Season 01: Episode 06: Davy Ran Transcript

Queer Diagnosis Podcast

Season 01: Episode 06: Davy Ran

[Theme music plays]

Interview

Zarya: This is Queer Diagnosis. I'm your host, Zarya. My pronouns are she/her/hers.

Srihita: I'm Srihita and my pronouns are also she/her/hers. Our guest today is Davy Ran, a third year medical student at the University of Rochester School of Medicine and Dentistry. Hi, Davy, could you please introduce yourself with your pronouns.

Davy: Hi, my name is Davy ran, I use they/them.

Zarya: Can you tell us how you identify with the LGBTQ+ community?

Davy: I generally identify as queer. Sometimes I also say bisexual. I also say trans, non-binary or gay. But when people ask, overall, I like to just say queer because it encompasses all of those things.

Zarya: What are some situations in which you would make that distinction where you would specify whether you're trans versus bisexual versus so on so forth?

Davy: It definitely has to do with how safe I feel in a situation and also how knowledgeable I feel the people I'm with are. Sometimes, if I don't feel like explaining what each word means, saying queer or gay is a really good shorthand when people don't really know the specifics. If I'm at a party and looking to date someone, then I'll say bisexual to kind of make my preferences more clear. If I'm in a place where I feel it's safe to say that I'm trans, I usually say trans and non binary. I like to use both because I feel they both apply to me. But if I feel like a space isn't very safe, then I'm definitely not going to say trans, To be honest I'm much more comfortable saying gay, even over saying bisexual.

Zarya: I've had some friends who have also had the same thing where they don't tell everyone that they're trans, because it could possibly change the dynamic that you have with the person. I can't speak for their experiences but I've seen that sometimes they will tell somebody and then everything shifts in a way that they didn't expect. Even if the person comes out saying that they're very accepting. So that definitely makes sense to me. I know that with the bisexual identity, some people say that, or at least I've been trying to read up on it, people have said it's common for bisexuals to just say gay. So I was wondering what your take on that was?

Davy: At this point, I'm basically an elder gay because I came out really really young, like over a decade ago at this point. When I was coming out, bisexual was just coming into the mainstream. People didn't really use it that much. Most people did just say gay, and there was a lot of stereotypes about bisexual. There's the idea of being promiscuous or the high school girl who just wanted to seem cool, not that there's anything wrong with that either. A lot of people misunderstood what bisexual was. A lot of gay people wouldn't date bisexual people because there is the idea that they're really gay and just in the closet. So I think a lot of people felt more comfortable at the time not saying bisexual. I specifically chose to say it because I wanted to say, "Hey, this is a real thing." It's an important thing. It's not a shameful thing. For me, I still go by those old queer politics. So I'm not so up to date with the modern ones the same way. I've kind of had that identity, my whole life, and just stuck with it.

Zarya: Very cool. So I know that you wrote a book called The Rainbow Book for your medical school. I was just wondering what exactly that is and what inspired you to create it?

Davy: One of the reasons I went to my school is they have something called the Blue Book which is a student written guide. It's maybe 100 pages about how to succeed as a student at that school. And I thought that was so impressive. It tells you things you can do in the area, if you've never been to Rochester before. It tells you how to approach teachers, how to write nice emails, what to expect from courses, how to do well on exams, how to reach out to upper-years, and I loved it. It made a huge difference for me. But when I arrived at the school, I felt like there were a lot of things, like a hidden curriculum, that I wasn't really aware of before coming to school. There were a lot of things I didn't know how to do. I didn't know how to talk to people about discrimination, and how to get it addressed. I didn't know how to suss out if faculty was LGBT friendly or not. I didn't know how to approach a researcher to ask about LGBT research. I felt that there was a real need for students coming in to have that resource: to know how to live in Rochester and go to the school as an LGBT student. I actually haven't pulled up because it's a little long, checking out the table of contents. By the way you can find this book if you just Google, URMC Rainbow Book for University of Rochester Medical Center. It was published on their website. So it's available now and we've gotten amazing feedback in the last couple of years of LGBT students who have looked at it before coming here. It includes sections on where to go for LGBT safe bars, LGBT safe gyms, food, community, haircuts. It talks about the health resources that are LGBT friendly and LGBT trained on our campus, how to deal with a non discrimination policy, how to register your gender with the school, how to make sure people know your pronouns, where the gender neutral bathrooms are. It also talks about every element of our curriculum which includes something about LGBT health. It talks about research projects students have done in the past, other queer projects that are going on that the school is doing that people can take part in. We have a list of student spotlights to celebrate queer students and their achievements. We also have this constantly updating faculty Out & Ally list who people can reach out to.

Srihita: So, you mentioned a hidden curriculum. Currently, how well do you feel like the curriculum that you've been going through addresses the concerns of LGBTQ health?

Davy: I know that the average medical school, if they include LGBT content, has four hours of LGBT content in all four years. And I would say, unfortunately, my school is not that different.

Srihita: It's crazy that there's four hours in four years. That's a very, very jarring statistic. Do you think the rainbow book can kind of help with that by spotlighting it. so it further encourages LGBTQ curriculums and research?

Davy: I really hope so. One of the projects that I did with a couple other students that I know other students are doing even now is addressing areas in the curriculum that could be made more LGBT friendly. I think that has produced positive changes over the years. Even though it's kind of a slow-growing process, as students we don't really know how to do curriculum change. It has to get approved by a lot of different people, and then we have to make sure it's being maintained over the years, but I do think definitely highlighting those projects and showing that students both current students and students interested in coming are invested in having more of a curriculum has been really important. Our LGBT affinity group actually has done supplemental lectures on their own with outside organizations which has been really powerful as well.

