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Season 02: Episode 09: Dr. John Pang Transcript

Queer Diagnosis Podcast

Season 02: Episode 09: Dr. John Pang


[Theme music plays]


Interview

Zarya: Hi, welcome to Queer Diagnosis. I'm your host, Zarya, my pronouns are she/her/hers.

Srihita: I'm Srihita, your co-host, and my pronouns are also she/her/hers. Our guest today is Dr. John Pang, a plastic surgeon at Mount Sinai. Hi, Dr. Pang, could you please introduce yourself with your pronouns?

Dr. Pang: Hi, thanks for having me. My name is John Pang, my pronouns are he/him. I'm a plastic surgeon at Mount Sinai's program at the Center for Transgender medicine surgery.

Zarya: What motivated you to pursue medicine?

Dr. Pang: That's a loaded question. I think a lot of things. If I think back to my natural inclinations growing up, I've always loved taking care of things, particularly animals. I set myself up to go to veterinary school as an undergrad and considered a bunch of other things as well. I seriously considered going into teaching, but ultimately decided on veterinary school. It was an overnight event where I rethought what I was doing. I thought I would like to take that same passion and direct it towards people instead. I decided overnight, I woke up, I called my advisor, I called my dad, and talked to him about possibly changing to medical school. I made that decision that day, I signed up for the MCAT, and the rest is history.

Zarya: That's amazing. I was listening to another podcast recently and they were talking about how when you get asked the question, "Why do you want to become a physician?" People mentioned five, six different things that motivated them to become a physician, but there's one seed. There's only one moment that starts that whole momentum. Do you remember what your seed is, what that one moment was for you?

Dr. Pang: I think the funny thing is, especially in Asian households, you grew up being told that the honorable professions are lawyer or doctor. These are stereotypes that perpetuate in most Asian communities. Most of us don't really take it to heart once we're adults, once we're in college and deciding what our career paths are. I never say that there was any particular moment in my childhood or young adulthood. Certainly, as an undergrad I contemplated what I wanted to do, where I wanted to go. I started working with a veterinarian, taking care of animals. It wasn't one particular moment, it was the experience of partaking in the care of animals that I realized that I want to expand that. Not to be pejorative towards veterinary medicine. That wasn't my intent. What I meant is to redirect that to taking care of people. I just came home from work one day, and I sat there and I thought, "I would love to also direct this kind of passion and care towards people. I think I would find that very rewarding." It's when you realize that your inclinations, your interests, and your passions are congruent with his career path, that you realize that he chose the right one. For me, that happened overnight. It just propelled me that morning to immediately reach out to everybody from whom I could get advice. And I just pivoted.

Srihita: Was it always going to be plastic surgery? I know we talked about this in our pre-interview meeting, but could you kind of explain why plastic surgery?

Dr. Pang: Yeah, I wasn't immediately drawn towards plastic surgery. Even now in retrospect, it seems like it made a perfect fit. The truth is, even as a medical student, I say this whenever I speak to medical students or even residents, but I don't think most of us know what the specialties truly are like until we're actually in the field. I for one, as a medical student, certainly didn't know and I couldn't decide. I was interested in geriatric medicine and psychiatry, as my number one, two career paths. Through working with some future mentors, I realized that I might enjoy surgery as well because I was good with my hands, and attention to detail. I spent a year doing a surgery internship before deciding to pursue general surgery. During general surgery residency, I was also drawn to a wide range of specialties that include critical care and trauma. The pivot point for me was when I realized that, as much as I enjoyed taking care of the scary mortal and morbid pathologies that are a huge part of what general surgeons do and truly an honorable course for the profession. I felt my calling in improving people's quality of life. That's where plastic surgery excels because it takes pathologies or takes the moments in somebody's life during the duration of their lives to affect their outlook and their quality and their ability and function with their bodies. It pooled my interests in my artistic endeavors as well.

Zarya: Can you speak to what plastic surgery entails, specifically as it relates to gender-affirming surgery?

Dr. Pang: I enter a patient's life at a particular moment, right? It's for those in the transgender and gender non-binary community who decide at some point in their lives that they would like surgery to better align their bodies with their identity. I say that because not all transgender or gender non-binary people seek out surgery. By no means do you need a physical change for anybody to explain who you are, your identity. I think that's a really important point. I serve a small subset of the population who decide that they would like to have a surgeon help them to better align their bodies with their identity. That's where I come in. My role is to affirm the patient's identity and in any way that I can to align their bodies with their identity. That includes any range of trans-feminine or trans-masculine surgeries. We can go into that more if you'd like. That can include facial feminization or facial masculinization surgery, top surgery that can include breast augmentation or mastectomy. I can alter their body contour, so it can include liposuction or fat grafting so their body silhouette matches their identity better. That can include genital surgery. There's no complete surgical transition. Patients can get any surgeries that they need to do, or none, in whichever combinations they'd like to better align their bodies with their identities.

Zarya: So one thing that you mentioned, is making alterations to facial muscle. I've never heard of that before. Could you expand on what that might look like?

