Season 02: Episode 07: Dr. Sonali Paul Transcript

Queer Diagnosis Podcast

Season 02: Episode 07: Dr. Sonali Paul

[Theme music plays]

Interview

Zarya: You’re listening to the Queer Diagnosis: The LGBTQ+ Health Podcast, and welcome back for our second season! I'm your host Zarya, and my pronouns are she/her/hers.

Srihita: I'm Srihita, and my pronouns are also she/her/hers. Our guest today is Dr. Sonali Paul, a transplant hepatologist at the University of Chicago. Hi Dr. Paul, could you please introduce yourself with your pronouns?

Dr. Paul: Hi, I'm Sonali Paul. My pronouns are she/her/hers.

Zarya: Could you speak to the article that you wrote in the American Journal of Gastroenterology and what inspired you to publish it now?

Dr. Paul: The article starts with an anecdote right after having my son. I'm gay and married to a woman. I carried our son and we used a sperm donor. He had some hematological blood issues that weren't serious, but they wanted to have the pediatric hematologist come in just to take a look and make sure that everything was okay. And the attendings, the person in charge of the whole team, is just fixated on the father’s history. He knew my history but kept asking about the father's history. And I was two or three days postpartum and overwhelmed with life, so I didn't really say anything, I just internally screamed. And it wasn't the first time that kind of the heteronormativity of medicine had crept into my life. As a patient and as a gay physician, it's all over. But it was one of the first times that it was not only affecting me but also my family. And that was the motivation to write the article, because it really depends on what specialty you're in, and kind of the geographical location of where you practice. But within GI and hepatology, there's not been very much talking about LGBTQ+ care, and queer health in general, and how to be inclusive in creating those environments. So that was my motivation to at least write something that would construct the conversation.

Zarya: Have you always been out in medicine?

Dr. Paul: No, I grew up in a very traditional South Asian environment. My parents are immigrants, they immigrated in the 70s. From India, my dad's a doctor, my brother's a doctor, and my mom's a nurse. So that's like the story, right. I knew I was gay quite young, probably 10 or 11. I never really came out, officially to myself, really, until college, and then in residency is actually when I met my wife. And I knew I had to tell my parents at some point. Some of my close personal friends knew that that was happening, that I was gay, but I wasn't out to the program as an out physician. I first came out in medicine when I was actually interviewing for my first job out of fellowship. So that was only about five years ago. It was the first time that I interviewed very openly that I had a wife and a son. Because I was looking for a place where that would not be an issue. And thankfully, I found it at the University of Chicago.

Srihita: Can you expand on that first anecdote in the article? What has been your approach to addressing similar microaggressions? And what advice can you share with someone currently being badgered in that same context?

Dr. Paul: I think it is really hard when you're the person that is in the spotlight. And when that happens to you, you need to take a moment and step back and point it out in a non-aggressive, gentle kind of way. And so I have to say, in the past, I haven't been very good about correcting people. Everyone assumes I've been married to a man, at least that's what they assume during my training. And it would really depend on the person who was around in terms of me wanting to actually correct that. I think I'm now more comfortable in myself and my designated position. I'm much more vocal, I think about this at least in our hospital and in our clinics. So that we can create a more inclusive environment so that misgendering and microaggressions don't happen on a daily basis. You know, I think it's easier for me to do it now, as an attending. If I see something that happens, or if something happens to me, or something happens to someone around me, I know what to say, in a gentle way. To not make them feel bad, because most people aren't doing things consciously. It's a very unconscious decision. And it's all really related to a lack of education and lack of awareness. And I don't think anything is out of malice. So I think I've learned much better over the years in terms of how to gently point out how something could have been said differently.

Zarya: Being South Asian how did your family respond to you coming out?

Dr. Paul: I wish they were cool with me being out. Everything that's happened, it's made me a stronger person. And I think it's allowed me to do the work I'm doing now and be an advocate. But it was tough. I mean, my parents kind of had an inkling during my residency, and then I quickly denied it because I wasn't ready to deal with that. And then I think they put my profile up on Shaadi.com. And they had my CV up and they sent it to everybody. And I started getting dates. I was like, “Okay, now I really need to tell them” and then at this point, my now wife, my girlfriend at the time, and I was getting fairly serious. We knew that we were going to get married. So when I did tell them, they pretty much completely shut me out of their lives for a long time. And it was tough; I got married, and none of my family was at my wedding. It was just my in-laws and my close friends. And then I don't entirely know what happened, it could just be the golden child grandson that came into the picture but I got pregnant with my son. And then, we had some other aunts and uncles who kind of came around to it, they were a little bit more accepting than my parents, and kind of tried to explain to them why this was not right, what they were doing. So I did have some advocates in my corner. And at that point, they'd all met my wife, Kathy, so they knew her and they knew that she wasn't actually mean, and that she was helping me get through training to do the things I wanted to do. I had my son, and then they kind of came back into the picture in a slow and gradual and painful and awkward way. But now we actually have a fairly solid relationship. We talk. We're cordial. And they come over, they love our son and we FaceTime together so they can see their grandson. They love my wife, probably more than me at this point. So I think they've come around, but it's taken time. And again, I wouldn't wish that journey upon anyone. But at least I know that I'm a lot stronger for having been through that.

Zarya: So as a South Asian woman and being in medicine, I know that you mentioned that some people assume that you were married to a man. Are there any other stereotypes that you encounter with orientation?

Dr. Paul: I think it's not so much the stereotype. It's not so much being South Asian. I don’t think it's a stereotype. Although some people are very surprised that South Asian gay people exist. Some people have said that to me. Certainly. I think it sounds like a lot. I think it's just being gay stereotypes that people kind of perpetuate. One of my co fellows actually asked me who the man in the relationship was, which is just absurd. And so there are things like that that happen that perpetuate stereotypes, but nothing in relation to being South Asian, at least.

Srihita: What is a transplant hepatologist? And what drew you to that field?

