While studying to become a physician associate, Vanessa decided to take a leave of absence to avoid burning out, but greatly feared disappointing her Colombian parents. And Sunny Nakae, a medical school dean who specializes in access and equity, shares strategies for developing self-compassion while pursuing demanding academic careers.
Our expert this week is Dr. Sunny Nakae, Senior Associate Dean for Equity, Inclusion, Diversity, and Partnership, and Associate Professor of Medical Education at the California University of Science and Medicine. She is the author of Premed Prep: Advice from a Medical School Admissions Dean. Learn more about her book, here.
If you loved this episode, be sure to listen to She Has a Ph.D, But Papí Still Wants Her to Serve Him and Under Pressure from Mom to Finish, But Questioning If College Is for Her.
We’d love to hear your stories of triumph and frustration so send us a detailed voice memo to virginia@lwcstudios.com. You might be on a future episode! Let’s connect on Twitter and Instagram at @TalkToMamiPapi and email us at hello@talktomamipapi.com. And follow us on Apple Podcasts, Spotify and anywhere you listen to your favorite podcasts.
Juleyka Lantigua.:
Hi, everybody. Today, I'm speaking with Vanessa. Vanessa was born in Colombia and moved to North Carolina with her family when she was a child. She has always been a driven and hardworking student and has big plans for a medical career. Earlier this year, Vanessa decided she needed to take a break from grad school and was really nervous about telling her parents. Let's get into it.
Vanessa: My name is Vanessa. I am 24 years old. I was born in the beautiful city of Cali, Colombia, and I currently live in Portland, Maine with my husband and two cats. In my family, I did not really call my mom mami or papi. I just called them by their names. As a little girl, that's what I did and it just stuck. I was four years old when I arrived to the United States. My parents and I immigrated from Colombia in 2001 and we arrived in New York City. We then shortly moved to North Carolina.
There I did all of my schooling, and then I decided to become a physician assistant. Now the title has changed to a physician associate. I thought to myself, well, I graduated with honors in my undergrad years. I did very well in my master's program. So why can't I do PA straight off the bat as well? And it was also the pressure from my parents. They at times were pushing me like, "Have you applied? How's the process going?" There are times where like, oh, I don't know if I should take a break, and my mom...She discouraged that. I started the program and every day I woke up, and I was just like, "Oh gosh, here we go again." The information is not hard. It was just, we were bombarded with so much information in so little time. Mentally, I just couldn't do it anymore. I would stay up until 3:00 or 4:00 AM studying, go to sleep for two hours, and do it all over again. There were days where I was like, "Did I eat dinner? Did I take a shower?" And I was just losing myself as a person. I actually had a conversation with the program directors.
And right off the bat, one of the professors just by looking at me and my body language, he knew. He asked me a question that I was just like, "Wow! How did he know?" And he asked, "Is this another part of your life where you're just reading a book because you have to, not because you want to?" And I was like, "Oh my God! Yes, you are correct. How did you know?" He explained why. I told myself this is something I've worked my whole life for. I've done nothing but to reach my goal and I did it and I'm not going to let it escape. I think it's best to go ahead and take a leave of absence before things become worse.
Honestly, I felt like it was a weight off my shoulders. I just felt like I could breathe again. At the same time, I felt so disappointed, like a wave of disappointment and of failure came in as well. Everyone saw me a certain way just as a very successful student, and they're like, "Well, Vanessa doesn't struggle. So why is she struggling right now?"
The higher you go up, the less you will see of people of different ethnicities or different backgrounds. I was the only Latina in my cohort out of 50 students. When I completed my masters, I was also the only Hispanic. I felt like I had to represent not only my culture, but my community. Growing up, I had DACA and I always had to show the States that I belonged here, that I was able to bring the same or not even more than someone who was born here, because I also had to prove that through paperwork. I had to show that I was either at school or I was working. I was getting good grades. That has only driven me to become a better person, a better student to push myself forward. But at the same time, it has led to me being not confident in myself at times and having low self-esteem as to why some people are outperforming me. My mom, she doesn't want to admit it, but she compared me a lot with other family members to the point where she one time said like, "Oh, you can't be the black sheep of the family. You have to show everyone that you can do it," basically.