Dr. Pang: It's not necessarily just muscles when we're talking about facial masculinization or facial feminization surgery. In society, when we interact with people socially, we often gender people by their faces. We look at somebody and we automatically assume. It's probably not the best practice that we do that, but that's just what we do. We look at people and we immediately gender them as male or female. When we have a patient who's seeking out trans masculine or trans feminine facial surgery, what we do is take those key points of somebody's face that can mark them as more masculine or more feminine, and we can make those key changes to their face. We know, for example, what hairlines or length of the forehead is more feminine, the brow position, the bone position, the shape of a nose, the arch of the cheekbone, the fullness of the cheek, the width of the lower face, the width of the midface, the width of the chin, there are certain markers we know from skin bone, soft tissue that we can manipulate, to make sure that when they interface with the world, that they present in a way that's most congruent with their entity and increase their comfort, socially.

Srihita: I think as someone outside of that experience or any interaction, I think when most people hear gender-affirming surgery, the most basic level of knowledge is to think of either top surgery or bottom surgery. Would you say that's due to, obviously just a lack of information and access to that information, but also, has there been a change in the type of surgeries and services that gender-affirming surgery entails in the recent 10 or 20 years?

Dr. Pang: Yeah, I think it's both of those things. I think it's both the evolution of the field and our understanding of the things that we can do. The field evolves with the community. For example, we weren't offering body-contouring surgery until patients started asking for it. Much of what we provide as surgeons comes at the request of patients. We figure out physically what we can do, what tissues we can manipulate, to help patients achieve a body that will help them exist in the world as they want to. There is an unfortunate belief that gender-affirming surgery is mostly genital surgery. I hear this all the time from people, that they think we focus just on genitals. When we think about the word gender-affirming, we are just affirming gender and by no means are genitals equal to gender. We have to break that binary contract in our heads. We have to accept the fact that there are women with penises out there, there are women without breasts. This binary contract of how these bodies have to be to affirm somebody's gender is an antiquated belief. Once we get past that, you realize that our role as gender-affirming surgeons is just that, to affirm their gender identity in however they believe their body should align with identity. I think that is where we've arrived and I think the field is continuing to evolve based on that understanding.

Srihita: That was great. Even going off how mainstream social attitudes have affected how we view gender-affirming surgery. I think we talked about this a little in our pre-interview, but you're very involved in research for transgender medicine, so can you talk about how that field of research has been stunted and how we're catching up?

Dr. Pang: A lot of clinical outcomes research, for example, looking at the interventions that we provide as physicians, whether they are medical or surgical. They rely on patient experience. Before about 2015, before insurance companies were covering medical and surgical care for trans patients, we weren't providing comprehensive care for the transgender and gender nonbinary community in the United States at all. Prior to that, there were a few individual practitioners here in the United States offering surgery. Medical care was very difficult to come by and there were a lot of hormones being obtained in the black market, patients were having injectables placed in apartments by God knows who, with foreign body substances being placed into their bodies to augment their faces and their bodies to better match their gender identity. The few who could afford surgical care would go abroad to Southeast Asia or to Europe to get their gender-affirming care. Prior to being available in the United States, we didn't know much about transgender care and medicine. Now that we are providing comprehensive care we're starting to develop more and better evidence for the kinds of care that we provide. And that's an exciting time for us to be in the field. You know, we can see active change occurring, not only is our sociological understanding of caring for the trans community expanding, but we're starting to realize that some of the things that we did before may not be as effective. We understand that some needs of the trans community were not being met. There are a lot of centers providing transgender medicine and surgery that are not coming out with good evidence-based guidelines for the kind of care that we can provide here in the United States.

Zarya: As someone who grew up in Hawaii and is practicing here, how do you think your practice might vary if you were practicing in Hawaii?

Dr. Pang: It's kind of hard to say. I'm here in New York. The special thing about New York City is that we have historically a very large queer community. A lot of queer history is embedded in the fabric of New York City. Stonewall was here, but many of the major protests movements and leaders in the community were born of either New York City or San Francisco. You think about cities where the queer community has congregated in decades past. Practicing here in New York City is an exciting opportunity because we have a large community and we have a lot of people who over the decades have been eager to get medical and surgical care. This means that working here means we have a lot of patients from a variety of backgrounds, from a variety of ages. I get to meet them, I get to hear their stories, and I get to take part in this exciting new step for queer care.

Zarya: Being that you're part of the queer community and have queer patients have you been able to connect with patients on that level, through your identity?

Dr. Pang: Yeah, for those who don't know, I identify as a gay, cis man. I think it helps, or at least I hope it helps. I don't want to sound presumptuous that I, in any way, know what it's like to be a trans person, but I do know what it's like to be othered. I know what it's like to sit there and wonder if this place doesn't work as a place for me or if I'll be okay, I know what it's like to suddenly lose family or your entire social support system overnight, I know what that loneliness feels like. I also know that personal strength. I'm not tooting my own horn, but I'm referring to this all too common queer story, which is that it takes a lot of strength to get through all of that, and then to succeed and find your place in life despite all of that. As a member of the greater queer community, I think I certainly respect my trans and gender nonbinary patients, I better empathize with their human experience. I hope that translates in some way to my patient care. It definitely lends itself to the passion that I feel for my work.

Srihita: So you touched on your personal experiences in that answer. Can you expand more about what your journey has been being out in medicine?