Dr. Paul: A transplant hepatology physician is someone who specializes in liver disease. I do the medical side of everything. And I'll also take care of patients with any kind of liver disease and then also the end-stage liver disease cirrhosis and get them ready for a liver transplant and then take care of them after. The only thing I don't do is the surgical part in the middle, thankfully. And there are a few things that drew me to it. In medical school, you have to do rotations in hospitals in your third and fourth year to get familiar and figure out what you want to do. And one of the first rotations I did was a medicine clerkship. And I rotated in the liver service and saw just the breadth and depth of liver disease and kind of how humbling it was for one organ to create such devastating consequences. And it's really the only organ that doesn't have a bypass. And so like the lungs have a ventilator, and the kidneys have dialysis. You know, the heart has something called an L valve, which is like a mechanical pump. The liver doesn't have any of that. And so when it really fails, it's either people die or they get a transplant. And it was just so humbling to kind of see that and humbling to get people through transplant. And then also equally humbling to build those relationships with those people and their families. There's something about it that is really nice. And I think the other thing is that it's very objective. So it's very algorithmic, there are numbers, everything is very much set in the presentation. It doesn't vary too much from that. So I'm a very logical kind of thinker. And that was the other thing that made me want to do hepatology.

Zarya: Have you been able to find other physicians who are also part of the LGBTQ+ community at UChicago?

Dr. Paul: Yeah. So I was in GI and liver. So, for hepatology, actually, I had to do a gastroenterology fellowship, after internal medicine. And most liver physicians are kind of housed within their gastroenterology department. So it's not like we're a separate division. So within our division, there's no one else that identifies as LGBTQ+, but within the hospital there are and we've actually started collectively getting together and trying to form a more cohesive LGBTQ+ healthcare system and creating a more inclusive environment. So we're currently in that phase. And part of this started just because our electronic health record started capturing sexual mutation and gender identity data, and it has been a long time coming. I'm glad we're doing it now. So the impetus came from that to actually make sure that we're educating everyone correctly.

Zarya: Has that been a recent shift towards LGBTQ+ inclusivity? Or has it been there since you were in medical school?

Dr. Paul: I haven't seen it since med school even through my training. I think it really depends on the institution. And I trained in the northeast, and when I had left one of the institutions they had started rolling out kind of sexual orientation and gender identity questions and things like that. So I think some institutions are a little bit ahead of the times than others, but others are kind of catching up and trying to do the right thing. So I definitely do think there is more of an acceptance of it. And I think there are more people accepting of it, and it depends on your specialty and practice in terms of how inclusive it is of an environment.

Srihita: So going back to when you were talking about what drew you to hepatology, you were saying that you were kind of drawn to like the humbling aspect, but also the logical aspect to it, was that also what initially drew you to medicine? I know you obviously come from like a history of a lot of doctors, can you talk about it? Where did you ever try to rebel? Or was it always going to be medicine?

Dr. Paul: You're kind of right on. So there was never really an option to do anything else. It was always to be a doctor. I tried to rebel in high school. I really love to cook and I really wanted to go to culinary school and wanted to be a chef. And that didn't go so well. So, no, I wanted medicine. I think, looking back, this is exactly what I want to do with the rest of my life. I picked the right specialty. I wake up in the morning, and I want to go to work. I mean, not every day, obviously, not everyone is like that. Every day can't be perfect. But for the most part, I actually love the idea of helping my patients and taking care of them. The path to getting here is really hard. You know, med school and college are hard. And there are so many classes, medical is tortuous and training is even harder. So it's a lot of blood, sweat, and tears to get to the place where you finally feel financially sound. I feel like an adult now, I'm 39 now. And I finally feel like I've established myself, whereas my wife is a software engineer and she started getting a real paycheck right out of college. I didn't get my first real paycheck until five years ago. So you get paid through training, but it's not. It's enough to get by.

Zarya: Yeah, I have friends who are in computer science right now and they’ve been talking about the new grad offer that’s coming their way hopefully after graduation and I was meanwhile looking at Twitter and there is this trending tweet that says that the average pay is $15 for residents. And that's the minimum wage in New York City right now.

Dr. Paul: No actually, you're probably making less than minimum wage because of the hours you work.

Zarya: Oh yeah. And then there's a whole breakdown.

Zarya: How have you been? How was your experience? That was like med Twitter but have you found others? Have you found a community through Twitter yourself?

Dr. Paul: So I'm fairly new to Twitter, which makes me feel really old. But I think we're starting to realize that it's obviously a really good way to not only learn things but also to connect as a community, especially with COVID. Because you haven't seen each other in person for over a year and a half. None of our conferences and meetings happened in person, everything was done virtually. So I definitely think I started Twitter around that time. And I think it's great because not only do I like the tutorials and things that are on there but I learned a lot on Twitter that I normally wouldn't see. I'm not going to read every single journal that comes out every week, that's just not possible. So I think there is some eye-catching stuff, and there are some really pivotal articles coming out on Twitter. So I think that's really nice. And it's also a really good place to not only promote yourself in what you're doing but also promote others. And so there's a lot of women in medicine, people that follow each other and promote their articles. And I've learned a lot about gender equity and medicine through Twitter as well.

Zarya: Can you explain more about gender equity in medicine?

Dr. Paul: There's a lot, I think, you know, with the #metoo movement that happened several years ago, there's been, I think, an impetus in medicine to really realize what's happening in medicine. And there's a really great article that came out in the New England Journal of Medicine to perspective. And there is a physician, her name's Erica Kane, who wrote about misogyny in medicine. And it was just so powerful because it's something that we all faced and it doesn't even have to be medicine, you could have put misogyny just in general. But the things that happen to female physicians, and the hierarchical structure of medicine is absurd, especially because there's such a power dynamic as you're kind of going up the ranks. And so when you're a med student you really don't, but you should, have enough power to be able to tell someone to not sexually harass, but it's often kind of overlooked. And I think there's a lot that needs to happen within medicine. And it's not so much overt sexual harassment, because everyone knows not to do that. For the most part, I think it's more kind of the microaggressions that happened, right? You know, I'm only five-two, so I'm very short. But this just happened last week, I was rounding on the inpatient service and I had a whole team of men, and not once did anyone think I was the attending, ever. And so if there's ever a man who's taller than me, which is most men, the patients or other physicians will think they’re the attending. So that is a microaggression. They're not doing it on purpose, it's just kind of ingrained within the structure. And so, I think, there's a lot of kind of gender equity issues with that and then also just in terms of the pay gap between men and women. In medicine, it's just astronomically different. And it's not transparent like now the process isn't transparent. So no one really knows how much anyone else makes. There are some systems that if there is transparency, but in most places, it's not transparent.