Zarya: So obviously the rainbow book is like this great tool if you're part of the queer community. Can you talk about your own experiences navigating medical school as a member of the trans community?

Davy: That's what I'm gonna write my book about. It's hard to say all of it in one sentence, but I think it's been scary for sure. It's also been exciting. It's been uplifting. It's been all the emotions that I've ever had. Throughout medical school, I mean, it's obviously scary, which is what people think of immediately. I don't know whose queer friendly. I don't know who's going to treat me differently because of my identity. I don't know what discrimination I might face and I have actually faced discrimination. I faced discriminatory measures. I've had a doctor yell at me for an hour in a locked room about why trans people shouldn't be in medicine and trans people shouldn't be doctors, and trans people shouldn't do sports, and all sorts of things. At the same time, I, as a trans person, have been able to do so much in my school saying "Listen, I'm coming from this community, I have competency in this community, and this is what the community needs to feel more comfortable here." And people have listened. For example, our school, I believe for the first time ever, after my year came in started recording, who applied who openly applied as transgender and including it in the demographic statistics year by year so they know who to reach out to more. It's been exciting in that I can trail-blaze in that way, and at the same time, there's actually so many more queer and trans people in medicine than I ever expected. Certainly a lot of them are not out, necessarily. I know when I started going to Rochester people said our year was the first year to have trans people, which I've learned over time is absolutely not true, but we are certainly the loudest. My class has four openly trans people at the very least, which, in a class of 100 is fairly high. It's like 4%. Overall my class is actually almost one fifth queer. So, having other students go through that journey with me has been so exciting. There's such an intense community feeling every time I meet a trans student at any other medical student. We're immediate friends. I'm so excited to talk to them about their experiences, and there's a lot of work being done in this area. It's so exciting to be at the forefront of that but also not so to the forefront, that you don't have other people doing it with you.

Zarya: Thank you for sharing that there was a physician who yelled at you. That's insane. I'm really sorry that you had that experience. I think I've said this so many times, but I think it bears reminder that I'm five feet tall and I can take anybody. But of course violence is never the answer. So it seems like, at Rochester, the students are pretty active and you guys are making changes and trailblazing but what was the school's response to the Rainbow Book?

Davy: The school is very supportive of the Rainbow Book. It's published on the Admissions website. The admissions director, Dr. Nobay, her first year that she recruited was our year and our year was a phenomenally queer year. So, she has been integral in addressing the lack of queer people in medicine where a lot of schools don't even consider queer people underrepresented in medicine. They don't even know that they should exist in medicine in the first place. So, it's been a great response. I had no trouble at all getting help on the book, getting support for the book, and getting it up on the website for people to use.

Zarya: When you're applying to medical schools, and this is something that I'm thinking of as I start compiling a list of medical schools that I want to go to, how did you look at medical admissions committees and just the schools themselves? Is there a way to find out what the hidden curriculum is for the LGBTQ+ community in these schools?

Davy: That's a great question. Nothing beats knowing someone at the school. I do think that if you are in the process of applying, most medical students, and any Out & Ally faculty on a website are totally okay with being cold emailed. Maybe even DM them on Twitter if you see someone, just saying "Hey I am an LGBT student; I want to apply. Do you have any advice?" The amount of willingness to mentor that I've seen in the community is really wonderful and really unique because a lot of us didn't come in with mentorship. So, we want to pass it on. When I was doing research into different schools, I looked at the LGBT friendliness of the cities they were in, what the demographics were. I would Google their name and LGBT and if an article came up that was like the school was sued because of this, I'd be like, "Nope, not that one". But if other things came up that seemed much more affirming, then I would certainly look into it. I also asked a lot when I got my interview. Interview day is a great chance to ask the students what their experiences are. Students will be honest. They should be honest. I certainly was honest about the pros and cons of coming to my school because the most important thing is that people come and they feel happy and supported. So it's certainly possible to get an assessment of the hidden curriculum. If you don't have connections in the medical system, I do think it's difficult which is why I'm encouraging people to take the Rainbow Book and make it for their schools. If anyone wants to steal this, please do so. All I ask is that you post it everywhere so I can get to see it.

Zarya: I think that it's crazy to me that this is the resource you've created for just one school. I feel like it should be implemented on a national level. It just seems that important because I read through it and where I live, at least, it's generally conservative, and I didn't really know who I could speak to growing up, just to support my friends as an ally, but also as part of the queer community. I feel like that should be implemented, not even on a medical school level, just like an area level, but I know so much of that comes from networking within your community. So what does trans healthcare mean to you?

