or social placeholders. For me, as a transmasculine individual, it means that I am comfortable with both he/him and they/them pronouns. Some individuals like to vary depending on certain situations. Some individuals want them interchanged in a sentence. For me, it just means you can say, “That's Laurel. He's my friend,” or “That's Laurel. They're my friend,” and both are fine with me.

Zarya: And do you identify as non-binary?

Laurel: Yes. I think non-binary means different things to different people. I identify both as trans and again, transmasculine. But, because my gender does not fit into a binary understanding, I also view myself as non-binary.

Srihita: I've heard people use trans and non-binary interchangeably. Is there a distinction that you draw between the two?

Laurel: I want to be careful because again I think my understanding and my distinctions are not necessarily going to be universal. But for me, I view transgender very much as an umbrella just meaning that you do not identify necessarily with 100% adherence to the gender that you were assigned at birth. Whereas, non-binary - I view as more a not fitting, or necessarily, existing in parallel with the binary understandings of gender being man/woman, male/female. I think there are non-binary folks who are like, “I am adjacent to womanhood, but not a woman, but because I was assigned woman at birth, I'm not transgender, but I do resonate with non-binary.” So I think everyone's different. So for me, I include non-binary under the trans umbrella holding space for people who do not.

Srihita: Okay, that makes sense.

Zarya: I also really like that comparison you drew of one-to-one because I think a lot of people do tend to assume that gender goes with sexuality. And there's so much that I think is misunderstood with that. So where are you right now in your second-year medical student life? Are you rotating?

Laurel: I am finishing up my didactic blocks. I'm an MD-PhD student. So I'll take Step One in a few months and then go into my PhD. Right now I'm studying brain and behavior, which I'm actually enjoying a lot as someone who's interested in neurology, development, and psychology.

Zarya: That's pretty cool. I was thinking about taking some neurology classes, as I plan out my last two semesters at my university. Could you explain what exactly didactic blocks are?

Laurel: Sure. While we do have some integration of clinical experiences at the University of Utah, generally speaking, our first two years are classroom setting, lecture-based, knowledge-based curriculum. And then we—in our third and fourth years, generally, with some wiggle room there—switch to clerkships, hands-on clinical experience: the more real, visceral practice of medicine.

Srihita: How long is the MD-PhD, the whole process?

Laurel: It depends. There are the mighty few who wrap up their PhD in three years. I would say the average at the University of Utah is four with some individuals taking five just depending on the research field and how long it takes to generate meaningful results. And so anywhere from—University of Utah has what's called the EPAC (Education in Pediatrics Across the Continuum) program where you can truncate your third and fourth year if you're specifically interested in pediatrics—hypothetically, you could finish in around six and a half years, but it might take as long as nine. There's a lot of variability.

Srihita: Okay.

Zarya: When you get into your third year, when you start meeting with patients, are you planning on sharing your pronouns with them?

Laurel: Yes, I don't have a choice. I made the conscious decision. My pronouns are actually embroidered on my white coat. And so part of my professional introduction, wearing my white coat in clinical spaces, is “these are my pronouns.”

Zarya: I think that's pretty cool. I've only actually—in the clinics I've been in—I've seen the pins, but I haven't seen it embroidered. And I think that's a real step up. I love that.

Laurel: It's a recent development with our medical school that we're pretty excited about.

Srihita: Okay, so everyone's gonna have their pronouns embroidered on their coats.

Laurel: It's an optional offering, but it is available to everyone. So, I've had mine done. It's going to be offered, I believe, to every incoming cohort moving forward. I think that there are individuals who might feel pressured, like pronouns change [and] understanding of self can change. So I don't want to make it seem like it's a definite need for everyone because sometimes the flexibility of a pin is a lot more nuanced. But for me, as someone who's pretty firm and comfortable with it [pronouns], it's very convenient—I feel like I am always losing pins—and so it's gonna be a nice investment for me.

Zarya: Yeah, I think that's pretty cool. I was actually going to ask you in what situation do you think somebody wouldn't put their pronouns on there? But it makes sense the way that you put it. It's pretty fluid (what pronouns somebody uses) although I'm sure there are also some individuals who simply don't agree with the idea of pronouns, and I've met those patients and people in my own classes. Have you come across anybody like that?

Laurel: Yes. [Laughter] It is always fascinating to me when people disagree with grammar. Everyone uses pronouns, and the singular 'they' is older than singular 'you' in English. So it's very intellectually curious for me, but it's not something that I feel like spending energy worrying about because there's going to be people who take issue with many things. There are people who are taking issue with me just practicing medicine and the institution of medicine. There's a lot to unpack there, and honestly medicine should be criticized as an institution. There are people who are probably not happy I eat eggs (which I do). I think that there must be standards of respect in our practice, especially from provider to patient, but towards me as an individual, I feel very secure. And I'm generally not bothered by people who want to do whatever it is they're doing.

Zarya: Do you tend to take the time to educate people? With what you just mentioned about the grammar of it, I know some people who are just hesitant to say they and using 'they are' versus 'they is.' They're just not sure how to use the pronouns correctly. How do you approach educating individuals who are not sure how to use they/them pronouns versus the people who are [opposed to] trying to understand where somebody is coming from and when they want to use those pronouns?

Laurel: One of the decisions that I've made—being as out and as prominent as I am, like I am the “trans friend”, I am the “trans student”—is that I always make time if people want to learn. I've met with tons of my classmates, tons of individuals who were like, “Hey, can you take an hour and walk through it with me?” That's something I will always make time for. I will say that I have developed a pretty good radar on who legitimately wants to learn and who is wasting my time. I think it takes a lot of negative experiences to cultivate that perception because I used to give a lot of benefit of the doubt to everyone and spent a lot more time than I'm now willing to. I think that it's just something that comes with experience to know. Like, this person is unfamiliar, [and] I speak Spanish (although I'm sure I'm very rusty because I haven't, unfortunately, had a lot of opportunity to practice). I've had a lot of experience with people who speak English as a second language, or especially from gendered languages where, I understand, there can be a difficult mental block. But, there is a difference between “I want to understand” and “I want to waste your time.” That's sort of how I distinguish.