Zarya: There's a cardiothoracic surgeon, I shadow her at SBU. And I'm five feet tall, she's like, 5-1 or 5-2, but she walks in a room and everyone stops. It's just, it's crazy. Because I'm five feet tall. I'm always at least, five inches shorter than whoever's next to me. And, you know, that's crazy because they'll stand next to each other and everyone will be looking at her and just everyone's just dead silence and it's another way that's like respectful like nobody will ever speak over her cut her off, and I don't feel like I’ve seen that enough because I've seen other female positions as a medical scribe. And even as an EMT, when I'm giving an order, I’ll get cut off. And, you know, I think to some extent, you do have to be able to raise your voice and really assert yourself but I wish that I didn't always have to, just because you know nobody ever assumes I'm the one that's gonna get bullied, especially on the call. So it's interesting to see that it still happens even at your level of training.

Dr. Paul: Yeah, I mean, I think the issue is that it's not blatant things that are happening. It's very subtle. And so there have to be mechanisms to report those microaggressions. And most of the time, it's the same offenders. Like, it's not everyone that does it. But I think we've made a lot of progress. But I think there's a lot that we need to get done in medicine.

Zarya: So returning to what we're talking about earlier, within the LGBTQ+ community, have you had the opportunity to share your identity with any patients? I don't know if it comes up in your specific fields. I’m actually not really sure what happens in your specific field so could you go through what it's like in the day? That'd be really great.

Dr. Paul: Yeah, that’s a good question. I get that from a lot of trainees. Are you out to your patients? I am not. And, you know, I go back and forth, because Chicago, it's obviously a very progressive, liberal city, but you never know. And I never want my identity to make someone else uncomfortable because there’s a lot of personal questions, especially when we start thinking about transplant. It's about knowing kind of what their social supports are, who they live with, do they drink; a lot of them have substance abuse. And so kind of divulging those details and kind of getting that kind of patient-doctor relationship and trust. I don't necessarily think that them knowing everything about me is going to facilitate that or help. If it does help, I mean, sometimes patients will have kids, and I'll connect with them on that level, I have a six-year-old. So I'll relate to them on some things but I'm not openly out, I mean, maybe now I am because it's on Twitter, but I don't go out of my way to kind of bring it up. The only time I do this is if I know they identify as LGBTQ+, then I will freely talk about my family and my wife. And then in terms of the second question, day in the life, so every day for me is a little bit different, which I like. But generally, it is mostly clinics or outpatient-based. I’m in the clinic, five half days a week. And then I do a little bit of endoscopy, so colonoscopies and upper endoscopy, that's probably a half-day every other week. And then, with the transplant, there comes a lot of meetings. So there are conferences and radiology is where we review everyone's imaging. And then we have our listing conference where we kind of review all of the transplant candidates. That's kind of day-to-day. I also have administrative conferences, and then there are 10 weeks out of the year that I do the inpatient service where I don't do any outpatient, I just take care of the patients in the hospital.

Zarya: If you don't mind me asking what goes into evaluating whether someone's a good candidate for a transplant? I'm not sure if you’re allowed to share that information.

Dr. Paul: No, it's really kind of publicly available. If they're appropriate for transplants their heart and lungs have to be strong enough to get through a transplant. Liver transplants are very complicated surgeries with a lot of changes in physiology. And the heart can take a hit pretty easily, but we need to make sure that the heart is healthy enough. And then a lot of it is related to their social support; meaning that after transplant it's a lot of visits back and forth once they get out of the hospital. They have to come in sometimes twice a week to get blood work. And so it's a lot of back and forth. We need to be sure that there's someone at home that can kind of take care of that and bring them in when they need to come in. And because of COVID, the rates of alcohol use disorder have skyrocketed in our patients, so a large number of people that are coming in are people younger than me. They are coming in with liver failure from just alcohol use and needing transplants. So trying to kind of delve into their alcohol use and what insight they have into their use and are they willing to do a program after transplant and things like that. So there's a lot of kind of nitty-gritty personal details that I think are a privilege to know that information. But it's certainly a lot of heavy heavy stuff.

Zarya: Were you're not interested in the surgical aspect of it?

Dr. Paul: Yeah, so surgery is tough. One, I can't stand on my feet for very long. In my first surgery, I think, as a med student, I passed out, which to my brother was so horrifying because he's actually a cardiothoracic surgeon. I think to be a surgeon, you can't be afraid of taking risks. And I think liver transplant is kind of one of the biggest surgical risks. The patients are just so sick; it's a very complex operation. And so that aspect of it never really interested me as much as like the medicine and the thinking. But don't get me wrong, surgeons also have to think, but in terms of taking care of them pre-transplant, there's a lot of finesse of medicine, or the art of medicine in taking care of them. So that's what kind of drew me, more than sitting in the OR because the transplants are long operations, they can be up to like 10-12 hours, so I could never do that.

Zarya: Are there other specialties that you coordinate with when you're in the clinic.

Dr. Paul: So in transplant clinic, yes, not so much the specialties. But the evaluation, that's very multidisciplinary. So there's a surgeon that always sees the patient. There's a social worker and psychiatry, pharmacy, and nutrition and finance because we have to be sure that the patient is financially cleared. So it's very much a team-based approach in terms of our decision to transplant someone or not, which is nice, because no one wants to be that one person to say,” No, you don't get a transplant”. So it's a group decision, which is a good thing.

Srihita: If you could turn back the time and talk to your pre-med self, what would you tell them?