Davy: So, trans healthcare to me is all about cultural competency. I like to say trans healthcare is just healthcare because there's really nothing that we're providing for trans people that we don't also provide for people of all identities and all bodies. The one exception might be bottom surgery, which has been designed for trans people in large part, but things like hormone replacement therapy, we've been using on people for years and years for all sorts of reasons and all ages. There's children who have, for example, adrenal insufficiency, which means that you know these organs in their bodies called the adrenals produce hormones, and they don't produce enough so we give them hormones to replace those hormones and these children turn out totally fine and wonderful. There's a lot of conditions that can cause adrenal insufficiency, even something like asthma, which most people have heard of. People who take steroids regularly for asthma might have adrenal insufficiency, and they might need to take hormones to replace, and that's totally fine. Things like double mastectomies, which trans people refer to as top surgery, that's something we certainly provide for people all the time, especially as the awareness of breast cancer is on the rise. There are people who get it without any indications that they currently have breast cancer, There's people who get it because they're worried they might have breast cancer. So I argue that there's really no difference in the healthcare we're providing for trans people, it's just that we might call it different things, and that's where I think the difference comes in. I mean, a lot of doctors don't know the basic terminology of the queer community as a whole or of the trans community specifically, which I think is a huge issue in medical education. Like we were talking about before, a lot of people feel that they don't have to learn it, or that it's too complicated to learn which is wild from people who learn how to say like Sphenopalatine Ganglioneuralgia, you know or like Choledocholithiasis or Borborygmi. People learn, on average, 10,000 new words in medical school. They can learn words like top surgery, bottom surgery, HRT, which is hormone replacement therapy. The big thing with trans healthcare is knowing, first of all, how to recognize that trans people exist. So in the intake forums you should have options for people to put their pronouns, options for people to put their gender identity. When they come in for the actual meetings in clinic, there's something called SOGI data, which is on every electronic chart that we take for patients. If you click right under their name, SOGI stands for sexual orientation and gender identity data, where you can put in for every single patient what their orientation is, what their gender identity is, what they want their body parts to be called. It actually is very extensive. It has open answers and multiple choices depending on what the patient needs, and this data is crucial to knowing who we are serving, how we are serving them, and what the outcomes are. But, most doctors don't know about it, or if they do, they don't take it regularly. They might only take it for someone who they think is visibly trans which is another thing. You really can't tell by looking at someone what their gender identity is. There's also something called Trans broken arm syndrome, which I think a lot of very well meaning physicians fall prey to. This is the idea that when trans people come in for healthcare, because often in schools when trans healthcare is taught, it's exclusively taught in the context of LGBT health, people don't realize that trans people also need healthcare in every other area of health. They'll assume that whatever they're there for is a trans reason, or they'll turn that reason into a trans reason. So what does that mean? It means if a trans person comes in with a broken arm, instead of treating a broken arm, the physician might be like "Well, so tell me about your gender? How do you feel about that? Do you want to change that? What are you doing for that?" Meanwhile, you have this person here with a broken arm being like "Hello, I really just need this taken care of." So I think those are the big things: just recognizing people exist recognizing all their problems are not related to being transgender, and recognize that being transgender can be a wonderful, beautiful, and empowering thing for people. It's not always negative, and devastating. It shouldn't be the leading point of interviews to assume that your patient needs or wants "help" with being trans. Finally, it's just recognizing that their healthcare is already in use. If you feel anxious about providing this healthcare to trans people, even if you provide it to other patients, there are lots of very short programs where you can get a certificate to learn how to provide transpacific health care. You don't actually need specialized training.

Zarya: Can you tell us what it's been like for you pursuing trans healthcare? Actually, scratch that. It's not trans healthcare; it's simply healthcare for a patient.

Davy: Exactly. So to answer your question just about medical records and charts, this is totally anecdotal, but every charting system I've seen has included areas for SOGI data, and I've done that in multiple states. I can't say it's the charting system everyone uses but if they don't, you can certainly still put it in the general note for the patients. Every system has that because you need to be able to write a note for your patients, and it would be really helpful for patients who use, for example, different pronouns or who are seeing multiple genders and don't want to experience discrimination and don't want to have that conversation again and again to have those notes for the providers to look over before they come in. And as for your second question about what is it like to be a trans patient pursuing trans healthcare or healthcare, it's been very hard. I would say I don't come out to most of my doctors, even as someone who's out in every area of my life, and I've been out for a long time. I have no issues being out. I'm very proud of being out. I have no worries about my reputation. My reputation is based on being out at this point. But it's so complex. And it honestly ends up being like a waste of time where I'm too exhausted to explain to a physician, what my identity means, that I'm too tired of seeing physicians stumble around it and not know how to react to it. I honestly just don't say it sometimes. Even now, being a medical student, I know how to read patient charts. I've glanced over to computers that the doctors are looking at and I've seen my gender identity and my pronouns listed on the chart that they've pulled up, and doctors still don't acknowledge it. So at that point I think, well if they haven't acknowledged it already, what's going to happen when I bring it up? So it's been difficult. For example I pursue, have pursued, and am pursuing transpacific care like hormone replacement therapy and voice training. There's maybe a couple trans physicians who are providing that sort of care. Their waiting lists are like five or ten years. There's so much need, and then there are cis straight providers providing trans health care but it's always scary. You don't really know what they know. When I have gone to them, I've ended up sometimes having to go to pediatric clinics, because there's such an emphasis on adolescence care for queer people that people forget that trans people can be older than 18. Plenty of trans people are. So as someone who's essentially aging out of pediatric care, or has been aged out of pediatric care, that's been a very peculiar experience. I've even had the experience of being referred by a trans clinic, for a trans related reason, to another clinic that is supposedly LGBT friendly. I've showed up wearing my pronoun pin on my chest speaking about why I'm there, which is for trans related reasons, and still had the physicians misgender me and think I was cisgender. It gets to a point where people will see what they want to see and that's a scary reality in medicine, and I hate to say it. I know how terrified a lot of trans people are of accessing healthcare, and I really don't want to discourage anyone from accessing the care they need, and for demanding the affirming care that they need, but it is a reality that sometimes I just don't have the energy.