Srihita: So going off of the Spanish thing, I've heard that you translate health documents from like English to Spanish. How is that an opportunity that you came across?

Laurel: Yeah, it's not something I'm currently doing. But it's something that I've done in the past, particularly for LGBTQ documents, and even gendered documents, because I think that's something where there's already a dearth of resources in Spanish. When you add LGBTQ or queer resources—unfortunately, a lot of the global conversation ends up being in English, which is frustrating. There are queer identities in every culture who may not even use the word 'queer.' So that's something to be mindful of. I actually contacted LGBT health nonprofits and checked to see if they had these resources, and if they didn’t, I said, “Hey, can I do it? Is this a thing that you would let me do for you to have available?” And generally, I don't think anyone means to have barriers to care. It's just a thing that happens. So people were generally pretty receptive to it. I did the bulk of translation. And then I had a couple colleagues who spoke Spanish fluently as a first language, who would then review my work and the most—I don't want to say tedious because it was meaningful—but the arduous aspect was trans inclusive resources in a language that is gendered. So that's something that I, as a queer person who knows other queer people who are Latin-a or Latin-x, or however they personally identify, collaborated on at the community level to find what was the most affirming language. It was really good, and I think it will be something that, since I'm aware of that language now, I can hopefully take into future practice to be as affirming as possible.

Zarya: You mentioned Latine and Latinx. I've only heard of Latinx. Can you explain what Latine is?

Laurel: Oh, yeah, it's just something—and again, my parents’ [families] came over in the 1600s to the US as white Americans, so I don't ever want to speak for anyone's experience outside my own. I have some friends who are very proud of the label Latinx. I know some people where Latine, which is just an 'e' at the end, is easier to say in Spanish, and therefore preferable if their focus might be more in touch with Spanish speaking. I want to be very careful on how I express this: Latinx is very Americanized. Latine is a gender inclusive alternative that I know is used. But again, I think that they're both used with a lot of thought just perhaps used in different contexts.

Zarya: Thanks for making that distinction. Srihita and I always do a reflection after each episode, so we'll look into that a bit more. That's actually pretty cool. I didn't think of it as the Americanized version because my mindset is just very narrow in that I didn't think of—even the word 'queer,' for instance, I don't know what it is in other cultures. And I think that is something important to think about. I also appreciate you mentioning the 1600s. My family came here in the 1980s. So it's pretty cool to know that time difference. You mentioned you looked for nonprofits in the LGBT community, and I was wondering is that something that you came across locally? Because, for instance, we're from New York and I know that there are a lot of different nonprofits here. Where are you from, and how did that play a factor into finding those places?

Laurel: So the way I did it was perhaps unorthodox. So I'm from Georgia. I went to the University of Georgia. But I actually attended a conference in New York City: the LGBT Health Workforce Conference which is great. I presented there, and while I was there, I did a lot of networking. And so my focus was a little bit more on national resources. Georgia is—I love my home state, and this year I feel like especially is a good year to be from Georgia for once—but I think that because we have a really large, immigrant population of many different nations’ identities in Georgia, we were fortunate that statewide—I felt like—we had, generally speaking, solid resources. So I was focusing more on a national level of institutions that were more white, non-Hispanic that, if people googled an identity, were the first ones to pop up. I feel like local efforts are always the first place to start like the most boots on the ground. I was fortunate that the local efforts had been pretty well covered where I was.

Srihita: So when you were majoring in Spanish, was it with the intention after recognizing that there was this lack of resources at a national level? Or were you just interested in Spanish, and then you found this opportunity to use it?

Laurel: I learned Spanish in my early teens because my dad didn’t—he’s the worst at learning languages. He's been trying for forever and can't. He was involved in a religious capacity with a lot of undocumented immigrants and was trying to connect them to resources and could not learn Spanish. So 11-year-old me was like, fine, I'll do it. Not with that degree of attitude. I was excited to do so. But I learned Spanish really to speak with Spanish-speaking people, and it's just something that I love—communities that I've been really happy to be a part of. I got a degree in Spanish because I got to college, and I kept taking Spanish classes. I kept spending time with undocumented immigrants. That's a part of my advocacy that I prioritize. I think undocumented immigrants, not just Spanish-speaking, but overall, are some of the most neglected in every field like healthcare, policy, and safety. For me, it was a combination of I love the language, and I also love the people that it's connected me to. Now, going into health care, I'm really glad to at least have a little bit of linguistic wiggle room with some of my patients because, again, I think access to care is really unfortunately skewed. And honestly, I just love language in general; I always say that if I wasn't where I am now, I would have gotten into linguistics and learned all the languages that I could, and I'd like to learn more. So I guess it's a combination of intention and genuine interest for it.

Zarya: Let me ask you another question. So you said that your start was with undocumented immigrants. Was that also in the context of healthcare and medical documents, or was it more translating with [government] officials? How does that really work?

Laurel: I did a lot. This was honestly from the age of 12 until I left my hometown and went to college where I kept doing it but in a different capacity. So I taught English, I translated, I sometimes would translate regarding health care, I've translated at PTA meetings, which is always fun. I really love kids. I have connected [people] to job resources. I went with my dad to community get-togethers so that he could continue building relationships with folks because he's someone who (more than teenage me) knew, like, okay, maybe this is a place someone could get hired, or this is a place that someone could find reliable transportation. In Georgia, as in many places in the US, undocumented folks don't have access to driver's licenses, and so they can be penalized and criminalized just for trying to get about their daily needs. So I feel like I was really fortunate to do so many things. And I think that was really—I don't want to be a white savior—but I think it was good, you know, I'm happy to have helped. But also it was something that I got a lot of exposure and gained a lot of awareness of the various obstacles, like I'm very mindful of my citizenship at all times now.