Dr. Paul: That it gets better. I mean, I think everyone knows that going into medicine is going to be hard, I don't think you really realize how hard it is until you're actually doing it. And on top of medicine and training being hard, I was going through a lot of personal stuff with my parents and coming out and so I think the other thing that I don't think anyone fully realizes is that not only is there training, but there's your life still happening around you. And bad things happened to people in life. And like parents may die, or grandparents may die, there's death and other things that affect training so much, or you could get sick. I used to always think that school was it and that's all I'm going to do. And that's what I did for so long. But then you know, life happens, and you kind of have to pivot and shift and kind of work around it and figure out how to work around it.

Zarya: Do you have any advice for coming out to your parents?

Dr. Paul: I wish I had better advice. Because, you know, I was able to come out. And financially be able to support myself when I did come out. Because if I had done that, when I didn't have a job, I don't know what I would have done. So, I don't think there's ever a right time to come out. I think that I want to say that if your parents love you, and being a parent now, I can't even imagine not. But there's nothing my son can do where I still won't love him. And so I think about it from that perspective, I think you should come out and be yourself, but knowing the kind of the culture and expectations and the shame and stigma associated with being gay makes it hard. I had an aunt, and she didn’t know I was gay at the time, who was like “Gay? Is that like a disease? Can you catch that?”. People in my family in medicine would just assume that a gay man would have HIV. So, you know, there are so many things that are just so wrong. But I think you have to come out when you're ready. And on your terms. I think you have to really be at peace with the consequences and what's going to happen and how it's going to shake out. I knew it was going to be bad, but I didn't really realize the extent to how bad it was going to be. But I was prepared in that sense, but you have to do it when you want to do it. It can't be anyone else telling you to.

Zarya: I think that it is very difficult to figure out the right time to come out.

Dr. Paul: No, I was gonna say just in terms of coming out. I think in general, I think not even to parents. I think in general, in life. It's on your terms like you have to be ready. When I was in fellowship and training my program director actually outed me to the whole division and, you know, she didn’t do it out of malice. She just was like, “I don't understand why this is such a big deal for you like no one cares that you're gay, right? Like, it's not an issue for us”. And that's kind of where she came from doing it, but not realizing like, that was just so awful because I was like, traumatized. So I think knowing when you're ready and doing it when you feel ready and in control of what's going to happen is so important, especially in medicine, where you don't know what you're stepping into.

Zarya: I'm sorry that you have that experience. It's a good cautionary tale. And I hope you kind of got to have that conversation with her after all this is over at least.

Dr. Paul: Yeah, I mean, we're actually really good friends now. She's actually one of my best friends. She was still my boss at the time and I think I didn't tell her that. But I did tell her once I got to know her a little bit better. And I was like, “Listen you can't do that ever again, that's not okay. You don't get to out anyone. It's on our terms to come out when we are ready to and I wasn't ready at that point”. But she was right, it didn't matter; no one cared. But that's because I did my training in Boston, where it was totally okay to be gay. I'm pretty sure if I was living somewhere else, where it really wasn't, then it'd be much harder.

Zarya: I think you’ve answered all the questions I had and I learned a lot. Srihita do you have any?

Srihita: No, I'm Good. I learned a lot. I don't know anything about medicine. So I always enjoy these because I feel like I learned a lot. So thank you.

Zarya: I did too. It was really cool. I don't know about many other specialties besides emergency medicine and now a little bit of radiology and cardiothoracic surgery. I'm trying to get more into OB/GYN because I think that's very LGBTQ+ friendly, based on my understanding. And recently I looked into plastic surgery because that's where jobs are right now. Do you have a take on plastic surgery?

Dr. Paul: I don't because I don't know enough. I think in medicine, you will always have a job. It doesn't matter what you end up doing. Because there's always a need for someone. You know, whether that'd be primary care or radiology. Like through the pandemic, medicine became one of those things that were really crucial. So I think going into medicine, you'll always have a job. So are you guys in med school yet?

Zarya: No, I'm an undergrad. I'm a rising senior right now.

Dr. Paul: Okay, where are you?

Zarya: I'm at Stony Brook and Srihita is at a different school.

Srihita: Yeah, I just graduated from Stony Brook. And then I'm starting grad school in the fall.

Dr. Paul: That's so funny. I actually live in Hauppauge. My parents are from Hauppauge. They grew up there.

Srihita: Oh, okay. So you’re a Long Islander.

Dr. Paul: Yeah. I'm a Long Islander.

Zarya: Oh, my God. That's so funny because everyone we interview is pretty much from Long Island.

Dr. Paul: That's bizarre. Like I live 10 minutes away from Stony Brook.

Zarya: Oh, my God. We can't ever get away from Long Island.

Dr. Paul: You really can't. That's really strange. Yeah, my parents now moved out of the house that we grew up in. They live in the city now. But yeah, it's weird.

Zarya: Have you moved around a lot? Did you go from Long Island to Boston to Chicago?

Dr. Paul: Yeah I did undergrad, med school, and all my training in Boston and then moved to Chicago for my first job five years ago.

Zarya: Okay, so you're all set in the East Coast, and not really interested in the West?

Dr. Paul: I actually would love to be on the west coast. There just wasn't the job that I wanted on the West Coast at that time. But I do have to say after having lived in the northeast, I love the Midwest. It's so awesome. I mean I like New York and Boston, I lived there for so long. All my friends and my friends are still there. My family's in New York. But Chicago is just such a cool city. It's so diverse. It's so clean. It's not like New York City where there’s like hot garbage on the streets. It's like getting a very clean city. We have alleys that pick up the garbage.

Srihita: Well we technically have that too.

Dr. Paul: I think it's just the people. I mean, I think the people are just so friendly and wonderful. It's not something I've ever been used to. And so like the first time we were walking our dog when we just moved here and someone said good morning to us, I looked at my wife, as I was like you already know them and she was like, “No, they're just being nice.” But that's what normal people did. I just lived in the northeast for so long that I don't even know what polite is. It's nice to raise our son here. It's a good city.

Srihita: I was actually born in Illinois. I have all these pictures because I moved to the northeast when I was like two and I always use pictures. And I want to really go back and see Chicago, but it’s amazing, especially in the summer.