Zarya: It seems like those four hours of focus on LGBTQ+ healthcare throughout four years of medical school is just for those four out and visible trans students in your year. It's a one to one ratio but I don't think it's in a good way.

Davy: Yeah, we each get an hour.

Zarya: They knew exactly how many students were coming in and they planned it based on that. So in the Rainbow Book, are their names of physicians who are LGBTQ+ friendly and know how to provide care for trans individuals?

Davy: That's a great question. I certainly hope so. I took my Out & Ally list from a list that already existed at the school and have added to it from my own personal experience when I've met physicians that I've personally vetted and thought that they would be great for the Out & Ally list and asked them if they wanted to be included. I can't say that everyone on that list has had training. I certainly think there are people on that list who are very well meaning, and have not necessarily been trained, but I think that's extremely common in LGBT health because a lot of people don't know of any LGBT health trainings. There aren't very many, and it's not incorporated into the everyday curriculum. I will also say that we do have queer providers also on the list. So at the very least there's that.

Srihita: What are your thoughts on allied physicians and also queer physicians to provide affirmative care for all members of the LGBTQ+ community?

Davy: I think it certainly is pressure on the queer physicians. I know, even as a medical student, I felt a lot of pressure to be out, to be loud, and to be there for students in whatever way I can all the time, because there is such a huge need. For me as someone who went into med school knowing I wanted to do LGBT health, it's not a huge negative pressure since this is what I want to do. I wish I was getting paid for it now, but it's what I want to do anyways. It's what I'm passionate about. I don't get bored of it. I like doing it, but I certainly think it is emotionally exhausting for a lot of people. And I think it is exhausting for queer physicians because they truly know what we're lacking. They know how much the system needs to go. They've also seen the system evolve over time so they do have that insight which is also good. I think for allies, this is just my guess because I'm not an ally, there's less pressure. I think there's less pressure because there's maybe less understanding. A lot of people don't understand how the queer community has so many different identities within it and different cultures within it and how that relates to different experiences, resources, and networks within it. I think a lot of people don't actually distinguish between the LGB and T in the community, which is not necessarily the wrong thing to do but sometimes it's not what students need. So I think physicians who are allied, because they may know less of what students need, feel more comfortable providing it because it's less of a burden because they think there's less to provide if that makes sense.

Srihita: It definitely makes sense. It also, for me, brings up a previous interview that we did where especially now, allyship has almost become a buzzword and everyone wants to be an ally without necessarily doing the work of being an ally. I definitely have to constantly remind myself that there's more to learn and I should constantly be listening to other people's experiences. As you said, it can be really easy to over simplify it. So we were looking at your resume and you have done so many things abroad, and it all looks really cool. Can you talk about how your experiences have varied within the LGBTQ+ community in the United States, compared with the places you've traveled to abroad.

Davy: Absolutely. For the people who I didn't send my CV to, which at this point, after med school applications feels like everyone has it, I traveled a lot my whole life. My parents are professors and they love traveling so I essentially moved every year or every two years. I've lived in 20 ish countries. I have not been out in all of those countries. First of all, our concept of gender and sexuality in America is completely different from anywhere else. So that's really important to recognize. There are a lot of communities that have multiple genders, beyond our concept of binary genders. There are a lot of communities whose idea of sexuality isn't necessarily related to sexual behavior but maybe who you end up marrying, or maybe it's related to behavior but not who you end up marrying, or any variation within. There's so much variation in the world. I really recommend people look it up; there's a Wikipedia page of different genders around the world that's fascinating and wonderful. My experience, I think because I am at my core an American, and also a New Yorker, I am most comfortable being out as queer in America and in New York because I understand all the queer codes. I understand how to dress queer. I understand how to talk queer. I understand the lingo and the way people move and the kind of events people go to. I know how to meet people and I know how to also tell when someone isn't so LGBT friendly. When I go abroad, it takes much longer for me to suss that out. Of the places that I've been abroad, I've been most comfortable being out in the places that I would say are more westernized, not because I think that they're more accepting necessarily. I think they just have similar ideas to orientation and gender as I identify with, so it's easier for me to come out because I don't have to explain what it is. It's certainly scary. I would say that I, in general, have never felt as comfortable being queer as I have in big cities in America. Many, many times I felt that I've been in danger if I say anything. So, there are a lot of places in the world where it's just a completely different level, it's a different level of fighting, Our fight for so long was the right to get married and some people are still fighting for the right to legally be gay. So it's really different. I've used LGBT guidebooks, to different countries but for the most part it's a learning experience. I'm usually not out in other countries until I meet people who are out and hear from them what the experience is like.

Zarya: Just to clarify, did you volunteer primarily in these countries?

Davy: Yeah, I did a lot of healthcare volunteering and I tried to do LGBT volunteering whenever I could. A lot of times that looked like HIV volunteering with a subspecialty on the queer community. I would kind of build a relationship with the community before I started seeing people openly come to me. But absolutely, I tried to do work everywhere I went.

Zarya: Are there any patients that you've perhaps come out to that you remember and it was a positive experience?