Zarya: I think that's interesting, because I always thought—well, let me backtrack a little bit. My dad is also a very giving person, and he's always trying to help different people. So when we were younger at airports, we would always stay behind in lines when we were coming back from Pakistan. And my dad would always be translating for the elderly into English, from Punjabi, Hindi, and Urdu. And I was kind of like, "I think that's really nice, but I think we should go forward in line," and I didn't really realize the importance of just taking that time to help somebody. And even now, whenever somebody comes from a different country, and they don't really have resources, my dad tries to help them out by educating them about the school systems here and trying to help them get enrolled in classes. So I kind of appreciate that in knowing that other people are like that as well in other capacities is pretty cool.

Laurel: I view language as pivotal. I think that how we communicate, how we express is just immense. I've helped like kids with homework because their parents didn't understand or weren't able to speak the language. This comes back to what you said about school systems and whatnot. And I think a lot of that goes back to my understanding of gender: someone's understanding and expression may be made more complex or nuanced by the fact that we use different language, maybe even within the same language, but still different. I want to be a helper. I like to help. And I think the understanding of how different access can be based on language reminds me that I have access, so I might as well help.

Zarya: As kind of an intermediate to overcome language barriers, how do you expect practicing Spanish as a translator and helping others understand systems like education will factor into your interactions with patients going forward?

Laurel: I think it'll be important. I have a friend who's been really frustrated because he has a family member who is Spanish-speaking, and the physician didn't bother to explain anything to him and basically put him on a medical and legal path that he did not understand and give adequate consent to. And so my friend, who is a medical student who is very busy, and has all of his obligations—you know, which I could talk forever about the different obligations of different types of medical students. But anyways, he is now having to navigate the healthcare system on behalf of his father, both in terms of medicine that is overly complicated, and all the resources that are immediately available are in English, like you have to fight for your resources. So I think as a medical student and future provider, I think my goal is to make sure I'm having that conversation with patients. Like, "Do you understand? Are you getting the resources that you are entitled to both legally and ethically?" with our oath to do no harm. And so I know it can be really helpful if someone can speak Spanish to explain something or translate something, but I'm also aware of the broader need for accessibility, and maybe the time. Maybe I can't refer you to this specialist because they don't speak Spanish. And because they don't offer adequate translation, maybe I need to spend extra time finding printed resources. A lot of the charting we do, a lot of the default resources, are in English, but they do have translation. So I feel like both the practical implementation, but also just the awareness of like, this may take more time and energy—both are absolutely necessary. It is unthinkable for people to get worse healthcare because they do not speak English. English isn't the official language of the US; we don't have an official language. It's just the default. And I don't think that is appropriate in any setting, let alone a medical setting that determines people's health. Sorry, I feel very strongly about this.

Zarya: And I think that you should. I actually was wondering—so I know getting a Spanish translator and printing out documentation in Spanish is helpful. What other implementations are practical, as you said, that somebody could do, even me as an EMT? What are other things that I can do for a patient who speaks Spanish?

Laurel: I think, well, it may not be as applicable as an EMT, but something a lot of people don't think about is websites or online resources. A lot of times it is difficult even just to get to the appointment. And maybe they have a translator at the appointment, but if it's difficult to call, if it's difficult to go online, that's an issue. I think not assuming—you never know who has what degree of familiarity with a language. I think, also creating a space that is very [affirmative]—I expect to make people uncomfortable as a physician because I am pretty adamant that I will go hard for undocumented folks. I've done a lot of decriminalization advocacy for sex workers. I am pretty transparent in the communities that I value and how I prioritize their safety. And I hope that people will know that I am, like, if you make an appointment with me, I'm going to do what you need to receive adequate care. And so I think even like creating—I hate to say creating a culture because that sounds so corporate—but like, if people know that they can utilize this resource and the people are trained. And they are—again, welcoming sounds superficial—but they are equipped, and they are also willing, I think that's a big deal. Because I know that communities talk and people talk. My trans community is very, very explicit in our inter-community conversations of like, don't see that doctor, don't talk to that nurse. And so I think that making yourself transparently supportive and aligned with these communities so that they know they can pursue care and receive it—I feel like that's very important. I don't know how that would directly translate to being an EMT. But I think that the awareness and pursuit of support is a great first step.

Zarya: Yeah, I think that's important. And I'm actually just thinking about the consent form that we have patients sign when we transfer them over to the hospital. And I'm trying to think if we even have a Spanish version of that, which I'm sure that there must be. I've just never used it, and I have had Spanish-speaking patients before. I wonder if I could have perhaps switched over to that to make it more convenient for them. Another thing that you mentioned that I thought was interesting was that your trans community has a list of physicians who are available and ready to help and physicians who aren't. How did you find those people who—well, first of all, how did you find the community? And second, how did you guys kind of figure out who to go to and who not to go to?

Laurel: The internet is wonderful, it turns out, for queer communities. And so honestly, when I was moving to Utah after living in Georgia my whole life, I went on Facebook and I searched "transgender Utah," and there's a Facebook group for transgender people in Utah. And so, there are community resources, Utah Pride, I’ve done some work with Genderbands, which is a nonprofit that has also become something of a trans community. Especially with COVID, these online spaces have been really, really significant and supportive. Physical, in-person spaces, I think are necessary for all communities, because they allow people to congregate, but I've also utilized a lot of online spaces. And again, we are very honest with each other. And so if someone posts in the group and is like, "I made an appointment with this person, what should my expectations be?" We, as a community, we try to take care of each other because that's what communities do. Part of the reason I went into medicine—besides the fact that I like science (and ultimately, I want to write sci-fi novels)—is that if I know how to navigate a system, I view it as my moral obligation to go back and help the people I know navigate that system. That's something that now, I know a lot of the healthcare providers personally. I know more about insurance. I know more about making appointments. I know more about even just like, what are the medical side effects or implications of hormone therapy? What are the normal timelines for surgery? These are things I know. I had a relatively good understanding, but now I have more privilege and understanding as a medical student. To me, that's something you take that back. you take that to your community. And that's the bridge you try to form. So, yes, [I found community and info on physicians] through Facebook.