Dr. Paul: It's such an amazing city. There are museums, the food scene, the festivals during the week, or during the summers. We live in Hyde Park. So it’s right next to the University of Chicago, and it's one of the most diverse, amazing neighborhoods I've ever looked at. Like I can never see myself living anywhere else.

Zarya: That's actually really funny because I told my parents really want to get out of the house because they've been inside for like COVID, like the whole quarantine period. So they're like, “Oh let’s drive somewhere” and the first place they said was Chicago and I was like absolutely not. Because to me, Chicago is just way too quiet but also I'm not coming at it from your perspective. Some of my cousins are living out there and I’m speaking from what they told me. There's not much to do. But I think I'm just speaking from a very biased point of view.

Dr. Paul: Oh, the city has a ton of stuff to do. I have to say. It's quiet in the sense that it's not like New York. There isn't that constant chatter and noise in the background. The city is just so cool. Yes, it probably can't compare to New York, but it's cleaner than New York. That's all I can say. If you're ever in Chicago, definitely let me know.

Srihita: I was gonna ask you do you think a younger version of you would have been surprised at where you are? Because sometimes I think about a 12-year-old me, even now, like 21. I'm like, “Oh, that's not how I thought I would have been as a person”. Do you think younger versions of you would be surprised?

Dr. Paul: I don't think I'm surprised, I always said I was going to be a doctor and be married. And, I think I am surprised as to how I got here. And I'm surprised as to what my work now is focused on. I kind of jumped around with my research interests and things. In a fellowship, it was all about Hepatitis B. And then I came to Chicago and there wasn't a lot of Hep. B so I had to shift into the fatty liver. And now I'm becoming an advocate for LGBTQ+ health. And that's kind of really my focus now. I think that's what is very surprising. I don't think I knew how I was gonna get here eventually. It's just a very bumpy road. I knew it was gonna be long and hard because my brother had gone through it. So I'd seen that. But I don't think I fully realized that I can actually live the life I wanted to and be my authentic self. That's, I think, probably the most surprising, especially as, 12 year old me was like, “I'm gay”. And I could never come out and, have a family and be married. So I think those are the things that are pleasantly surprising.

Zarya: Yeah, I can definitely understand that, even with the podcast this is something that I never thought I would do. Also, earlier you said your parents sent your resume out with your shaadi.com profile?

Dr. Paul: Yeah, my CV. My parents didn't do it because they aren’t technologically savvy. But my uncle did. And I was so livid. What is it called biodata? Right? So there's like my picture, me in a saree, with my credentials. It’s so embarrassing! I'm glad that's over. Very happy that it's done.

Yeah, I mean, you mentioned your podcast, I was asked to write this article. And I did. And then they were like, yes, we'd love to have it. And then I sat down with my wife. And I was like, “Oh my God, I'm going to be coming out on a national platform”. And she was like, “Did you not know that that was going to happen, like when you were trying to write the article?“ But it was funny, because when it came out on Twitter, my first thought when I saw it was “ holy crap, I hope my parents don't see this.” Even though I'm out to them, I think they would be mortified that I'm l now out on a national platform. So it's still never really ends with your parents

Zarya: To follow up on that, so you said that your parents were the ones who weren't as accepting. But your aunts and uncles were more open to it. So who were parents kind of afraid? Like if your family already knows? I don't know if that's too personal?

Dr. Paul: No, no, it's ok. My family is a really large, extended family. And the only people that knew were my closest aunt and uncle. And then we had really close family friends that both also lived in Boston, I call her my cousin. I grew up with her. We were actually in the same residence program, ironically. And so those were the people that I think to help the most. And my parents were just afraid. My dad's a doctor and we are in this Indian doctor community and they didn't want their friends to know. I don't even think their friends still know that they have a grandson. Because they're still ashamed of that part of it. Even though I'm a doctor, they don't even know I'm married. They just think I have a house in Chicago and go to work and do nothing else. So there’s still a lot of layers, with families and coming out. I used to get really angry at the shows and like books that like the coming out process was so seamless. The person struggled internally but then they told their family and the family was completely okay with it. Because that's always what happens. Like that's not the experience for so many. And I don't even know if there's been a movie that really kind of talks about it, at least in South Asian culture, that really kind of gets it. Because of how hard and how complicated that coming out process is.

Zarya: Did you get to see that movie, I'm not going to pronounce the name because my accent is absolutely terrible. But it was about two lesbians who came out together.

Dr. Paul: Oh, I think we tried to see it. Yeah, I think we tried to watch it. My wife watches a lot more Bollywood than I do, which is ironic. She's Filipino. But I think she saw it. And I think she liked it, but I can't remember. But Fire, this is a long time ago, I think her name was Shavana Asmi, it was a long time ago. And it was basically a woman who was married, but then, fell in love with another woman. That was scandalous because it was like in the 90s or early 2000s in India. People are burning movie theaters down to the ground because of that movie coming out. So that was probably, I think, one of the first movies I've seen in South Asian culture, but now I'll have to watch the movie this weekend.

Zarya: Yeah, I'll put that on my to-do list because the way that the movie was promoted was like it was the very first movie of its kind to come out. So I wonder why it was promoted like that, or maybe it was just the news source I was seeing. Bollywood is so scandalous today. I can't imagine them burning movie theatres, I mean, actually can, I mean that's expected I think.

Dr. Paul: Yeah, I mean, I think those movies, they weren't kind of like quite Bollywood-ish. Like, no one was breaking out into song and dance, it was much more serious. Those are the kind of movies that Shabavana Azmi normally makes. It's actually worth watching if you're interested,

Zarya: Do you have any other LGBTQ+ plus media that you've listened to, or watched, or anything that you can recommend?