Davy: I was on my site clerkship quite recently, when I was on the adolescent floor. There was adolescent who was having a difficult time. They were strapped down, because they're threatening to hurt themselves and no one could get them to calm down. I, in my med student hubris, because I am not a teen whisperer or anything, thought I could go in there and calm them down. I got very lucky because I walked in and I looked at the patient and I knew they were a trans patient. They're being misgendered and they're very upset and it was immediately clear to me what was going on. I immediately came out to the patient, I was like, "Hi, my name is Davy. These are my pronouns. How do you identify? What's your name?" Just with that introduction, their whole demeanor changed. It was incredible to see. I didn't provide any treatment. I didn't give any medication. I didn't even end up writing a patient note for them. I just sat with them, and just listened to their experience being trans in the hospital and answered their questions about being a trans medical student because they've never met someone like that before. And it was very powerful, I think, for both of us, certainly for me. I was like on the edge of tears the whole time thinking, "Oh my god, I'm so happy that I came in, I'm so happy I can help this patient feel more comfortable and feel empowered because they were someone interested in healthcare down the line". It was amazing to stand there and tell them it's possible and also to be able to advocate for them. Speaking of SOGI data, which is my favorite thing, I updated their chart immediately. The physicians were super nice. They saw the chart and I actually had people come to me and say that they had no idea and thanked me for updating like and asked how I knew, which was so funny to me because I had no idea how to answer. I think there's something called gaydar and I think it's real. Having been a trans patient and knowing the fear and uncertainty that comes with that, you recognize what it looks like on someone else's face. Also, if you ask, you don't have to recognize it. You just have to ask. So I think it made a difference to me and made a difference for the patient and made a difference to the doctors, which was really awesome.

Zarya: Speaking with previous medical students through the interviews that we've done, it seems like the adolescent medical teams are usually more open to talking about gender identity and sexual orientation. Is that your experience as well?

Davy: Absolutely, 100%. This is actually a hill that I will probably die on, which is that LGBT healthcare is not just teenage healthcare. I'm never gonna say it's a bad thing for teens to get health care and focus on the care that they need. It is so hard being a teenager. I remember. Even if I hadn't been a queer teenager, just being a teenager is hard, but the lack of understanding that queerness has existed throughout history is striking and terrifying. People really think that because they just started hearing about trans people or bi people or non-binary people, that they just started existing and that's just not true. But I think that the medical field really reflects that, and I have had many instances where I've been seeking research and I've said I want to work with older queer patients. I want to do queer research on older people, and people have just directed me to adolescent health care. So, it is not something that exists in such a consolidated form in the way that LGBT healthcare exists for adolescent care. They're absolutely more open and I think there are just more resources for it and more recognition because there are more people who are out right now. We have a lot of teenagers coming out which is amazing. And we also have it in the news constantly, for better or for worse, so people are going to know about it. I think if we had people talking about older queers in the news, then we probably would have more healthcare to go with it.

Srihita: I haven't been following the news very closely but I do know from the podcasts I've been listening to that there's been a rise in anti-trans legislation that's been coming up in different states. Obviously it's not surprising. As you said, for a really long time, the fight was for marriage equality and now this seems to be the next big political fight. What do you attribute that to or what are your thoughts on it?

Davy: That's a great question. I think that queer acceptance has kind of gone in the direction of like G to L to B to T. I think that the first thing was having gay people be accepted for being gay. That was the first fight. The second fight was having lesbians being accepted for being gay. That was the second fight because women wanting sex outside of men was considered crazy. The third thing was bisexuals. It was listed as a symptom of BPD, for example, which is borderline personality disorder. People thought that people were inherently neurotic for being bisexual. Now when I tell that to people, and that was a thing that existed when I was a child and a teenager, people in medicine are always shocked. They're like, "What? Bisexuality as a symptom? No, that's ridiculous". I remember my doctor telling me that as a child. So I think trans is absolutely the next thing. I think that people are more comfortable questioning orientation than they are questioning gender because it hasn't been done as often in our society and because our society is also so based on gender roles. People are very uncomfortable with it. I think that anti-trans rhetoric is very much linked to sexism; it's very much linked to racism. Trans women of color have the highest rates of violence against them. It's certainly related to classism. I think that in some ways it's a self serving cycle because these are people who are the most vulnerable in society so they get more hate because there's not that much ability to fight back. It's interesting. In some ways I think it's also very powerful because people know what trans is. The first time I heard the word trans, I was in college and this is a person who's been out as queer for such a long time. Now, everyone knows what trans is in some way. I think that whenever you start getting hate, it's gearing up for a stronger response of love and care and support. So that's where I hope we're going.

Zarya: On a more general scale, what improvements do you see happening for the LGBTQ+ community in terms of healthcare and the future?

Davy: I do think, overall, people are becoming much more aware of pronouns, even just what pronouns are even though they're something everyone uses every day. A lot of people don't think about them. Even right now, as we're zooming, I see you have your pronouns in your username. I see a lot of medical students and friends and everyone doing that in their zoom profiles. I see them do it on their email signups. I see faculty doing it as well. I see people wearing pronoun pins. This is all regardless of whether they're cis or trans. It's open to everyone. I also see cis people who use pronouns that aren't necessarily binary, like women who use she/they. There are men who use he and she, which is super common historically in the gay community. People are learning about what this is and are pushing the boundaries of it, regardless of how they personally identify. I think that's absolutely wonderful and very powerful. I think these are like the hot topics so we're seeing more in those. I see all gender or gender neutral bathrooms where I didn't see them before. And that's one thing I was really impressed by coming into medical school actually. I did not think those would exist, and there's tons all over and they're not called unisex, not that there's anything wrong with unisex. I love a good unisex bathroom, but it shows the fact that the university, the institution, was actually thinking about this. They actually said, "Oh, there's this controversy over gender, and we are going to address it in this peaceful and important way". So, certainly there's really positive changes being made.