Zarya: I love that. I think it's really great because I was actually talking to another friend who's in the process of transitioning right now. And they were talking about how with their doctors, they had to completely change that set, because their doctors were unaccommodating, and they gave the wrong dosages of things because they just didn't know. So I think that Facebook comes in handy. [Laughter] You know, that's important to know. So going into your residency [post-medical school] and thinking about specialties, is it important to you to have a community like that within the place that you're applying to or within the specialties that you're looking at?

Laurel: I think so. I mean, at the end of the day, I am one person. And I think I've done good work, I think I've opened doors for trans people; I'm proud of my accomplishments. But at the end of the day, I am a person and a human and a partner and a friend, and it is exhausting. It can be lonely and isolating to be the only queer person or the only trans person. I have been alone in certain spaces. And I'm not currently and I'm grateful. So while I love the idea of going to a 100-person town and kicking down the door and being like, "The trans is here." I think that in practice, that is a really hard thing to sustain. I feel like the community is really important to me, and I'm more interested in—I have classmates who plan on going back home to their rural towns. We've had conversations about "What does affirming healthcare mean?" And "What does normalizing queer identities mean?" I feel like I can take care of myself and help the people around me be resources in their community. When I think of residency in my long term practice—even though I'm really interested in rural and telehealth—I feel like me physically, it's most sustainable if I do have this community that understands me, and we can support each other and the work that we do.

Srihita: So you kind of touched upon this in your answer: could you define affirmative care for us?

Laurel: Yeah, I think it's complicated. I think it's going to mean slightly different things to different people but to me, affirming care means that the patient is not an issue that is talked down to. That the patient is empowered in their own care, and their entire personhood is able to show up, be respected, validated and incorporated. And so for me affirming care means really seeing the patient and putting that into their care and their practice. Because I think it's not just queer people who need to be affirmed, I think there are all types of patients who are completely underserved. And a lot of that comes from, I think, just lack of awareness. And so for me, it means I put in the work, I did the homework, I prepared myself so that when you come to my clinic, we're gonna be able to really, as a team, focus on your care. Because I think what goes wrong is when providers do a one size fits all, and it's very paternalistic. It's very inappropriate in my opinion.

Srihita: For non-binary [individuals] or anyone who exists out of the cisgender world, how do you plan on practicing affirmative care with them?

Laurel: I think every point of contact needs to be affirming. Must be ensured to be affirming. So for me that means—we mentioned intake forms earlier: the person at the reception desk or intake desk, when they hand you paperwork, that paperwork should be affirming. That paperwork should have language that is inclusive, that is applicable, that you can fill out. Like, I had filled out my health insurance paperwork, and I got really annoyed, and so I blacked in both the male and female box. And this caused all kinds of insurance issues, but I was like, I am annoyed and I don't know what to do, so this is how I'm going to resolve this situation. And so to me, [affirmative care] means that every point of contact—the nurse or medical assistant or whoever—is just as equipped for inclusive and affirming care as me, the physician who is ultimately going to sign their chart. That's part of the reason why I think that it's really important for members of communities that have been historically excluded from medicine to be incorporated into healthcare teams, and to be involved this because when I am in a clinic, when I am in an office, I am giving feedback constantly, because I see what they could do better and what they should do better. As a provider, as someone who will be given—for better or worse—the social power to negotiate change, that's something that I intend on doing.

Zarya: I think the more you speak, the more I'm tempted to just email people that I know, who are physicians and be like, "Hey, how are you working on this, on a day-to-day basis?" [Laughter] Also, one thing that I'm thinking about, like the way that you mentioned that you just blacked it out, and you gave them feedback. I'm wondering if—again, going back to patient intake forms where I really only see an option for male or female—like on our digital documentation, I'm wondering if I could follow up and say, "Hey, can we open this up to a few different identities?" Not even just a few [but also] whatever identity somebody is willing to identify with? So I think already your words are working on me, and I appreciate that.

Laurel: I've sent a lot of emails, and sometimes you don't get responses, but sometimes you do. And I feel like even though you get various nos, I'll get a response from a random national health record place like, "Oh, okay, we'll look into it." And so it's one of those things where I've gotten really used to making phone calls and sending emails and if you want to too, it's you know, it's fun. Sometimes you get funny responses.

Zarya: What do you consider a funny response?

Laurel: I guess there's two. I think sometimes people are afraid of me which I think is very funny because I think I'm very nice. I'd like to think I'm nice, you know, and I don't think I'm scary. But sometimes people fall over themselves being like, "Thank you so much, wow!" And I'm like, it's not a big deal, you do not need to fall over yourself. I'm just emailing you, you can email me back, there's no need to—I'm not going to show up outside your house about this. [Laughter] You do not need to be this apologetic. And then there are other people who are like, "I won't because I don't want to." And I'm like, "Ooh, you're powerful. Look at you and your sass. You really showed me. My life is now going to be drastically different because you were very curt to me on this email" which I find funny. Because, again, I am very intentional about what I put my energy into, and so, I guess both of those are examples where people put a lot of energy into responding to me, as opposed to making change and being conscientious of the system they work in. And to me, that's funny. I don't know why they do that.

Zarya: I think that's interesting. Even on those emails, I'm sure that you introduce yourself. If their system [the person being emailed’s] doesn't allow for anything outside of the binary, have they ever misgendered you or been adamant about not acknowledging who you are?

Laurel: Yes! Which is so interesting to me. I equate it to a lot of my friends have their names in their emails, and their names are in their signature. I don't want to assume, but I would assume that people have misspelled your names. And it's you’re kind of like, “My name is literally right there. Why did you—it was right there. That's kind of the feeling it is for me where I will be like, “Hi, my name is Laurel. I use like he/they or they/them. Sometimes they'll just use one pronoun set to keep it simple. My email signature will have my name and my pronouns, and then I will get responses that will be like, “Dear Miss Lauren, thank you so much for your email.” And I'm like, “You missed all of it by 100 yards.” So it definitely happens, and I think sometimes it's malicious. Sometimes people are just living their life and don't put any more thought into it than they put in many other things. So, again, it's just not worth the energy it would take to be upset about. And so I laugh. That's what I do.