She freaked out. I told her straight up. I didn't sugar coat it, and I said, "Hey, I'm taking a leave of absence. These are the reasons why." And she said, "Oh Vanessa, but you already signed the paperwork. Why?" And I said, "Because I want to enjoy my schooling. I want to enjoy the process of becoming a PA, and I was not enjoying it." And two hours later, she sent me a text message saying, "Well, I support you with that decision. Now you have to be strong and keep going." Everyone's been very supportive. I was taken back by that, because at times I felt alone when it came to that. Because growing up, my parents were always telling me that, "Well, life is tough. Suck it up and keep going."
In order to take care of myself, I know that I have to keep doing what I love and not forget about it, which is running, going to the gym more often, sleeping as much as I can. Hopefully I will land a job in eyecare. And now I'm actually debating whether to volunteer with animals, since that's something I've always wanted to do but never had the time to. I am scared to not do well the second time around. It sometimes keeps me up at night. I'm like, "Do I have what it takes?" At times, I'm like, "Yeah, I'm doing pretty great," and at times I'm like, "Oh no, I'm not and here we go again." It's a cycle.
Lantigua: Vanessa's story deeply resonated with me. Navigating grad school as a first gen can be incredibly taxing and sometimes straight up demoralizing. I know. I have two masters and the mental scars that go with them. How can we address these challenges and communicate our decisions and strategies to our parents who may not always know just how high pressure academic environments can be. To help us figure it out, I called in an expert.
Sunny Nakae: I'm Dr. Sunny Nakae, Senior Associate Dean for Equity, Inclusion, Diversity and Partnership at the California University of Science and Medicine in Colton, California. I'm an associate professor of medical education and the author of Premed Prep: Advice From A Medical School Admissions Dean by Rutgers Press. The thesis of the book is how to consider not what you have to do to get in to medical school, but who do you need to be to be someone's doctor?
I have a lot of chapters in there for first gen students and re-applicants and minority students, undocumented students, because those are the students that I've worked with for my whole career, and I wanted to elevate their stories and their wisdom and give it back to our communities.
Lantigua: Doc, you heard Vanessa's story. What did you hear in her story as you listened?
Nakae: I just wanted to reach through the recording and just hug her. She was so hard on herself. I wanted to tell her how strong and phenomenal she is. And just hearing her story, I just heard such a familiar experience of students who are the first and the only, who have just a much more difficult journey on top of things that they've already overcome.
Lantigua: So let's talk a little bit about some of the challenges that you have seen your students grapple with and overcome over the years. And what is at the basis of those challenges, both on the personal and on the educational side?
Nakae: The three big ones that came up as I listened to Vanessa's experience was one, stereotype threat, being the only Latina in a lot of the educational context that she was in. That matters. That impacts our performance, that impacts the way that we see ourselves. Feeling like you're carrying the reputation and perception of your people with you everywhere you go, where other students just have the freedom to just sort of be themselves and the freedom to fail, right, without additional consequences on their shoulders. I know a lot of my students from immigrant families, they're like, "All my cousins are looking at me. I'm the oldest in my family." They just have such tremendous weight navigating around these obstacles.
The second one was imposter syndrome of just not feeling like you're enough. You don't feel like you fit in, or you just really wonder if you got lucky. You question yourself. But it's a whole different thing in the context of racism and sexism and all the intersections of oppression and white supremacy that our institutions steep us in as we go through this journey. It's one thing to feel like an imposter in a new professional space. It's a totally different level of imposter syndrome in a space that was actually designed to make you feel that way, with environmental cues everywhere you go and microaggressions every time you talk that actually reinforce that syndrome, right?
It's not just, "Oh, it's in my head. Everybody has this." It's a very deep level of belongingness threat that can be an incredible distraction and takes a toll just on our well-being, our overall sense of wholeness.