Dr. Pang: It's a long story, but to make it pretty short, I think things have changed for the better certainly in the last decade, and I've witnessed it. I see a lot more queer medical students and undergrads coming into medicine and that for me is, really heartwarming. Because for me, much of my undergrad and medical school career and residency was spent in some degree of fear. I came out to my family in my last year of medical school, but I remained pretty quiet professionally because I knew that it could affect me. The way medicine is constructed is that it takes one person to just arbitrarily decide that they don't like you, and they can derail your career. I wanted to apply to surgery residency, then in general surgery residency, I decided I want to get into plastic surgery which is even more competitive to get into. If I was to open with my personal life, I knew it could affect me. I was advised as a student to keep my personal life quiet. I was told as a plastic surgery resident or a plastic surgery applicant, that I should keep my personal life out of the interview and those "Meet and Greet" dinners. I should keep it vague to protect myself. That was the professional advice I received. As painful as that sounds now, as outdated as it sounds now, at that time, it was advised to me by people who meant well and who wanted to see me succeed. Those things stayed with me. What's interesting is before I even left for residency, I was told by a family member no one wants a gay doctor and no one will hire a gay doctor. It sounds super antiquated now, crazy antiquated and inappropriate, but at that time I believed it. I took it to heart and throughout residency, I was very quiet. It took me 10 years into my medical career before I met my first gay surgeon. It says a lot to you about visibility and the importance of representation. Prior to that, I thought, everyone is cis and straight, the majority of whom are white and old. These are the people I have to please to get to my next steps. That is a game that I felt that I had to play and win at. It's been a long journey. When I see medical students and I see openly queer residents it makes me so happy.

Zarya: I just wanted to add to that because I'm applying to medical school at the end of this year, fingers crossed. I'm working on my personal statement right now, and one of the questions that I got is, "what makes you different from all the other candidates who are applying?" I listed out seven different things that I did. I wondered if I should add that I have a podcast because I don't think that the podcast is directly related to healthcare but really it is. That was never my intention, which sounds weird, but it was more so I needed a good community and I felt that a podcast would be the best way to find people. I remember I put down, "I have a podcast called queer diagnosis," and the person who was going through my personal statement with me said, "that should just be your whole statement." For me, the traditional line of thinking is where you don't talk about it. My family doesn't know about this podcast. With you having had your first exposure to anybody in the community 10 years in, and I've had my first position experience with somebody who was part of the community was when I was a medical scribe. You can tell who's part of the community just because they're cooler. I remember there was a doctor because I was working in urgent care at the time. So we had a different doctor here every day of the month. I met close to 60 doctors while I was working there. I remember she had pink, short hair and it was flaming. It was always just up there, a mohawk, and I remember we had seen a patient together who identified as a gay man and he had been asking for STD testing. He said that he visited another clinic and disclosed that he identified as a gay man and it was interesting because they apparently had turned him away, but this pink, mohawked physician was very accepting and open-minded. I think having representation of LGBTQ+ identifying folks is so important in healthcare, even if that's in the form of allyship.

Dr. Pang: Yeah, absolutely, there's immediate comfort with it. There's a candor there.

Zarya: I felt that. I was thinking it feels really great to be with people who are part of the community and they get it.

Dr. Pang: It's interesting you say that because there are really good studies out there. For example, women are more comfortable with women physicians. They seek out women physicians more often than they do male physicians. That's the same with any community, certainly any marginalized community that you see, certainly within the queer community. I think that holds, you see that in practice.

Zarya: I don't know what to do for my personal statement. I just put the podcast logo in my signature. I remember I emailed a bunch of my professors who are white and old, and I said, "I know that we're close, but how would you feel if I was to put this in my signature?" They said, "To be honest, I don't care what's in your signature. I don't read your emails." No, it was nothing like that, but professors just don't care, but I had been so worried about what would happen if I talked about this with my mentors. So far, I haven't seen any shifts with any of my mentors, which is really nice.

Dr. Pang: I'm really glad that you haven't seen a shift, but the fact that there is hesitation there. I applaud how brave you are and just how wonderful you are for making this podcast and wanting to share that even as you apply to medicine. It reminds me as I'm sitting here, as much as things have improved so much within my short career so far, that the societal pressures and microaggressions that we face are still very, very present. It takes people like you to openly discuss in this kind of forum and further our understanding of both queers in medicine, but also queer topics in medicine to propel us into the next evolution of medicine as a whole.

Srihita: Do you think part of your experience and having certain mentors and advisors, the antiquated advice that they gave, motivated you to be involved with residents and medical students today, was that motivation for it?

Dr. Pang: I think it is impossible to separate the two. A lot of what propels us into the positions that we take, the roles that we assume, have a lot to do with our previous experiences in every stage of our careers. I do think it has a lot to do with it. I think that's part of the reason I seek out students from minority backgrounds. It's a reason that I'm intrigued and interested in first-generation and low-income, for example, FGLI students. There's a reason I'm interested in queer students. It's because of my personal experiences being a part of all of these communities. It's impossible to ignore those things after you have come in attending and now you're in practice. You see all of these students from a variety of backgrounds, you immediately understand where they're coming from, you know what it's like. I think that will continue to define a very large part of when I practice medicine and the roles that I occupy outside of my specific role as a surgeon.

Srihita: In our pre-interview, you talked about growing up in a space where you were watching the HIV/AIDS epidemic happening and how that was being falsely linked to being gay and there was a lot of just not good energy. How do you think, or did it all, affect your relationship with your sexuality, and how did you decide to navigate it as you got older?