Zarya: I like that approach. My name has been pronounced as “Jah-kar-ee-yah”, which is interesting because there's no “J” in my name, and there's also no “K” in my name. [Laughter] I've been there before, too. I'm wondering with the people who are intentional [about misgendering], especially with classmates or even patients, if this has ever happened to you? Have you ever had that conversation as to trying to educate them?

Laurel: Yeah, it's really interesting. I think people talk really tough online. I've found that it's really hard for people to be super directly rude to my face. And I am a person who is very comfortable with discomfort, I would say. A lot of times I don't have the time to educate. The bare minimum is to [be] in a system like basic human respect. I've had my classmates for the past year and a half, and everyone has known me long enough. I've been very vocal in my class, and everyone is aware of me. It's not really an issue with classmates at this point. But generally speaking, if I correct someone to their face, they may not get it right, but they're generally not going to be as malicious or antagonistic as someone has often been online or over email or social media or Twitter. Something I'm very cognizant of is that as a provider with a patient, even as a medical student, I hold a degree of social power and social privilege. And I think it's similar to a lot of my friends who are even women, but especially women of color and whatnot, where you have people who are rude and maybe would be antagonistic in other settings who - when it comes to the point that you are the person interviewing them and giving them the route to their healthcare - that dynamic suddenly shifts [such] that you are the person in power. That's something I try to be very mindful of and very careful with. Even though I think I deserve to be gendered correctly, and my pronouns are on my coat, and the vast majority of patient experiences I've had have been super positive. And people have been wonderful. But I really am more interested in normalizing queer people who are openly queer in medicine than I am making someone afraid that if they are rude to me or misgender me, then they're suddenly not gonna have healthcare. Because I don't think that's appropriate. I try to be very mindful of the power differential in when and how I choose to address the situation, if that makes sense.

Zarya: I think that makes sense to me. And I'm thinking about how I'm even just changing pronouns in a zoom meeting, for instance. So I think it's really important to start normalizing for instance, like pronouns at an early stage of one's health education. In my classes, I've heard people misgender and no one's really gonna stand up in the middle of a 500-person class and be like, that person's not right, and I think especially on zoom it's easier to start putting pronouns into the zoom information. For instance, I'm actually planning on sending out an email to my own classmates, like, "Hey, guys, this semester, we're going to put pronouns across the board and make all of our professors really uncomfortable". I think it's a good place to start just to get that ball rolling. So I was just wondering if in your curriculum, I noticed that you're saying your class is aware of you. I see what you're saying, because yeah, I've seen that. One of my friends who came out as transgender in high school—one of our teachers just kept misgendering them. And it wasn't intentional—actually, I can't say if it wasn't intentional if it was the whole year—but they did always make that adjustment after that person corrected them. Yeah, I definitely do think that's an important conversation to have. Because I saw that my classmates, for instance, weren't [consistently] standing up for that person, it was just kind of a conversation between just that person and the teacher instead of having it be a support system. In your curriculum, is there a strong LGBT emphasis on patient care and also with physicians?

Laurel: I think it's a work in progress. And I think that it's honestly gotten better since I've been at the School of Medicine. And I don't want to take credit for that, necessarily, but I think that you are aware of the things that are in your space, which is why I try to be really mindful of who's not present in the room and who's not—who doesn't have a voice in the conversation. I came in [to med school] as very queer and very trans. Because I was coming to Utah, and I was like, "I don't know what to expect. So I'm just going to be as out as possible, and as adamant as possible.” And now, the first year, which is only a cohort beneath me, they incorporated—it's now an expected part of their patient interactions to either ask for pronouns with teens, or people of a certain age, or with people over a certain age to ask for honorifics. So do you go by Mr., Mrs., Miss, or something else. I use Mx. by the way, if you were wondering. Since I've been there, I've had conversation as with our metabolism and reproduction unit; we had some trans inclusive material, but I was like, "This would be a great place to push in some some queer stuff, and this would be a great place too," and they've been really receptive. I think that part of the reason I came to the University of Utah is they have a great Transgender Health Program both in terms of surgically, adults, adolescents, training-wise, etc. The foundation is there, but I do think having queer people go through the program, and give feedback, then being receptive to feedback has been positive and is part of the reason again, why I think historically excluded individuals should be included and incorporated. We've had a curriculum on how to take a sexual health history, and I did raise my hand in front of 200 people, and I said, "Hey, I'm deeply uncomfortable with the way that you're advocating that people ask trans people about their sex life and people about having sex with trans people. I am uncomfortable, and I would be uncomfortable as your patient." They were like, "Okay, point taken. What would you do?" And I was like, "This is what I would do," and it worked out. I'm very adamant about the "nothing about us without us" [mentality], and I think unless you are including individuals—both in terms of practicing and research and the teams and the administrative—unless you are including people at all levels, you are going to speak over them as opposed to for them.

Srihita: So you kind of touched on the improvements that you've seen at school, but could you talk about what improvements are seeing maybe in healthcare at large to address excluded communities?

Laurel: There's a rumbling. I think that there have been smaller institutional changes in a variety of places. Now there's a larger, more cohesive movement for intersectionality. I am working with some trans colleagues on reforming best standard practice for electronic health records for trans people. And I think there have been a lot of institutional changes to "Okay, where can we incorporate pronouns? Where can we incorporate the name someone uses as opposed to their legal name?" I think there are institutions that are being more affirming of Black leadership, and the leadership of people of color, which I think is necessary because I think the Black community is the most ostracized by medicine, and people of color in tandem and Indigenous communities. The medical institution is really bad. There's a lot of really awful history. So I guess what I'm trying to say is there have been large and small efforts for improvement, but we have so far to go. I think it will take a continuous, concerted effort of everyone at all times to heal some of the harm and become a practice and an institution that marginalized folks can trust and have faith in. So our School of Medicine has declared racism a public health crisis, and I was part of an anti racism commission. Things are happening, but the history of medicine is nasty. The current practice of medicine is nasty, in my opinion. So I think it's going to take a while, and a lot more effort and a lot more blood, sweat and tears before I think we can really go "Hooray! Good for us.”