Lantigua: What's the third thing that you noticed?
Nakae: The feeling of uncertainty, of not knowing what you don't know. With every decision you wonder, is there something I don't know about repercussions of this decision that's going to haunt me later? And then Vanessa's experience of not being able to like reassure her parents that this was okay, right? Because I tell my medical students all the time, this is your first time going through medical school and hopefully your only time going through. There's just some things that you're doing all of it for the first time. We don't love that feeling of not feeling good at something when we've worked so hard to feel that way.
I like to tell a story about my daughter. When she was in fourth grade, we signed up for a 5K. It was at this huge race track, and there were thousands of people at this 5K. We set a goal to finish in 30 minutes, which I thought was pretty good for a fourth grader. We started running and sometimes we walked and sometimes we ran, and we had finished in like 32 minutes. It was like, okay, well, we missed our goal. And then later I actually looked at my app that was using to track and we had run around so many big groups of people. In other words, we'd made so much lateral movement around other people that we actually ran three and a half miles, which meant that we met our goal, but I was comparing it to like all the other 5Ks that I had done before and like using very different parameters. I think for first gen students, we have to account for that, that lateral movement around obstacles in the emotional energy that it takes away from.
It doesn't mean you're not brilliant. It means you're more brilliant, right? And you have to give yourself that credit and don't compare everything that you're doing to what you see your peers doing, because they may not have those same challenges. It's so hard because we tend to compare ourselves, and education steeps us in comparison, right? It's really hard to honor yourself and your own journey when you're constantly getting messages that you're not enough.
Lantigua: I want to go back to something you said, which seems antithetical to the ethos that immigrants and first gems grow up with, freedom to fail? What's that?
Nakae: Yeah. We carry the hopes and dreams and sacrifices and trauma of our families of origin and their immigration histories and stories with us. And often our parents and our loved ones carry the sadness of what they left behind. It is the hope in our achievement that gives them the ability to cope with that sadness. But as hard as it is, you got to really try not to take that on and really some recognition of even the trauma. I've talked with a lot of my undocumented students about the histories of trauma that they didn't even realize they were carrying.
Students feel so alone in their experiences until they find a trusted, protected space where they can talk to someone else and go, "Wow! That was my experience too."
Lantigua: Yeah. Yeah. Two things here that I want to recognize. One is that Vanessa's story repeats itself tens of millions of times around the US, and that sometimes there aren't other people around to talk to, right? Because you are the first, or you are the only, or you have reached a level where you yourself have opened the door, hopefully, for other people to walk through in the future. What are some of the signs that a person like Vanessa can observe in themselves to sort of take stock of the fact that they are letting themselves put a lot of pressure on themselves and that they're overburdening themselves with things that are not really theirs to be burdened by, and then what do they do after that?
Nakae: The self-recognition and self-compassion in high achievers is so hard. I mean, you hear so much, "Suck it up. Suck it up. Just get it done. Work hard. Just go for it." I think stopping and recognizing, and I think something that Vanessa said about "the joy was gone", right? She was just going through the motions. And part of her wisdom in what she said was, "I want to enjoy my training," and you deserve that, right?
You busted your tail to get this ticket to this amazing ride, and you don't want to go through it with a blindfold on and earplugs in because you're so dulled to that experience by the stressors. I try to keep in mind, in my program, what got me through was that my advisor kept telling me, what you're studying... I did a PhD in higher ed and I was really looking at access and equity issues. He said, "This is not for you. It's for the world. It's so much bigger than you. You are the conduit that is going to come through."
For Vanessa, becoming a physician associate is so important and what she's learning is for her patients. If she can't get to a place where she believes that she deserves that, well, I'm sure she can get to a place where she believes her patients do, and her patients deserve the best version of Vanessa at the end of her training that she has the capacity for. She absolutely deserves that as well for her career. But if this is for our communities and that's who we're representing in these spaces, then our communities deserve our best as well.