Dr. Pang: The era in which I grew up probably did not get the brunt of that stigma. I think that is even the generation above me, the majority of our community who kind of initiated the movements to seek out care for HIV/AIDS. Those were clearly being ignored by the greater medical community and certainly by the government. I posted that somewhat, so I don't think I truly face the stigma of the HIV/AIDS epidemic. I think my generation of queer people in medicine dealt with the social stigma. Certainly, I think the stigma that exists against the queer community from an HIV/AIDS standpoint still exists. I mean, to this day, gay men can't donate blood. It's an antiquated and disproven practice, but you don't see blood banks changing their regulations whatsoever. There are a whole slew of things that we're taught in medical school that didn't age well if we go back. That has a lot to do with how we as a medical community address the marginalized and underserved communities. We pathologized so many things on the topic of even race, not to diverge too much from queer topics, but even on race, there are so many things that we were taught about certain communities being at higher risk for hypertension, or mental illness in the queer community. As time passes, and we look back at these kinds of medical factoids that we were taught in school, we realize these aren't inherent to that race or this group. These are pathologies that we as a society have placed on these minority groups. It's a combination of things like minority stress, which is a sociological phenomenon of a lifetime of systemic oppression and not having access to good medical care, social services. Of course, you're gonna have populations that have higher rates of mental health issues. Of course, you're gonna have populations that don't have good access to preventive care services and therefore have higher rates of heart disease, cancer, hypertension, and the results of those things. I kind of diverged a little bit, but I think we're still at the point where we, in the medical community, are looking back at these broad strokes that we have. These non-nuanced approaches that we had to minority groups. We're still reassessing a lot of those claims and backtracking on a lot of them as well.

Zarya: I think you brought up an interesting point. In one of our previous episodes, one medical student was talking about how in their curriculum, there were only four hours dedicated to LGBTQ+ healthcare in four years, which is just crazy to me because I grew up talking about pronouns, my high school is very queer-friendly. Did they discuss LGBTQ+ health care when you were in medical school?

Dr. Pang: Not at all. It's embarrassing to say, but I knew nothing about queer health issues really, throughout medical school. I think the only thing we were taught about in medical school was the HIV/AIDS epidemic. In the years following, in my surgery career and plastic surgery, there were still a lot of perpetuated myths about the community. Higher rates of sexually transmitted diseases, or this population has a higher rate of HIV or hepatitis, perpetuating that stigma against these members of the queer community. When I was considering transgender surgery, I was embarrassed to realize as a gay man that I knew very little about the greater queer community. I knew nothing about the trans and nonbinary community. I spent a good part of a year during my plastic surgery training, aside from studying plastic surgery, with adolescent health practitioners. I spent a lot of time with pediatricians, psychologists, psychiatrists. I went to these multidisciplinary monthly meetings where they would talk about caring for the transgender and gender nonbinary community of Pittsburgh. I did a lot of my reading and research, I watched a lot of documentaries. I sat down with my partner and we spent a long time just re-educating ourselves about the transgender and gender nonbinary community. I grew to love and understand the community. After I educated myself, I spent time with transgender surgeons to look at the craft of what plastic surgery for the transgender community would look like.

Zarya: It seems that a lot of your interactions with the LGBTQ+ community came through providers or patients. Are there any memories that you still reflect on?

Dr. Pang: One of the earliest profound memories was as I was watching a patient receive bottom surgery, vaginoplasty. This woman woke up from anesthesia, and usually, when patients wake up from anesthesia, there isn't much; they're very groggy. Understandably so, and they're not very coherent. They're waking up. Her first response was to burst out crying, which was to be a very raw moment of somebody just expressing a lot of relief that it was finally done and over. What stands out to me very early on in experiencing and watching transgender surgery, I thought, "Oh my goodness, this woman has waited decades to receive this surgery and she did, and even in not being fully cognitively intact from anesthesia, the most basic human response of relief and joy came out. It's a very profound thing that has kind of stuck with me and that has happened to a fair number of patients since, but certainly, her story stands out. In the years I've met many patients whose stories I often find out after the fact. I find out a lot of my patients are very well-known activists in the community, who have done amazing things to give back to their community, to raise money for very humanitarian causes. It's just awesome to see. These are people who are just incredible, very motivated, very prominent in the community, whose life's work is really to better the station of their community, the trans and nonbinary community, as a whole.

Zarya: I went under anesthesia twice in my life. I was not coherent at all. For somebody's first response to cry, that's a very significant moment.

Dr. Pang: Yeah, it's very raw and honest. I think that's part of the reason that it stuck with me because it's truly a raw and honest moment. As surgeons, we meet people in the most vulnerable setting. They are unclothed, unconscious, in front of us, and truly vulnerable, both emotionally but also physically, and the kind of conversations that we're able to have, but also, should they desire the kind of change that we can provide for them, it's an incredible thing for them to share with us. It's a profound moment.

Srihita: I think we're all just letting that sink in. I think the fact that you recognize how profound it speaks to the fact that they're in very good hands. Also when you were talking about all the things we incorrectly pathologized, I remember we had a guest on here once who told us that there was a certain point where bisexuality was looked at as a symptom of bipolar disorder. That stuck with me and I thought, "Oh, my God, we've gotten so many things so wrong." This is not good. Kind of pivoting, how would you say COVID has affected you personally?