Zarya: I have noticed that change to now that you mentioned it - from unisex to gender neutral. I didn't attribute that to increasing visibility of the LGBTQ+ community and it's interesting how you made that connection because it makes sense to me. On our first floor, actually, there's a new sign that's posted that has a figure of a male, a female, their version of someone who's non-binary, and also a wheelchair.

Davy: The four genders

Zarya: Yeah, my favorite four nations of the avatar state. I hope you know that reference.

Davy: Absolutely, I'm gay. What do you think?

Zarya: So if you could turn back time and talk to your premed self, what would you tell them?

Davy: You sent me this question ahead of time and I've just been staring at it like, "Whoa, this is a hard question". I think I've changed so much in medical school, in ways that I have yet to identify from being a pre med student. I would say, first and foremost, that LGBT health is actually a real thing. It's a real field that you can go into. It's a real study of research. When I came into medical school, I wasn't so sure. I knew of LGBT clinics, but I didn't really know what they did. I didn't know about queer research, and I didn't know about queer networks and that all these things existed. If you want to go into queer healthcare, you absolutely can. So I would say that first and foremost because your school is not going to tell you. You're not going to have a clerkship, most likely, in LGBT health. This path is not presented to students as a usual path to take. So, a lot of people don't know it exists. I would certainly tell myself that. I would also tell myself, and this is true for anyone applying to medical school, don't waste your time trying to kiss up to people or impress people or make people like you who you wouldn't want to work with anyhow. I spent a lot of time doing this - going to conferences and meeting impressive people and thinking, "Oh my god I should make sure they like me just in case", even if they're incredibly bigoted. I have reached a point where I know there's enough people who aren't bigoted in medicine, that I don't need those people to advance my career. I don't need to pretend I'm something that I'm not to be able to work as a doctor. I think that has been true for people in the past. I think it's true for people in certain areas of the country, but it doesn't have to be true everywhere. I think the final thing I would tell myself is that don't be afraid to ever stand up. If I don't stand up, it's often at the cost of my own dignity and my own mental health and my own ability to continue working with the passion for medicine that I really value. It's experiencing a concept that I just learned about called moral injury. It is emotionally painful, hard, and draining when you see something or have to act in a certain way that goes against your inherent values. There's so much that burns us out in medical school. There's so much that drains us. The last thing we need to do is to drain ourselves. So I'd say don't be afraid to stand up, but also at the same time, be prepared for nothing to change. Be prepared to face pushback and weigh the value of protecting myself from moral injury versus the potential injury that might come from standing up. To me, it's often worth it. It might not be that way for everyone. That's completely fine, but I think it's important that people think about that choice, so that they can make that choice. It's not always going to work. But I would say for every time I have had someone be transphobic or homophobic or push back against my initiatives, I have also had someone be the absolute opposite, and people who have encouraged me, who expanded on my ideas and my passions more than I ever thought were possible. I guess that would be my advice.

Zarya: MedTwitter has been incredible because I've met so many people, including yourself. I honestly don't think this podcast would be possible without Twitter, which sounds like a weird attribution and Twitter's probably gonna call us in a few days to take control. Even right now, I'm writing a presentation and I don't know that many physicians where I live who are LGBTQ+ friendly or who identify with the community themselves. When I did look it up, there were a very select few. I could count the number of physicians on my hand. So I think for Twitter, just social media in general, connecting all of us in such a great way showing that you have support and what you said earlier about how, even in faces of adversity, there's such a strong pushback of love and support. I think that's the thing that we need to keep pushing on. As an incoming student, is it possible to know who among your peers is also queer?

Davy: Yeah, definitely. I can't speak for every school because unfortunately I didn't get into every school in America which is wild to me. I know at my school and honestly everywhere I interviewed, the queer people wanted to meet other queer people, so it was very clear right off the bat who else was queer in the cohort and we would always find each other and always talk about it. At my school, Spectrum is our GSA essentially. It's our LGBT affinity group. I was one of the co-leaders and we have a program where the administrative department forwards us the information of students who said they were interested in LGBT connections. It's one of the things on their secondary that they actually asked students to mark, and it's not a part of the application. It doesn't go to faculty, besides the administrative department who forwards us their emails and says that this student marked that they were interested. Then we will have somebody from Spectrum reach out to that student and say, "Hi, are you going to be in town? Would you want to meet over zoom? If you want to meet in person, we can get coffee and talk about all of your questions". So, that I think is a wonderful way to meet queer people. I also did just reach out and cold email any GSAs I saw at other schools to say "Hey, I'm interested in the school. I want to know from your perspective as a queer person". A lot of people responded to that. It's certainly possible. Maybe not when you are first applying to the schools, but definitely when you're at the interview level, absolutely.

Zarya: Today I was in a meeting with a medical school representative, and I wasn't sure whether it would be okay for me to ask questions like what are the LGBTQ+ considerations you guys take in your EndoRepro curriculum and things of that sort. I felt like it was grounds for them to change the relationship almost and see me differently although I have a feeling this is gonna end up being all that I talk about.