Zarya: There's a lot of important things that you're talking about, and I'm trying to think of ways that I can get more involved. The more you talk about it, the more I'm like, “I have to do more!” Are there any suggestions that you have for somebody like me, who's pre-med, and I want to get to know more about how I can provide more culturally sensitive care to a patient? What are some resources that you've used in the past? Besides Facebook?

Laurel: I think community is the most important thing. Learning directly from people is the best avenue to learn about their struggles. I don't want to go into a meeting of my mostly white med school class and be like, "We need to talk about Indigenous health." I want to go to my Indigenous friends and Indigenous community events and forums and pay people and compensate them for their labor and learn from them. My undergrad, University of Georgia, had International Fridays, where they did different cultural events, and the different student groups would come in. I literally just met people, and I got to know them. I asked them about what was important to them and what things were difficult. I went to community board meetings, and I heard about, "What is the thing that frustrates you? What are the things that are in your way?" it took a lot of time and energy, and I'm an introvert, so it was really, really exhausting. There are so many things that I don't think you can be aware of until you talk to the people that it directly affects. Especially as a white person, the statistics are not good. It's something like 8 out of 10 white people don't have a close friend of color. And that's something that means—okay, you are not aware of the racially charged experiences then that those people are having because you're not talking to them about it. I want to be careful because I think it's important to be cognizant of positionality. I don't expect people to educate you without compensating them. I do think that just getting involved at the community level with community organizers or just the people who are closest to the issue, on the ground level, before you go into the academic spaces, or the medical spaces, where suddenly those people are more of a concept than human beings. To me, that's been really important in shaping what I know and how I approach problems.

Zarya: You said that the University of Utah has a really strong LGBT curriculum that you were familiarizing yourself with. I'm applying to med school eventually, hopefully. How did you find it? How did you determine like, "Okay, this is a good school that has like, a strong curriculum, versus this is one that needs more work, and I might not feel as comfortable there."Is that from talking with people?

Laurel: Yeah, talking with people. Before I went to the University of Utah, I have had a phone call or email exchange with all the people who are in charge of the Transgender Health Program. Here's my little life hack: look at syllabi. Because the resources people use tell you a lot. And so I looked at some places, and they cited people, like researchers, who I knew were transphobic. And the University of Utah cited a researcher that I'd worked with, that I liked. So the most technical advice I can give is look at their syllabi, look at what they use, and what they study. And if you have a familiarity—if you know this person is bad and this person is good, which person they cite is going to be significant. But also, again, talking to people, finding what's distinct or unique about the institution [is important]. Because every single School of Medicine is going to say, "We're committed to diversity and inclusion, and we value justice for our students, and we're super receptive". And they're all going to say that. That's what they do. It's not until you both talk to the faculty and to the current students. One of the reasons why I chose to go to University of Utah is I talked to current students who said, "Hey, they're actually super receptive to feedback". And I went "Good." I have a lot of feedback everywhere I go, and I'd rather go somewhere where that is listened to than where it poses problems for me. Last super technical suggestion I have is to look at the webpages and see how quality they are. A lot of places will have like, "Here's our Diversity and Equity page," and you go, and it hasn't been updated since 2014. The animations are just wack, and that is something where if they have not put effort into this resource, for the people who are specifically going to look at the resource, that means it's not a thing that they value. And that sounds silly. You would think all of these institutions with a whole lot of money would have aesthetically-pleasing results all around. But you can kind of look and be like, “Okay, there's a lot of detail on your science page, and none on how you guarantee quality of life for your students.” That worries me.

Zarya: That definitely holds true. When I was first thinking about this podcast—and actually, at that point, it wasn't really even a podcast, it was just something I was Googling—I was looking up Out and Proud lists at different universities. I saw very interesting pages on different university websites, and I think that's a good trick to look at. Your talking about syllabi reminded me that our semester’s going to be well underway pretty soon, and I should start reading syllabi in general. So I appreciate the reminder. [Laughter] So going back, you're a med student now. You have a lot of things going forward. If you went back in time, and you were a pre-med student, what would you tell them to look into?

Laurel: I would probably tell them to take a huge chill pill, honestly. I would tell myself to calm down. It's not that serious. So much of medicine and so much of everything—like American culture, American professionalism, academia, etc.—is a hyper, capitalistic product-oriented rat race. And I worked myself sick, figuratively and literally. Like I said, I'm very mindful now where I put my energy and what I put my energy into. And I think I would have told myself, “You arguing with classmates after class for three hours is not going to do any good whereas you having lunch with a community member for an hour is going to be way more enjoyable and long term like meaningful.” So I think I would just tell myself, “Focus on the long term.” I was really fixated on—it's a long story, but my background is kind of rough. I was really scared I wasn't going to get to go to college. I was terrified I wasn't going to get to go to med school, right? So there was all this pressure I put on myself of these are the things I need to do. So I can be a trans person who succeeded, and trans person who”got out of my circumstances,” right? That pressure—once you put it on yourself is really hard to take off. It's taken a lot of conscientious effort to tell myself I deserve to relax. I deserve self care. I deserve to have nice things. Because I talked to people who are like me and never gave themselves that opportunity to just take a step back, and they dropped because of a cardiovascular event in their 40s. I'm no good to anyone—not my communities, not myself—if I burn myself out before I even really get started. So I think I would tell myself that and honestly me then wouldn't have listened to me. But I would probably say it anyways.