Dr. Pang: That's another very loaded question. I mean, COVID was a difficult time for everyone. It still is, it's an ongoing pandemic. I think for a lot of us in New York City, in early 2020, it was mid-March where the pandemic hit us hard, first in the nation. If I think back to that, it was exhausting and it was terrifying. We didn't know, at that point, any of the things we know now. There were no protocols for treatment. We didn't know that we could use steroids, certainly no monoclonal antibodies. We didn't even know the mode of transmission. Do you remember the CDC backtracked on saying no masks needed, to everyone needing a mask now, to that nationwide lack of PPE. In the middle of that, many of us were deployed to help at hospitals that were completely overrun with COVID. Just imagine not knowing any of the treatment modalities that we know now, in hospitals that were completely overwhelmed here in New York City. It was very stressful. I think it certainly recontextualized my role as a physician and the greater medical community because up until that point the specialties of medicine exist in your little spheres. At that point, suddenly plastic surgeons were in the emergency department. I mean, like a fish out of water. I'm helping the emergency department. I'm helping the critical care unit. I felt a strong sense of community within the medical community. I think New York City banded together at that point as well. I still have videos of this nightly 7 pm cheer that would echo throughout all the boroughs of New York City, and it occurred every night from spring when the epidemic hit us into summer. Every night at 7 pm there'd be clanging of pots, people cheering on the health care workers, and honestly, that brought tears to my eyes almost every night because it was that kind of a period that we were going through. There's a strong community we experienced during the pandemic. If we take a step back from even that and look at the ripples of the pandemic and the communities it affected we get a slightly different perspective. This is to say that it laid bare the disparities that exist, we saw minority communities that were disproportionately affected. Throughout the pandemic with people at home, we're already looking at very marginalized communities being disproportionately affected. We also saw on the news, these disparities come to light. People can now see while at home, the awful racist undertones that make up the fabric of America. We saw the Black Lives Matter protests, we saw the Black Trans Lives Matter protests. We saw a rise in anti-Asian sentiment, all spurred on by a President and administration that seemed pretty indifferent to the impact of their overall racist tone. I think that also added to the stress of the pandemic. What's interesting is, I'm not gonna speak on behalf of the Black community or the Black trans community, but as an Asian person, seeing the anti-Asian sentiment that arose from the pandemic just acutely reminded me that these things have always existed and they're just being re-perpetuated, repeated. This is not the first time an Asian person has faced anti-Asian sentiment. We have a history of that in the United States. We have a history of subjugating Asians during times of war and economic struggle. Great things like the Chinese Exclusion Act, Japanese American internment camps in World War II, post 911 hate crimes against South Asians. We've lived through the model minority myth. Certainly, nearing the end of last year or early this year, the results of long standing sexualization and fetishization of Asian women. We see the stereotypes of Asian men as weak. These things aren't new. The pandemic laid bare the social injustices and disparities that exist to perpetuate in the fabric of what it is to be an American. That was a long answer to a short question about how COVID affected me. It was profound, on both a medical level, but also just my role as an American citizen and my ethnic background. It's taught me a lot. It gave me perspective on where we stand in America and going forward certainly as a surgeon who takes care of a marginalized community, it renewed my sense of purpose in what I'm doing and my role in the communities I serve.

Srihita: It was a loaded question and I think one that everyone is still grappling with the answer to. One of the many insightful things in that answer was about how it laid bare the disparities. I remember when COVID started, they were calling it the great equalizer because everyone was going through it. I don't know if that works because not that it had the opposite effect, but weirdly, it kind of laid it very bare exactly what disparities that we were struggling with and the severity of them.

Zarya: I don't think I fully understood the effect of COVID until I heard the story of Dr. Susan Moore, a Black physician struggling with COVID at a hospital in Indiana. She definitely knew the severity of her symptoms, and she was trying to communicate that with her care team, but they kept pushing her away and even wanted to send her home, which I don't think would have happened if she was a white patient or even a white physician. At that point, I had been so out of touch with devastating news events and I think emotionally I was oversaturated with information and the things that were happening around me. Learning about Dr. Moore snapped me back into what was happening with COVID. At that point, I clocked in and I started to check in on my friends again to see how they were doing. Just because I think anybody reading that story would be shocked to learn what we learned. I think the most surprising thing for me was that as a medical student, you have the privilege of even understanding medical terminology, and the fact that Dr. Moore knew her condition, and she still wasn't able to receive the help that she needed. That was just really jarring for me.

Dr. Pang: Yeah. I had the same response, what a heartbreaking story. What an honest exposure to the disparities that exist in medicine. God, we can't protect our own. You can't protect yourself with how many decades of advanced medical education and just being who you are in the community that you belong to, will desperately affect you. It was truly a heartbreaking story. What you say resonates. When we talk about the pandemic as a whole, we create a nebulous world community affected. It's a lot easier for people to digest. You just don't find it as shocking. When you put an individual face to it you're able to pinpoint a specific person who was affected and you watch it, you know this person's story, you know their level of education. Suddenly it recontextualizes everything for you and becomes a much more personal moment.

Zarya: Exactly. I don't know if you remember the capital riots, but that broke me. That was the very last thing that I could personally take. I distanced myself from the news. I've talked to Srihita about this probably a million times, but on one hand, it's a question of "I should be aware of the issues and I should be doing my best," but when I was talking about this with my peers and my colleagues at work, they were like, "at this point, the best thing that you can do is just do what you need to do to become a doctor and help people from there" but then she was a doctor. It's just this whole never-ending cycle that I hope gets better as time goes on.