Davy: Yeah, that is 100% what happened to me. I was just way too gay in my application to not be out. It was getting ridiculous. A way that I've seen people do it is saying I'm really interested in health equity, and I want to know how you guys are making moves to address underrepresented populations or vulnerable populations. Can you tell me about LGBT healthcare? Can you tell me about your efforts to support and empower black and indigenous and other people of color in your healthcare system? If you group it with a lot of other things, I think most people don't pick up on it. Honestly, most straight people don't pick up on it. You have to be so gay for them to pick up on it. I've been so surprised by people who have no idea that I'm queer. And then they think I'm not out. I don't know how to be more out. People will see what they want to see. I would be not so scared of being blocked, if that is like a big worry and just saying I'm interested in health equity and social justice and this is important to me, is a value every medical student should have. Especially since LGBT health is such a hot topic now, I think you have more leeway with that as well. I will say that I think I started my application not being out and then transitioned to being out. When I first started applying to medical schools, my goal was just to get into medical school. I don't care what medical school. I don't care what it is. I just want to get in. I need to get in. As I've gone through medical school, I've realized that it's more important to go to a medical school where you feel safe, because it's so hard. I cannot imagine doing all this while closeted. It's certainly possible. People do it, but I would encourage anyone who has a choice to be open to make sure they're going somewhere that they like to. The whole application process is focused on how you have to impress other schools but schools should be impressing you too. They're also recruiting you. They benefit from having you there, especially as a queer students, especially as a diverse student with unique experiences and thoughts and perspectives. You are a huge value to any institution and I think a lot of queer people don't think that. Institutions want to have a token queer first of all, but they want to people who are trailblazers. They want to have people pay them money, and submit to their whims for four years. It looks good for the school, so never feel that you have to suppress yourself so much for a school because they should be recruiting and impressing you too.

Zarya: Was your personal statement centered around LGBTQ+ topics?

Davy: No one who is a family of the patient should ever be translating. It's a HIPAA violation, and it's not a good translation. I was a child. It's weird for me to know medical things about my family and I didn't know the medical words. I didn't really understand what was going on. There's a lot of miscommunication and it's just not providing the best quality health care for someone. If you ever see anyone trying to use family as interpreters or friends as interpreters, hospitals have the resources. They can call up an interpreter. They just don't want to.

Zarya: Cool, because I feel like it's really common practice. One of my friends speaks Urdu and when his grandmother was in the hospital, he was there day in and day out, translating for his grandmother. I thought it was spectacular. I thought it was a really altruistic thing but he was really young at the time. You're all in all day when you are also in classes. So that's interesting. That's a whole other thing in and of itself too.

Davy: It's terrible. It's not even legal. It's a HIPAA violation, but the people who are being interpreted for don't know that.

Zarya: I know we're really focusing on this. I'm also an EMT so we're allowed to write if someone translated. No one ever calls us out on that, that it's a HIPAA violation. Is it just the kind of thing where it flies under the radar because technically it's in the best interest of the patient? But, it's not necessarily in the best interest for their medical care. You don't want to divulge all their personal information to their relative, or whoever it is.

Davy: A lot of times there is an unspoken assumption when writing it in the note that there was a talk with the patient about consent and they insisted on having the family translate. It’s legal if the patient says it’s okay. It's just that usually the patient doesn't say it. A lot of times, doctors ask who can translate for you. They don't say we have interpreters. So patients will say this person can translate for me which sounds like consent, but it's not informed consent. I think it's inappropriate. I think it is very racist. I think that's why it doesn't get called out, to be honest. I think that a lot of old white men don't want to spend extra time with patients of color, and they get away with it because they're in power. It sucks. Even as a medical student, I can't legally translate for my patients and I’ve still had doctors constantly ask me to translate for patients when I'm not a certified interpreter. Just because I speak three languages doesn't mean I know other medical words in those languages. It doesn't mean I know how to talk about consent in every language. Even that is inappropriate and people don't know that. I will also say, that in all of my interviews, I talked about being queer. It was very obvious when a school appreciated that. That was actually a huge part of what played into the choice I made for schooling, when I saw that they were appreciative of that part of my identity and saw how it was a benefit to their school. It's not always a bad thing.

Srihita: Obviously I'm not applying to medical school, but I feel like if you did disclose that you're queer and the medical school wasn't appreciative, you probably wouldn't want to go there anyway.

Davy: No I would not. The other thing is that it helps that I'm a queer activist. I can say, "Oh I'm not just queer, but I'm doing queer healthcare", which makes it like look better, I guess.

Zarya: How do you view queer activism outside of healthcare? I know that’s a really broad question, but I don’t really know what to do outside a healthcare setting.

Davy: You’re doing it right now.

Zarya: Oh yeah, I guess that’s true.

Davy: One hundred percent.

Zarya: It's so funny because we advertise the podcast on campus in our newsletters or things of that sort. We have to get COVID tested and I swiped my card and the person who was checking it was like, "Oh my gosh. First of all, you're my TA and second of all are you a host for this podcast?" I said yes. Everyone's first initial responses were about how it would look good for med school. I'm not doing this for med school like. I don't even know if this is something that I will talk about. I care about it a lot so I will probably talk about it. I'm inching towards talking about it with our pre-health advising team because I keep accidentally referencing things I've learned from interviews in my conversations with them, and they're like "Why are you interviewing medical students?" I'm like, "Oh, they just want to run through their mock", but I'm under qualified.

Davy: As a queer person, I don't think you can be under qualified to explore what it is to be a queer person.

Zarya: Yeah, I agree with that. Where did you get this phrase, moral injury? I wrote it down.

Davy: I got it from Twitter a week ago. I was like, "Oh my god, this is what I've been experiencing". It was on med Twitter somewhere talking about racism in medicine. It was super super helpful. It changed my life.