Dr. Paul: Yeah, so I actually watched, if you have seen it, “Paris is burning”. It's all about ballroom culture. And it’s about black transexual men, kind of in the 90s, having this ballroom culture, where they would get together and build their own families. It was all these people that were going to be kicked out of their own families and so they would come together and build their own families and have these competitions, it's really good. And then there one, I think it's on Netflix or Hulu, called “Pose”, which kind of takes ballroom culture and makes it into a really cool series about characters and how HIV was handled in the trans-community back then. I didn't know a ton about ballroom culture and I learned so much. I didn't actually know that Madonna's” Vogue” song is based on ballroom culture. I was like, “Oh, Madonna is so cool. Like she knows how to Vogue.” I didn’t realize Vogue is not something she invented. This is all based on ballroom culture. I think learning about LGBTQ+ history, in general, has been kind of really cool and fascinating and makes me appreciate all the people that came before us and paved the way.

Zarya: I had no idea. I guess I haven't learned about ballroom culture, since we have to do ballroom in 5th grade. And if I'm being honest, I'm trying to figure out where I fall within the community in terms of involvement, and actually, on one episode, somebody had referred to us as queer activists. And I was surprised. It's just because it doesn't quite register. I think that you actually are also a queer activist, I don't know if you've seen yourself in that way. But when I read your article, I was like, “Oh that's a queer activist.”

Dr. Paul: I definitely think it's all about education and advocacy, and bringing something to the forefront and to the surface that people normally don't talk about or isn't seen as much. But I never considered myself an LGBTQ+ activist, I think until that article kind of came out. And it's actually been really nice to get emails and messages, from mainly trainees, saying, that I made them feel better about their decision of going into GI because maybe things are changing, like within the field. After having gone through all the stuff I've gone through with my family and my personal stuff, that's been really incredibly rewarding to have that.

Zarya: So you went a long time without coming out of medicine. Did you find community before that? Even if you weren't necessarily out perhaps as an ally?

Dr. Paul: Yeah, in college it was so easy to find the gay community because I just knew that so many friends and there was a rainbow house and all that stuff. And then med school was very isolating because I was constantly studying and doing things. So it was harder to find communities there. I still had some friends from college that stuck around. So we sometimes hung out. And then definitely when I was an intern, I started my training. It was really, really difficult. I mean, there may have been gay people in my class but no one really talked about it. No one was really out. And I kind of hid it too. And to be honest, like I wasn't even looking to date. I was like, “I'm done with dating.” No more. I just want friends. I want to find a community of people that I can hang out with, and go out to clubs and bars, to decompress and find my sense of self. And that's actually when I met my wife, it's really ironic.

Zarya: Please tell your wife, we have heard good things about her so far. So there wasn't any sort of like, Queer Alliance groups at your school, during residence? I don't really know how residency works; I have a better understanding of med school, which still has clubs. So did you have any?

Dr. Paul: I went to Tufts University School of Medicine and Tufts didn't have that, not that I can recall. But the University of Chicago Pritzker School of Medicine has outpatient, so it's a group organized by the queer med students. And there's a faculty liaison. And depending on the year they are more or less active, but I wish I had had something like that. I went to med school from 2004 to 2008. And it wasn't that long ago. But it feels, from this perspective, so ancient, because we didn't talk about LGBTQ+ health at all. And so I think some of that stuff is starting to change and get more education out there, which is great. And I think, at the same time, the clubs and things like that are starting to form much more so.

Zarya: It’s definitely nice to know that there is progress being made. Thank you so much for joining us and we’ll see you the next time we’re in Chicago.

Dr. Paul: Awesome. Thanks so much.

Srihita: Thank you so much

Zarya: Bye-bye.

Reflection

[Theme music plays]

Srihita: Welcome to the second season's first reflection, we're back and better than ever with two interns joining us, just to catch you up to speed, QD is now an internship that you can volunteer or intern with, be sure to email us at queerdiagnosis@gmail.com if you're interested. Interns, please introduce yourselves.

Aaliya: Hello, my name is Alan Sayed, I'm a senior at Stony Brook University with a major in Biochemistry and a minor in Women and Gender studies. I hope to be a physician in the future.

Ana: Hi my name is Ana Sofia Peralta. I am a Biology major, now in my senior year at Stony Brook University, and I'm hoping to be a Forensic Scientist in the future.

Srihita: So, getting to our interview with Dr. Paul, what were your thoughts?

Ana: I mean, for me, the biggest thing that really jumped out at me was that she spent her wedding alone, I mean not really alone but she didn't invite her family for something as big as a wedding. I mean, I'm also Asian so I know that within Asian families they're very close-knit. And, I mean for my family for everything that I do my mom, my dad, they all have a say in everything. So, for a wedding, that's big and family not being there that says a lot. What do you think?

Aaliya: Yeah, I completely understand where you're coming from because I'm also Asian, I'm Indian. A lot of like my life has been focused on trying to be in terms with what my parents want for me as well because they are coming from an area of good faith, but it's hard because sometimes your wishes aren't aligned with theirs, and I think that's what happened with Dr. Paul's situation.

Zarya: Actually, like, I can relate to that really hard because we actually have, if you guys didn't know, Queer Diagnosis merchandise. Interns, this is not directed at you, unless you want it to be. I did wink for anybody who can see us because this is an audio recording. I almost took my tote home, that says Queer Diagnosis in rainbow to my parents and I realized as I was leaving the door that my parents don't know about this, and I quickly put it away. So at times, sometimes I feel like being in college I have a certain like level of independence from my parents. But then other times I feel like that agency, kind of, is not it doesn't disappear per se but it definitely does decrease. I don't always know how exactly I'm going to tell them about the podcast specifically. Also, I think Dr. Paul's example of not having your family at the wedding, I think that's something that we've actually heard across different interviews that we've done so far. Where parents haven't always come to support their child, and I think that that really does show how different people have approached things.

Srihita: Yeah, I think, something that I've been working out, I think a lot of us are working out, is where my parents' beliefs start and where mine begin, and what the overlap is vs. what doesn't overlap. One thing that Dr. Paul was also saying is that since they've gotten married her relationship with her parents has changed and now they have a grandkid so her parents are still part of her life, in that regard. I think so much of growing up and time passing is that relationship changing, and always kind of figuring out and keeping track of, why am I making this decision and what are the factors that are influencing that.

Zarya: Aaliya, I know that in our earlier review. You mentioned that you wanted to speak to being a woman of color in STEM. Do you want to speak to that?