Dr. Pang: Yeah, I think it will. I think we'll always have moments where we are faced with something absolutely catastrophic or just devastating to watch. It's truly heartbreaking. It helps us to sometimes take a step back and kind of look at the overall arc of where we are headed and where we are from. It helps, it does help. Sometimes I do the same thing. I need to take a step back and I need to just get a broad perspective on how much things have changed even in my own life and my short professional course. It helps you to stay focused on where you're headed and not get overwhelmed or discouraged with what are going to be many, many moments like this to come.

Zarya: Working in the opposite direction of the future, let's turn back, and could you tell us, if you could turn back the time and talk to your Pre-Med self, what would you say to them?

Dr. Pang: What would I say? Hmm…

Zarya: That's good. They say that podcast hosts should always try to confuse their guests a little bit and catch them off guard.

Dr. Pang: A rapid pivot is always key. Yeah, I'll be honest, I'm thinking about it and I could think of a whole host of things that I might want to tell myself at that age. Honestly, and this is not to sound cheesy, but I don't think I would say much. I don't think I would say anything at all. The reason for this is because I feel that so much of our present lives so much of who we are and our perspective on things is a culmination of everything that we've gone through. I've had some pretty awful experiences and some pretty amazing and beautiful life experiences. I think we're better off for that dichotomy in our lives. I realize that this is a little bit cliche, but the reason I'm thinking about this is that I was just a few months back asked by one of my colleagues. We were talking about how we could never understand the experience of being trans, trans-ness. It's a moment in their lives we take part in, but we don't understand their life course or in no way could understand what they go through. I was asked by my colleague if I would change being gay. If I was given the option to not be born gay, would I change that? I took a moment to think, if you had asked my very young, very tortured, very pained, self-loathing version of myself, I probably would have said yes, at one point in my very early life. But no, absolutely not. I think growing up queer, and going through medical school and residency, having experienced the kind of aggressions and microaggressions that I've experienced, and my own life experiences sometimes without much in the way of guidance, has given me more empathy and perspective into kind of what I view as the human condition. That's a perspective that not many other people have. Whenever we're part of a minority population or an underrepresented population, we bring in perspectives that people just do not have. I think that is the magic of what diversity is. Each story is super unique, so precious, and we should protect those stories. In short, I don't think I would say much. I think all of our live courses are what they are and we come out of it better for it.

Srihita: That was another one of those, "let it sink in" moments. That was a very good answer. Zarya and I, because we live together, we were just talking about this last night. I had a breakdown or something last year because I just went into a self-loathing spiral. Just a year later, I was looking back and I was like what was happening? I'm in therapy, and I had a bit of a rough session once and my therapist said, "it sounds like you wish certain bad things had to happen to you". I was like, "Yeah, obviously”, but I think it's always this balancing act of understanding that, you learn a lot from the hard things and there are bad effects sometimes that you have to deal with and you get better at coping with but there are these incredible insights into the human condition. For you and for Zarya, who are going to be taking care of patients, thank God that you guys have those insights into human beings because you're going to be dealing with them, as you said, at their most vulnerable.

Dr. Pang: I think we're always tempted to change things in the past. The truth is, we can't. I've grown into some degree of pragmatism with that. It plays a role in how I see things today. I think that holds with all of us, but that's where that came from.

Zarya: My parents are from Pakistan, they immigrated here. My dad came here I think in the 1980s for University. He started out in Arkansas. Srihita has heard me talking about Arkansas my whole life. I've always heard about Arkansas as this far removed thing because I grew up in New York City, and I didn't know much about it. I've traveled to other places before, but I didn't know much about the Deep South. I remember when we went to Arkansas, my dad, who's a very talkative person, was extremely quiet and it seemed almost sentimental. I was talking to my mom and asked, "What's going on here? Why is he not talking?" And she said, "Well, the last time he was here, he had no money. He had no family here because he moved here entirely without his family." He went from having 11 siblings to no one and choosing to come back with your full family of six. She said it's a very different experience to see where you once were, and where you are now 37, 38 years ago. I asked my dad a similar question. "What would you have done differently?" And his answer is always, "why are you asking me these questions? You should go back to studying because studying is the most important thing," but I think that he never wanted to change anything. I think all those experiences that he had from Arkansas to New York City made him. I got to go into the archives and I got to find his yearbook and we got to find a bunch of his old college friends. My dad just started calling written numbers randomly. It was a shot in the dark. Somebody picked up, and from the get-go, I could tell where my dad got his personality from. I thought, wow, all of this is starting to make sense. I guess my point in saying all that is just your answer is amazing and I think my dad would agree.

Srihita: Even with that question. I always wonder, even if I told my younger self stuff, I don't think she would listen.

Dr. Pang: I mean there's something to be said about just having to live through it and experience it. You'll come back like your dad's visit back, you'll have a profound moment where it comes full circle and you look back.

Srihita: Back then I was too far lost in my angst. I would have been like, I don't care what you're saying. Thank you so much for taking the time. This is great.

Dr. Pang: Thank you so much for having me. This was fantastic. I had so much fun talking to you both. Looking forward to doing it again sometime.

Zarya: Thank you.

Srihita: Hi all, welcome to the reflection portion of the episode. Before we get started, a quick reminder to follow us on Twitter, Instagram and rate/review us wherever you listen to your podcasts. In case you missed it, this season we're lucky enough to have two of our interns Aaliya and Sofia joining us. So guys, what were your thoughts on the episode?