Zarya: I like this terminology a lot. I feel like for a long time I didn’t have the language to vocalize certain things. First of all, I didn’t come out to myself because I didn’t know that was an option. Then, with the podcast, I’ve become more confident with the terminology I’ve been picking up. I'm gonna go around and tell everyone what you are experiencing is probably a moral injury. I'm not gonna go around, obviously, labeling things for people but the language that we learn in this podcast is so important. Also, I should note before when I said that I'm better than Srihita for the medical school thing, it's a running joke. I don't actually think I'm better than Srihita for that. I'm better than her in other regards. I just wanted to make sure because I realized that comes off as condescending, sometimes.

Srihita: She makes that joke a lot. It's fine.

Zarya: She's better prepared for med school than I am. I was an art student. I showed up and people thought I was lost.

Srihita: It’s always cool to have those perspectives rather than just have people who have been in this since they were five.

Zarya: Thank you so much for taking the time to meet with us.

Davy: Of course. I just want to add before we finish; I did forget to mention social media. The hashtag #LGBTQinHealthcare is amazing, and this goes for pre meds as well. There are a lot of Facebook groups like LGBT Premeds. There's the Medical Students Pride Association, MSPA, there's the AMA Gay and Lesbian Medical Association. They have Instagrams. They have Facebook groups. They have conferences. The online community is going to be your biggest support. It was my biggest support, even with a class that's like extremely queer, I would say one of the queerest classes in America probably, having online support has been absolutely crucial. Yeah, it's been amazing and I'm so happy to have met you guys through it.

Srihita: I think that’s it. This was so nice and thank you again for taking the time.

Reflection

Zarya: Happy Pride! So, let's jump right in. There was an element that Davy mentioned and it was the concept of being an elder gay. Being an elder gay, based on their description is being a mentor for the younger generations when you yourself have come out earlier on. So you might have a better sense of community and might be able to help somebody else who's just coming out to also develop that for themselves. So I think this is especially relevant right now because I'm taking a class called queer theory, and we were reading a book called Stone Butch Blues, which is written by Leslie Feinberg. Their novel is beautiful. It's from the perspective of a butch lesbian in 1970s America. To be honest, before I read this book, I didn't really understand the concept of like butch and femme, and I don't think I really understood the struggles of the queer community. Right now it's pretty easy for me to be on social media and find people in my community, whether that's through twitter with the hashtags that we mentioned or even just at school. We have the LGBTQ+ center, and reading Stone Butch Blues really put into perspective how far the queer community has come. Of course it's written from the perspective of white America so it's not all encompassing in terms of how layered it is for other communities, especially minorities. It was really cool that I was able to learn this term originally from Davy and then explore further in this book. I'm so inspired to make this podcast but I also want to make a book club, which you would not be invited to, Srihita.

Srihita: I'm not really good at reading, which is why I've decided to be a podcast host. Literacy is not really a strong suit. We did discuss pronouns in this interview. It's something that comes up a lot in our conversations. And I was actually updating my LinkedIn recently. They were like, "Oh do you want to select your pronouns?" and I thought that was really cool. I do know that sometimes these things can feel a little corporate or performative or whatever, but I still think it was nice to see that even LinkedIn, which is considered a professional space, starting to have this incremental acknowledgement of the fact that gender and sexuality is more of a spectrum rather than the binary that it was like presented to be as for so long. That made me happy. I'm not on social media but I know that for my friends that are on Instagram and stuff, those options are starting to pop up. So I think it's cool. It's a little way of normalizing it everywhere.

Zarya: Right now my pronouns are in my zoom profile. I can't remember when I put my pronouns into my Zoom name, but also, I don't know why that's not always been a thing. I haven't filled out forums for too long, as an adult, but I feel like it's so normal for us to just tick off gender. Adding pronouns is so easy. I don't know why it's not available on every single platform. You mentioned before that your friends are on Instagram and they're putting in their pronouns. You also mentioned that they're losing followers too so I think that's a good way to weed out people.

Srihita: Weed out annoying people. We don't need that energy in our lives. If putting in your pronouns makes people leave they shouldn't have been there in the first place.

Zarya: That has the same energy as when I went to Trump's Twitter account, and I saw who I followed was following him and then I just unfollowed all those people. It's the same energy, same game. Yes.

Srihita: Do we have any other updates? We're moving in together. I think that's exciting.

Zarya: Yeah, it's something. It's funny, because when I meet random people, not that I'm just meeting people on the street - Just so that you guys know, we met sophomore year, well freshman year, but we didn't really talk, so we don't talk about that. But we started rooming together in sophomore year and became friends within that unfortunately. Junior year, we didn't live together. By the way, I'm in my senior year and Srihita has graduated at this point. Oh, congratulations!

Srihita: Thank you. I graduated since our last episode.

Zarya: She's not using that degree guys. She's doing the same thing she was doing before she got it. I'm joking. She was doing really big things. Big shout out to her for progressing in life. I hope to do that too someday. Going back to talking to random people, I never know whether to refer to Srihita as my roommate or my friend, because we're both. Now, just to spite Srihita, I'm going to refer to her as my roommate. Going forward I'm just going to say that's my roommate and not say that we're friends.

Srihita: We're roommates and we spend way too much of our time together which is why I haven't moved in yet. I think I needed some space.

Zarya: That's okay. I'm using your room as a garbage room right now.

Srihita: They started doing it here too while I'm still home.

Zarya: This has been our special and we hope that you guys check in again soon. Just kidding, we will be checking in, because we're the ones with the platform. On that note, we're gonna wrap up. Have a nice day!

Srihita: We hope you're having a nice summer. Happy Pride again. We love you guys. Bye!

Zarya: 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.