Zarya: I think it's good. It's okay. You said it to me. And I'm pre=med, and I'll keep it in mind. Although Srihita is not premed because she's not as cool as us [laughter]. She has a background in math, which we don't associate with.

Laurel: I almost became a math major. I was almost drawn into the cult of numbers.

Srihita: No, I've had a few too many breakdowns over a month. So now I'm shifting into economics. Because I was like, I don't think I have a healthy relationship because it really draws you in, and it kind of takes over your mind a little.

Laurel: Oh, yeah.

Srihita: It is sort of cultish. Yeah, for sure.

Zarya: That's how I felt in sixth grade doing subtraction. But it's okay. You're there now.

Srihita: You were doing subtraction in sixth grade?

Laurel: Big numbers.

Zarya: Yeah, exactly. I think the advice that you've shared with us today is really invaluable. And personally, I know that we're just meeting but I'm really excited to follow along with your journey and seeing those changes, no pressure, of course. Just keep doing what you're doing. It looks like you're doing great already. But I really think that you have a lot that I can learn from and our listeners can also get a lot from. So thank you a lot for taking the time to be with us.

Laurel: Yeah, of course. Thanks for inviting me.

Reflection

Srihita: Thank you again to Laurel for joining us. Welcome to the reflection portion of the episode. So you and I were just talking. We both listened to the episode.

Zarya: Because we just had the episode.

Srihita: Yeah, it just happened five minutes ago, you guys. But I remember actually though, after the episode, we were super inspired. I was like, "Oh my God, I need to be doing more." I think one of the best or biggest takeaways I had from the interview was Laurel talked about just emailing people, and cold-calling and cold-emailing people and seeing if they could get any sort of response and just making organizations and communities aware of the different levels of access that marginalized populations have to healthcare. I think the reason that was so inspiring, especially in our current political climate, it's really easy to feel super overwhelmed by everything that's going on. You just kind of want to—at least if you're me—you just want to lay in bed and not think about it because it can be really painful to think about it sometimes. But I think when you set yourself up with tasks to be like, "Okay, today, I'm going to like email this person or cold-call that person". When you set yourself up with daily tasks, it kind of does add up, and you can make a positive impact and at least feel good in knowing that you're making an effort. I think that was really inspiring.

Zarya: I definitely agree. And I think that for me, I used to look at a big pile of work or knew about things I needed to do, and I would very much be paralyzed. I was like, "Okay, if I'm going to try it, I have to be perfect on the first attempt. Otherwise, I'm not going to do it at all." I've definitely been better at realizing what my strengths are. For instance, sending emails! Sending emails is such a superpower for me personally because I know when to queue it. I have my email signature ready. It's such a simple thing, but you can get so much done with a simple email. So definitely like what Srihita was just talking about with feeling inspired afterwards. I actually had a patient sometime during that week [of our interview with Laurel], and with the patient—there was a big language barrier and I think communication would have alleviated a lot of our problems. So the patient was refusing medical care, and the team that I was with didn't exactly understand and thought that maybe the patient was being hostile. In reality, the patient was just kind of confused. I recognized that the patient was also Pakistani like me. So I thought maybe I could try speaking Urdu. But in that moment, I felt like I couldn't because that [translation services] actually wasn't ever a part of our training at my specific EMT station. I definitely think that I could have stopped and said, "Hey, let me just try translating this for the patient. Maybe they'll understand it better from somebody who is also of their culture." I understand the apprehension because my dad is the same way. My parents, even though they know I want to go into the medical field, when it comes down to them going to the hospital, they won't do it. But if it's me, then they'll automatically on-site, take me to the ER, they'll drive me whatever. So yeah, I definitely understand the language barrier. I think it's so important to speak up. So I was planning on emailing my supervisors and saying, "Hey, can we talk about translation services available? Are we open to using Google Translate? Is it okay for me to translate if I understand the language, and I'm able to use it?" We also talked about embroidered pronouns on the white coat. For me, we have embroidered name tags where it says our last name on them. So I was wondering if I could ask if we could get those with both pronouns [and our preferred names] attached to them [our EMT uniforms]? Or at least wear pins, because I'm not sure if that's allowed, and I definitely think that it's a conversation to be had. So yeah, I got to talk to Laurel about my situation with that patient [at a later date from the initial interview recording], and whether it okay for me to speak up. We definitely decided that it would have been. I think going forward, there's so much I can do, and I've made a list. I'm gonna get started. Also, for any of our listeners, who are medical students, pre-med students, anybody in healthcare—if you're part of an organization that already uses pronoun pins or has embroidered coats or anything like that—please feel free to send an email to QueerDiagnosis@gmail.com. It would definitely help me as I make a presentation for our supervisors and ultimately make an improvement on a small level that might add to affirmative care for the patient.

Srihita: So two other things that I've been thinking about since that conversation is Laurel said—that I thought was really insightful—is "nothing about us without us." You and I are actually taking a Women’s Gender Studies [Global Reproductive Justice] class together right now, and someone posed a question about how to make the feminist movement more inclusive because it has had these roots in being exclusionary. I think the importance of talking to other people and listening to other people's perspectives and experiences—which is kind of what this podcast is rooted in largely—is so important and something that I want to stay cognizant of. Especially with the internet, we have such an access to everyone's experiences. It's not like you have to go up and talk to a person. Someone has written about their experience somewhere. So I think just reading as much as we can. The other thing that kind of goes in hand with it is they talked about Latinx, and how sometimes that can assume an Americanized label or whatever. I think that kind of goes with the "nothing about us without us" and being aware of how American culture might project itself onto other movements and other populations.

Zarya: Another thing about—you mentioned Latinx—I learned about Latine from Laurel in that episode. I used that [in daily conversation], and I also used the Mx. honorific, a way of referring to somebody in an email. I actually was very afraid—I don't know why because it's just an email—that somebody might think I was being a social justice warrior. But no one commented on it. And actually, people seemed to be a lot more receptive to it because then they would remember to include their pronouns in their email signature after even though it wasn't there before. And I thought that was a really cool way to accommodate and be more inclusive.