Lantigua: Yeah, but there's our family who is sort of indirectly part of the community, but they're special. You rolled your eyes. I just want everybody to know. How does someone in Vanessa's shoes, how do we prepare to have this conversation with our parents? Please talk to me about some resources that might be available on campuses for those people listening where you can go and get advice, counseling when you're feeling stuck?
Nakae: Having that conversation with your parents is also about recognizing that you are an adult child. You are not asking permission for this decision. You are invested in your relationship enough to share it with them and to talk with them a little bit about what's going on. The threat of suicide is very real, particularly in medical education with medical students. I have lost three students to suicide in my career. These are highly accomplished students, but we're just very susceptible to burnout.
Part of it is just normalizing a lot of people take breaks and graduate students... My program has this percent of graduation rate, medical education, I know MD schools, 95% graduation rate over a 10 year span to encompass people who take leaves or do dual degrees, but most people finish. Providing some of that context of it's okay to step away. It's not going to hurt my career trajectory in any way. There's not going to be an asterisk on my degree certificate that says I took six months off, right? That's what I tell my med students, If you pass boards on the second try, you get the same license that everybody on the first try got, right?
The challenge too, I think, is differentiating yourself as an adult and being able to say, "These are the things that I needed in order to be my best self." On campus, there should be counseling programs available. There should be a way to either potentially take either a lighter load or an independent project where you could stay enrolled if you needed insurance, things like that. Some schools have tuition maximum policies, where if you take a leave or you have to repeat something, there's a maximum amount that you'll pay. Talking with the financial aid person about what are the implications of taking this leave so that you can have resources to put yourself back together to be able to come back and really do your best work.
Lantigua: Last question, when your students come to you and say, "Doc, I need a break. I need to leave," what do you say to them in terms of, here's what I want you to do now to take care of yourself and come back ready?
Yeah. I'd like to use motivational interviewing a little bit and say, "Let's think about a time when you were at your best, right? What were you doing?" "Oh, well, Dean Nakae, I was meal prepping. I was making these wicked salmon dishes every day. I'm just putting them in my fridge. I was going to the gym, or I was doing my meditation." We try to think about, like, what kinds of habits fuel you to do your best?
Usually I screen my students for sleeping because the lack of sleep and the skimping on sleep is the beginning of the stress spiral of not completing the stress cycle that lets it all build up. Often in graduate school, particularly PA school or med school, there's so much to study. You're just never done. You have to give yourself a horizon at the end of every day, right? I'm going to study. And then every day at 6:00, I'm done. Then relax, go to bed, get up, do it again to make sure that you're healthy.
Lantigua: You are phenomenal. Thank you for the work that you do. Thank you for being here today.
Nakae: Oh, my pleasure.
Lantigua: All right. Let's recap what we learned from Sunny. Reclaim the freedom to fail. Try not to take on additional burdens that are not for you to bear. And remember, you don't always need to be an example for younger family members or represent your entire community all the time. Provide context. Share data about graduation rates, risks of burnout, and options your school offers for students on leave. Use information to show your family how taking a break is normal and sometimes even expected in a long academic career.
And remember, honor your own journey, have self-compassion, and recognize what you need to be the best version of yourself without comparing yourself to others and without falling under parental pressure. Thank you for listening and for sharing us. How to Talk to Mami and Papi about Anything is an original production of LWC Studios. Virginia Lora is the show's producer. Kojin Tashiro is our mixer. Manuela Bedoya is our social media editor. Cedric Wilson is our lead producer. Jen Chien is our executive editor. Jimmy Gutierrez is our managing editor.
I'm the creator, Juleyka Lantigua. On Twitter and Instagram, we're @talktomamipapi. Please follow us and rate us on Apple Podcasts, Amazon Music, Pandora, Spotify, and anywhere you listen to your favorite podcasts. Bye, everybody. Same place next week.
CITATION:
Lantigua-Williams, Juleyka, host. “Taking a Break from School, Then Telling Her Parents.”
How to Talk to [Mamí & Papí] About Anything,
LWC Studios, August 16, 2021. TalkToMamiPapi.com.