Sofia: Hi, my name is Sofia. What I really liked about this interview was that he was very passionate about what he's doing. He said that his job is not necessarily anything very objective. He said that he was very passionate and I quote, "simply affirming gender identity and however they believe their body should align with their identity," and I think that's a very beautiful thing to do because you're not necessarily fixing something that is visually broken. I think that he is very passionate about what he is doing and that he is making an impact on the people that he has worked with, in ways that no other people do. They’re not fixing something that is visually broken, but they're affirming that their body is aligned with what they think it should look like. I think that is a very beautiful thing to do.

Aaliya: His wording throughout the whole interview was so specific because he knew that there's no way a certain gender is supposed to look. It's how you feel you should look as your gender that you identify with, one thing that is very important. I think he's so passionate about what he does and he finds so much satisfaction in his job. When I talk to people about medicine, the conversation always moves towards how stressful it is and how scary it is, and how much work you have to put in. Just listening to him talk was very calming for me. You know what, it's stressful. It's hard. At the end of the day, I will be just like him, hopefully. I will do something I love to do and I will enjoy it, even though it's hard work. It was nice to hear someone talk very pleasantly and positively about his field of work.

Srihita: I think that's such a great point because I started grad school a couple of weeks ago and it's been really stressful. I've been talking to other kids in the class and we've all been stressed and it was kind of a shock to all of our systems. We've all definitely had these moments of, "why did we sign up to do this?" Why did we put ourselves in this situation? I've tried to have these moments of presence and feeling grounded and knowing that I was so intentional about making this decision. My brain has been expanded and pushed to think in ways that I didn't even think that it was capable of. I've surprised myself at my own capacity for this. I think it's really nice to have that reminder. I know that we were talking about this in preparing for this, but at the end of the episode when we ask our trademark question of, "what's the advice you would give to your younger self," he was just so at peace with being glad about the way that things worked out and that he wouldn't change a thing. I think that's such a powerful sentiment to have from the perspective of, "I went through those things and I learned from them and they brought me here and I'm really happy here."

Zarya: Adding on to that, yesterday I had a conversation with a medical student who has been a great mentor to me over these past few years. Over the past few weeks, I've been struggling to figure out what I want to write for my personal statement because I have the podcast, I have a few life experiences to talk about, I have a strong history of cardiovascular disease, and as a Women's Gender Studies major, I also have a strong interest in reproductive justice now. I feel like my answer to the, "Why do you want to become a physician," question has become so pulled in so many different directions. This particular medical student, a big shout out to Josh, by the way, he's been an absolute help. You guys might know him on Twitter as Josh McGough. If you don't you should follow him on Twitter not to plug him in, but he just has really funny jokes about stuff, which I don't understand because I'm not in that position. Josh said, "you have to remember that when you're talking about your interest in cardiovascular disease and also about reproductive justice, that's using other people to do things really well. For your other life experiences, for instance, my identity as part of the LGBTQ+ community, that is solely you. It helped me just to form my thoughts about my personal statement, and also was just very reaffirming for me as to why I want to go into medicine when there are so many reasons to go in. Sometimes I feel that my different identities are tugging at me for attention. Whether that's as a Muslim individual who's also LGBTQ+, one of the things that I struggled with, especially last semester during Ramadan was I think I had accidentally prayed, "Oh, I hope that God forgives me for being who I am." That's internalized homophobia that I didn't even know I had up until that moment. I thought, "we need to step back, growth is important, resilience is key."

Aaliya: I totally get where you're coming from. For me, I think just a couple of days ago too, ironically, I was struggling with the idea of me actually becoming a doctor. Can I do it? Can I not? I feel like it's not true. I think a lot of what med students emphasize is their numbers. I feel like my numbers aren't where I want them to be. I am just a number, it's like my worth is so deeply rooted in the numbers that I lost a sense of self-worth because of my numbers. I talked to my research professor today, in the research lab instead of doing DNA testing. I was talking to him about my life. I said, "Here's where I'm at with my scores. Should I just stop, should I do pharmacy instead, even though I really want to be in medicine?" He's said, "You can't just give up. There might be a time in your life where you might come to the other thing. You're nowhere near it right now because you haven't even applied. You haven't even given yourself a chance. Why would you not do that for yourself?" It's hard just dealing with that. Imposter syndrome is so real. Especially as an Indian girl, because Indians are stereotyped as being smart people. I'm not smart enough to be an Indian person.

Sofia: Yeah, going off of that. I think that is the main reason why I haven't set on what I want to do after graduation. I've always thought to myself that I'm going to pre-med. I'm taking the MCAT, but here I am. I am a senior not preparing for MCAT. I'm not prepared to do anything after graduation. I'm at peace with what I'm doing and I don't want to pressure myself into what I don't want to do in the next five years at least. Which is something that every pre-med student should be. They should be at peace that the numbers that you get may not be the ones that you want, but then again you're not just numbers. I think that what Zarya was saying, you should show off what you do in your personal statement. The numbers, the GPA, the number of clubs that you've been in, the number of volunteer hours that you had. You shouldn't have to rely on the numbers. Then again, you're applying for NYU, which is a 0.0001 acceptance rate and it is very hard. It's not impossible. I think that if you can put that into words, what you do and who you are, it doesn't really matter the GPA is just a number.