Aaliya: Throughout the interview, I really related to Dr. Paul because she was talking a lot about being a woman and her struggle through it like in STEM. Not only being a woman but her sexuality and I'm sure the color of her skin and her ethnicity also affected how she perceived herself and how she thought others perceived her throughout her journey through med school and stuff until becoming an actual physician. I relate to that so much because just being pre-med is just so hard sometimes because you have to convince yourself that, you can do it. Then when you finally do it you see like others around you and you compare like prejudices of society. Like medicine is still a predominantly white male field and it's hard to step in there and find my way around that. While dealing with my insecurities and also society's pressure to belong somewhere because I don't feel like I truly belong in this field.

Zarya: Going back to what you were saying about being a South Asian female, especially in this male-dominated field. I've definitely experienced that both, as an EMT and also as a medical scribe. I know that you've also like interned at a hospital. Did you work with mostly male teams, what was your experience with that?

Aaliya: Yeah, most of the doctors I was around were white male doctors and most of the nurses were female. I think it's a very common thing in society right now that like nurses are seen more as female, doctors are male. Yeah, so that's what I experienced. It was really hard, working with male doctors. Like this one experience, I volunteered at the ER, it was my first day. I go in, I'm greeted by the nurses, they make me feel welcome. I follow them around, it's great, but then I walk by a group of med students or residents. I wave hello just to be polite because I'll be working around them my whole volunteer experience. Some of the females say hello, there was one dude in particular who wouldn't even look at me. I said hello, and he just looked at me and looked away like I wasn't even worth saying hello to. Where is this arrogance coming from? It is just hard to deal with, I'm not even a doctor, I'm not even a med student, I'm not even like anything in the field yet and I'm already dealing with maltreatment. Not really maltreatment, that is a big word to use, but you know what I mean.

Ana: I know that Dr. Paul mentioned in the interview, that there were times that she led a male team, and she was the lead, and people would approach a guy, and they would assume that he's the attending physician. I think that goes with everything because, at least for me, and just general social setting whenever I have my friends over, or whenever we go out and I'm the only girl, or whenever I go out with my boyfriend in a social setting like a party. They would approach him and I would just be overlooked. I feel like I'm just there as an accessory, instead of a living person who's also in the same room as you. It does get frustrating. Sometimes I blame it on my height. I know that Dr. Paul also mentioned that she's not that tall, and I'm very short, I guess, but I was pretty non-threatening. Sometimes I'm confused why people don't approach me, but people approach my partner. So, I don't know if it's just that it's he looks more approachable than I do. It could be just that he's a guy and I'm a girl and like, usually when in parties they just look at the guy and the girls are just there to call in more guys. Do you know what I mean, like in clubs and stuff like that? That's my experience, but I don't know about you guys.

Zarya: When I was first getting my training as an EMT, I was like one of the only females on a 11 person male shift, and that was just a lot of male energy for me. When we were training, I'm five feet tall, and my partner is about 6'3"-6'4" or something like that, so you can imagine at least a little bit of distance between us. So, I noticed that a lot of our male supervisors always made eye contact with him. But here's the thing, I'm very loud, I don't think that's disputable that's just like a known thing. I'm very loud, it's hard for me not to get your attention. So, how come you're not making eye contact with me? I go all out when I'm talking to somebody, I'll nod and Srihita actually told me before I'm a big nodder, and like just a quick tangent, there's actually a patient who, when I was shadowing in the cancer clinic. It wasn't an offensive thing but he kind of looked at me like, she's a nodder. I was like, is that a bad thing?

Zarya: Yeah, it was just really funny because the surgeon I was with was laughing. So, the good thing is that my EMT partner is an advocate for women's rights. He was like okay well here's what I think that we should do if you feel like the male supervisors aren't making eye contact with you, how about we both sit at a table and I lower my chair and you raise your chair up so that we're equal eye level right? That makes sense so that now you have no excuse of like this whole height thing. We were debriefing that call and I still noticed that they were talking to him. Here's the thing, I was there, like our supervisors are sitting right across from us, so you should make eye contact with me at least once in a while, but it really was limited. So after we went to them to say, "Hey we did the social experiments on you, and this was happening," and they weren't really cognizant that they were doing it in the moment, but after that, they were definitely making a conscious effort to change it. I just wonder if I would have ever gotten that recognition and have been more accepted as part of the team in terms of including me in conversation if somebody wasn't willing to do that with me.

Srihita: Well two things first, Zarya is 4'11" she's not 5' tall. Secondly, she's shaking her head, but it's true. I think, going back to how you were talking about the other podcasts that shall not be named, about how they were giving that advice. It reminds me of this Oscar Wilde quote, I found a few years ago. I think it's made the rounds, but there's this Oscar Wilde quote that says, "equality feels like oppression to the oppressor." It's just a phenomenon, maybe, where people who have held power in the power imbalance for so long that, when it starts shifting towards a more equal distribution and when people who are shut out start slowly getting into spaces that they deserve to be in, it almost seems somehow unequal or oppressive when it really isn't. It's just starting to become more equal. So, I tried to keep that in mind.

Aaliya: Zarya, your story was actually really inspiring because I could not imagine myself doing that, going up to a supervisor and saying like, "Hey, I've noticed you're not making eye contact with me," because it's kind of scary because you feel the power. They have authority over you and to go against that and say, "no this is wrong." It takes a lot of courage to do. I'm so happy you had a partner to do that with, your friend or co-worker. That was really cool.

