In this climate, it is so easy as a physician to shift into a mindset where nothing else matters except the patient. We quickly shift` into going above and beyond, working to the point that we compromise our own health and well-being. We learn very early in our training that self-sacrifice is normal – a belief which is a guiding principle in the culture of medicine. I can say that I’ve even, to some extent, brought this sacrificial culture into my household. However, there is a double burden as BIPOC women. We learn self-sacrifice very early with one message that many of us are familiar with- “you have to work twice as hard, to get half as far…”. I internalized this message, which led to my pervasive behavior of working to the point of exhaustion and this message convinced me that this was the only way to reveal my competence and know my value.

The journey for BIPOC women in medicine is one where we rapidly learn in our training and career that graduating medical school and finishing residency are insufficient proof of our aptitude to practice medicine when combined with our BIPOCNESS. Moreover, a significant proportion of us also learn that taking vacations or staying home because of illness, can be perceived by others as signs of less commitment to our jobs or inability to handle the work. This message of working twice as hard that has been passed down for several generations actually exacerbated doubts about my worthiness and increased my anxiety, which I later found out to be something called stereotype threat.

When I realized none of the “working twice as hard” behaviors worked to erase the racism and bias I experienced, I was devastated. It took several years of working as a physician (and being lauded by patients) for me to recognize how outstanding I was at what I do and to understand that my worthiness was not determined by being a compulsive workaholic. Yet, I also understood that Malcolm X was right that I was the most disrespected, neglected and unprotected person in this country, as a BIPOC woman, and that no one would protect my value as much as I would for myself.

My decision to protect myself by practicing self-care as a BIPOC woman in medicine, let alone practice it regularly, is an act of defiance. So while fellow women colleagues will shout about the benefits of self-care and are viewed positively when they practice it, Audre Lorde clearly recognized the unique difference in the experience of women of color who finally put themselves first. She famously said, “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

This defiance of putting ourselves first must not only be part of our approach to our work but also in our homes. BIPOC women, regardless of our profession, are the healthcare decision-makers in our families and households. Yet making healthy decisions for our families and choosing not to prioritize our well-being cannot co-exist.

Even from an early age, our kids , particularly our girls, see the discrepancy and are more apt to do what we do, than do what we say. It truly means removing our connections to the BIPOC superwoman schema that idolizes martyrdom. It means if I have a cold- I am not ignoring it. It means if I am ill or weak, I am resting not driving to work. These small acts are the warfare of self-preservation because they are a loud message to our workplaces, communities and even our families about how we deserve to be treated.

So what should we be doing?

First, we must recognize how much we matter, how valuable we are and the unique support each of us need. It has been so much easier to maintain unapologetically focused on my vision, to keep saying no, to ask for help, and to manage my time. This is what I gained from investing in self-development work, virtually and in-person, with motivated women and it is this that i would argue is the most important act of self-preservation.

We must recognize how brazen the war we wage is when we choose self-preservation. We are literally battling a societal message that our humanity and our role as BIPOC women is the overworked and underpaid pillar that everyone gets to lean on. We are battling messages within our own communities that lead so many BlPOC women to continue life-threatening work practices that wreak havoc on our bodies, our minds and our feelings. This weapon, self-preservation, — eating when you need to, sleeping, napping and becoming physical activity, not only has to be learned but has to be taught to our next generation. Without this message, we often burnout and leave medicine, making it difficult to increase the representation of BlPOC women in medicine. Even more distressing is the possibility that “the work twice as hard” philosophy will continue the cycle of little BIPOC girls, doubting their intelligence due to the onslaught of bias and working excessively as a solution to pervasive discrimination.

We need one more thing to protect ourselves in times of crisis. Connection. We have to maintain connections and too often we retreat because of the requirement that we become vulnerable. Who are you connecting with to share your fear, your concerns or your challenges in the wake of crisis? If the answer is no one, that needs to change. However, even if we practice meeting our basic needs and eliminate the Superwoman behavior from our lives, we still have not reached true self-preservation.  

Honestly, in my darkest moment in a hospital room in 2019, unable to walk, I had trouble with connection, even with myself. I had been so busy doing all the things, that I never invested time, energy or attention to myself, my vision, my goals, and my dreams. It was connection that saved my life, first connecting with myself and then with others. Connection helped me find my purpose and put my crazy dreams into action- like building a community for BIPOC physician women to be themselves and tap into their genius. Yes, we have to practice social distancing in the wake of this pandemic, but it doesn’t stop our need for connection even while we work from home.

In this time, more than ever, BlPOC women in medicine need to be able to connect, fight burnout together, and get clarity on what is most meaningful to them , what they want to achieve and then go do it, with the support of sisters in medicine across the nation.

No one, absolutely no one, is going to understand how crazy it is to be on the front lines except those of us who are there. No one else understands the stress of the hundreds of emails explaining how we need to shift our healthcare practices. No one else knows the burden to continuously be the go-to resource for everything health-related in our families.

For many women, self-preservation is a given for which there is no threat. For BlPOC women, we continue to fight constant judgement, discrimination and devaluing when we choose self-preservation over self-sacrifice. We absolutely must be vulnerable and come together, because there is no doubt that this is a battle for our own lives, our next generation and therefore, one that we must win.

How is this connecting with you and what do you need to do differently this week?