Srihita: I know it's such a balancing act. So much of life is a balancing act. Sofia, what you were saying about not setting too strict of a plan. I think as I've gotten older, that's something I've really tried to do because it's very easy to set incredibly specific goals. But what if it doesn't happen, what if this happens? I think the other part of it is also we change over time. Four years ago, or three years ago, when I started college, I was such a different person. I never thought I would be here and people always want to know what I'm doing next. I'm sure that's almost more true for pre-med because there are so many steps. Even for me, I'm in grad school right now. It's keeping me fairly occupied. When I figure out what's right for me next, then that's the next thing I'll go for.

Zarya: Srihita and I were talking about this too. When we first started interviewing physicians, they knew exactly what they wanted to say. They've had practice with this. They are very self-assured and rightfully so. I kind of hope, it's not even practiced really and is very genuine and authentic every time. It's that there's a certain confidence that you know when you're doing the right thing, and if you keep at it then it'll come naturally.

Sofia: I remember John saying that he initially wanted to be a vet. He instantly said he wanted to channel this energy to help humans. He called up his father and his advisor and said he wanted to be a doctor. It all went how he wanted it to be. He's having the time of his life. 20 years before, who would have thought that he would be a doctor? He was planning out to be a vet. I think we could all learn from that. We don't really know what's gonna happen in the future. It is scary, but also very assuring because nothing is set in stone. I feel we should just be in the moment. I think that as we get older, we are all gonna be just memories. I think that what I want to leave in this world is, I want, not gonna say I'm gonna be in history or anything like that, but people who are gonna remember me would think sunshine and rainbow, not something very depressing.

Aaliya: I think doctors are a lot more reassured because they've had so much more experience. I love the idea of just living in the moment, but I think that's what I'm currently struggling with. I came into college thinking, I'm 21, I'm gonna graduate college, 25 I'm gonna graduate med school, 26 I'm gonna get married, 27 I'm on my first child, 30 I'm done with the children. I'm done. I have names for my children. It's all done and right now I'm gonna have to take a gap year. That shook my world. A gap year is so normal for everyone, but for me, I'm a failure. Do I want to do medicine? Do I want to even be here? What do I want to do? It was so scary. To other people, it is just a year of relaxing, being happy, doing things that you want to do for fun. That's what I'm struggling with right now.

Sofia: What do you want to name your child?

Srihita: No, don't give the name. I think there's something where you're not supposed to say the name.

Aaliya: Oh, really? Okay, I won't.

Zarya: Srihita just out here making rules for everyone else.

Srihita: Zarya, Can I call you out? Can I do the calling you out?

Zarya: Sure. I don't know what it's about, but sure.

Srihita: When Aaliya was telling me her plan, it reminded me of you because you're such a timeline person. Compared to Zarya, I'm just, not to use any stereotypes, but I'm just like a hippie. I'm just going with the flow.

Zarya: I should also note that for listeners who of course can't see us at this moment, we were all laughing during Aaliya's story, especially about the babies. I'm not gonna lie to you. I can tell you my timeline right now. Maybe I wanted to not graduate in three years so I was a little bit better, and I gave myself some flexibility in graduating at 22. Because my birthday is in June, I'm a cancer. I'm not sure that's relevant.

Aaliya: Me too, I'm a July Cancer.

Zarya: Hey, we're both cancers. Okay, 22 I'm going to graduate Undergrad. 26 you would graduate medical school and then 29, not sure what I'm up to. I am probably going to be a medical student in my third year. I would have my first baby, who's adopted, and then I want to adopt twins, so that's two babies in one go, hopefully. Then from there it just keeps going up and I want eight children in total. I just really want to start a dynasty essentially. I want to be the grandmother that did it, and that all their kids are bred to be doctors. No, I'm joking. I have met quite a few people who are also pre-med and they're just like, "Yeah, being a doctor runs in the family." I'm like, "Oh, for me, it's type A blood." Do you know what I mean? We are just built differently. It is kind of reassuring to hear you say that too because I'm also taking a one-year gap, and I've fully been freaking out for the past three months almost. I don't know what to do with the gap year and I don't do well with long breaks. I'm either always working, or I need a week off. But, two weeks into summer my brain is just absolute mush. I'm never going back to school, but I'm also never going to relax again. It's just somewhere in between those two things. I appreciate you sharing that because now I know I'm not alone and now we can vibe about that after the podcast, too.

Srihita: The last few months for me have been such a period of transition. Zarya knows this because she's seen me struggle through it. I grew up in the suburbs. Moving to New York was a shift. I don't like saying this, but I am going to Columbia. Aaliya, you were talking about imposter syndrome. That's something I've felt a lot. Having Ivy League's be such a big thing when I was a kid and then resenting it because I didn't feel included and now being a part of it. It's just all been a bit of a brain freeze for me. Having someone like John, who has such perspective and such incredible hindsight on his journey and him being so at peace with everything he's been through, it's given me hope and a sense of calm as I go into this next rapidly changing few years of my life. I also want to say, we were touching on this idea of everything happening for a reason, but kind of being uncomfortable with that phrase. Something I like to tell myself instead of that is recognizing our capacity to make the best of every situation and grow from every situation. That capacity is one of many reasons that we should celebrate and appreciate ourselves because we're incredibly resilient people. I think we're gonna leave it on that note. Thank you so much for listening, and take care of yourselves. We'll see you next time.

Zarya: Bye.

Sofia: Bye.

Zarya: 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.

Sofia: 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.