Srihita: Laurel talks about the responses they would get to emails, and I loved how they let it fall off their back if people were overly apologetic or they kind of talked about how people almost seemed scared of them, or if people refuse to change or take the input. They had a humorous take on it. And I like that. I think, as you said, sometimes it can be scary. I know I've felt vulnerable to criticism when I've been talking about these issues because people will be like, "Oh my God, it's not that big of a deal" or whatever. And I think the fact that they had that kind of perspective on it, and were like, "You know what, it doesn't matter." You just have to keep going forward because there's always going to be people who are going to be unaccommodating, and that's part of it.

Zarya: Yeah, I think taking it in stride is such an important thing. Also, the thing that I was thinking about is falling all over. Do you remember when Laurel said that? I feel like when I email people—even just looking for podcast guests, I'm just ready to learn. And I think I'm a very enthusiastic person in general. Sometimes I understand it can be annoying, which you wouldn't say I'm annoying, right Srihita?

Srihita: [Sarcasm] I would never say you're annoying. I've never said that, ever.

Zarya: Yeah, I appreciate that. But I tend to fall all over people anyway because I think that they're amazing. The listeners will actually see this in following episodes where I'm just in awe., and I have no idea what to say because I'm so excited. I think that actually happened with Laurel as well during this episode. We had to decide where to end the episode because it was going to be way too long if we included all of it. We ended up talking for close to an 1 hour 30 minutes or 1 hour 45 minutes. But you know what, if this goes well, maybe we'll release it as a bonus episode with your input.

Srihita: Yeah, I know. We were kind of starstruck, essentially. Because we kind of went into this conversation not having met Laurel before. We had read about the work and stuff that they had done. But at the end of that 1 hour 45 minutes, our lives were kind of different afterwards. And it was—yeah, it was pretty crazy.

Zarya: You also talked about wanting to start volunteering, and you haven't volunteered since high school? Right?

Srihita: Yeah. I used to do a lot of volunteer work in high school. And I think sometimes, you go to college and you get busy with other things or whatever. And I think talking to them made me realize how disconnected I'd become from that part of myself and realizing—it's not a selfish thing—I think sometimes we talk about altruism in selfish terms, but it is kind of like a win-win situation because you get to have a positive impact on other people and then you also have the added benefit of feeling good about yourself. But going off of that, one of the points that Laurel made that I think we've kind of touched upon with other guests since is this idea of feeling like "Are you doing enough? How much time should I be putting towards this?" And they kind of talked about—because obviously, this has been a part of their [Laurel’s] life for so long that—I think they talked about how they started translating health documents when they were young as 12. So obviously, this has been such a big part of their life for a long time—but kind of navigating it through that period of time and learning just how much time can they give, but also taking care of themselves and having self compassion. So I mean, overall, just with the humor and the self-care, there's just they have such a good, positive outlook on all of it. And I think that's one of the reasons it was so inspiring.

Zarya: I agree. I also think that you have to choose the things you're going to be passionate about and really narrow in on those. As somebody who's pre-med, I don't like to think I go into things like, "Oh, I'm hitting a checkbox [for applications]" or whatever. But I think in freshman year [of college], I was definitely not in that mindset. I'd like to say I'm not either now, but now that I'm thinking more seriously about applications, you look on the AAMC website, which is the equivalent of College Board but for medical admissions, and you see what have past applicants done, and you see "Oh, 94% of them have done research." And I have to think well, have I done research and you start comparing, "Okay, what are my extracurriculars?" But I genuinely think that this podcast is such a great way for me to learn more while also doing something I'm —this is something I'm passionate about. I think it's so funny because it works in two ways that I'm learning how to be a better healthcare provider in the moment. I'm learning how to provide affirmative care at every step of the way. While I will say that I don't know how to do that exactly right now, I'm going to start those conversations. And I don't know if I would have been able to do that if we didn't have such great podcast guests. You know what I mean?

Srihita: Yeah, and Laurel was saying how they learned Spanish because they were just interested in language or were enthusiastic about learning another language. And then they found this kind of application for it within healthcare. And I remember a lot of the volunteer work I did in high school revolved around tutoring because I was just good at math. I think it's important to take self inventory, and there's probably skills that you have that could have a really positive impact. It's just about repurposing them. I think you're a very enthusiastic person, and you want to learn about other people and are in awe of other humans. You've taken that curiosity, and you've made it into something that benefits you but also creates this thing that hopefully other people can learn from as well.

Zarya: I don't think it was just me [bring this podcast to life]. It's you and Jameson [our awesome Editor] on the team as well. You guys are helping me do this. This podcast happened when I was crying one night, and I was thinking really hard. And then I messaged you guys, "Hey, what if we did this thing?" And I do generally feel like we're forming such a great thing. And I appreciate you for being part of it.

Srihita: You and I had always talked about a podcast just because we love to talk. I think that's another thing. We just love having conversations. And so the fact that—obviously, you and I get to have this conversation in the reflection—but we also get to include other really awesome accomplished human beings as well.

Zarya: Well, you just revealed that you'd like to talk to me, so I think I'm gonna have a good Valentine's Day.

Srihita: [Laughter] Is this gonna be up before Valentine's Day?

Zarya: It's gonna be up after.

Srihita: Yeah, okay.

Zarya: I think that's a wrap up for us—is it the same for you?

Srihita: Yeah, we hope you enjoyed this episode as much as we did.

Zarya: We really love this one. We love them all, quite honestly. Not gonna lie—it's hard to find podcast guests. Actually, it's not hard to find podcast guests; it's just that I'm very shy when it comes to reaching out and being like, "Hey, I'm like working on this thing with my friends. Are you interested in maybe joining us?" So if you guys, the readers, have anybody that you want us to interview or you're someone who wants to be interviewed, please feel free to hit us up. And you can always find us at QueerDiagnosis.com. Our Twitter and Instagram are also @QueerDiagnosis. And you know what? We'll catch you on the flipside.

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.