Zarya: Yeah, I appreciate that, actually. I think it was maybe towards the end of the fall semester, but I was going home for a break. Since I don't live by my EMT station, I'm not put on shifts for about a month. Towards the end of it, I was just feeling really weird because it wasn't as inclusive of an environment, as I thought it could be. I don't think it was a conscious thing that was happening. I think it was more out of it being just an all-male Alpha quote-unquote environment. So, they just didn't realize the effects of what they were saying at all times. So, I remember it was the last 10 minutes of my last shift from 2020. I went up to my supervisor, who is about our age, I was like, "Hey, I don't know if you would be open to like constructive feedback, but there are some things in terms of the atmosphere that could be changed, in terms of like work culture. I think we could definitely make it more inclusive." It was wild because he was actually really receptive to it, and he was also very apologetic about the fact that I didn't feel comfortable saying it before because I thought I would be alienated for it. Aaliya, I think that you understand this too because you're in Women's Gender Studies. When you tell somebody that you're either a minor, a major woman's gender studies people automatically assume I'm a social justice warrior, which has a really negative connotation that I've kind of been labeled as a quote-unquote city girl. I was reading about this in my psychology textbook that when a major university that's based in a large city, puts out a statement of inclusivity, parents don't take it as seriously if they know that the school is based in a city, or they're based in liberal values because this is what's expected of them. When it's more of a conservative University putting out a more inclusive statement, it has more of a significant impact. So I was thinking about that and I realized my words have value and I should speak up more. So, I'm glad that inspired you in some way.

Aaliya: Yeah, and you talked about being the social warrior. I experienced that in my own family, I told them I was minoring in women's studies and they're like, "oh right, my daughter is a feminist, my daughter is a feminist." I don't think they understand what impact their words have because that's hurtful because I am a feminist and it's social duty, like you should be too. I'm just always worried that, people trying to fight for equal rights have negative connotations, it's the people in power trying to keep power, are making people who are fighting to look inferior and to feel inferior.

Zarya: Ana, can you jump in?

Ana: I remember, I think it was my aunt and my uncle, I am very fortunate that I grew up with a very progressive family. My mother 's family, all of them are like activists and stuff like that, I wouldn't call activist but advocates maybe. It's kind of funny because I keep thinking that maybe being LGBTQ+ runs in the family because my mom has eight siblings, and five out of eight are part of the LGBTQ+, lesbian, bisexual, and gay. So I'm fortunate enough that I have been in that kind of family because I think that in terms of advocating for a lot of things like for feminism or LGBTQ+ rights. It's either females, or like women in general, or people who are part of the LGBTQ+. They're the only ones that actually fight for LGBTQ+ rights. You don't really see a lot of cis men fighting for that. I think that's when it doesn't impact your life in general, people don't really talk about it because you're trying your best to not get involved in anything. I don't think anything would change if you don't, step up especially for cis men because it's a common fact that cis white men are more privileged. Like you said, it's harder to be a girl in general, and being a POC woman, it's more tough. I think that a lot of changes would happen if we all just come together. In my experience, every time I go to the Pride March or stuff like that, I only see women, or LGBTQ+ people. I mean it's good, right, because you see all of these people fighting for the same thing. But, then again, you also see like this part of the world where they don't really care or they don't really mind or they're just saying downright no to what we're fighting for.

Srihita: I get that. I think there's something discouraging about how often people who seem to hold the most power distance themselves from certain issues. As you were saying it's often marginalized populations who make up communities of activists and advocates, and who are doing the educating, often for free without any compensation. I remember we were doing one of our earlier interviews and they were talking about the importance of compensating people who do the education, who come in and teach other people about pronouns or, you know putting that work in. So, first of all, compensate those people, but I think this idea that it's only up to the marginalized population to somehow fight their way out of whatever has built has been built against them systemically. It is frankly ridiculous and seems fairly ineffective. It seems like it would be a much more fruitful process if people who are already in those positions of power can go through the effort of educating themselves because they have the privileges and resources to do so and can probably make just as much of or if not more of an impact because they have that extra privilege.

Zarya: Not to be a psychology major, which I'm not, but I did take a psychology exam earlier. I don't have the grade, so it's safe to say that I am indeed a psychologist. Adding on to what Srihita and Ana were saying, you actually hit upon a really important point that was actually in my textbook, which not gonna lie to you, I kind of read this sentence today for the first time. It did say that people who don't have any direct involvement with the cause, actually have the most impact on said cause. What you're saying with the absence of cis heterosexual men. They actually would have such a major impact on advocacy for LGBTQ+ work in general because people would perceive them as not having any biases. Meaning, "oh they're doing this genuinely because they think it's a good cause, not because they think it's gonna further their own progress in life or whatever it is. So, really, kudos to you, probably could have taken my psych exam and done really well. It also is true what you were saying about, being able to take it upon yourself to educate yourself rather than waiting for other people to educate you. I think that's actually such a big part of why you guys should donate to our Patreon because we would like to compensate our guests. They do so much work for us in terms of educating us, but also I remember Laurel had talked about this in their episode when they said, you should do your best to educate yourself and inform yourself of different perspectives of people. For instance, like, Native Americans, I don't know anybody Native American so I couldn't ask anybody that I know personally to speak on that topic. Definitely, if you're going to research the topic, you should try to do it from somebody who is part of the community and not just do it from an old white man's perspective, if that makes sense. You guys are all laughing I really wish everyone could see our advantages in editing, but yeah. Does anybody else have anything else they want to add? Okay, cool. Well on that note, we're gonna wrap up our first reflection of the season. Thank you so so much to Ana and Aaliya for this episode. Of course thank you to my co-host Srihita. Just to put this out there guys, Srihita now goes to Columbia, and I didn't give her a shout-out in our last episode. Just so that you know, she has now successfully left the beehive.

Srihita: Thank you so much for that. I appreciate that so much. Please note the sarcasm in my voice.

Zarya: Okay, cool. Well on that note, we're going to wrap up here. Read the transcript for this episode at queerdiagnosis.com. Queer Diagnosis is:

Aaliya: Aaliya Sayed.

Jess: Jessica Pathmanathan.

KaiQi: KaiQi Liang.

Lara: Lara Castaneda.

Serena: Serena McDaniel.

Ana: Ana Sofia Peralta.

Jameson: Jameson Coleman.

Srihita: Srihita Mediboina.

Zarya: And me, Zarya Shaikh. Music is composed and provided by Cara Dugan and Adam Fredette. This podcast is supported by listeners like yourself. Our Patreon is patreon.com/queerdiagnosis rate and subscribe to Queer Diagnosis wherever you like to listen..

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.