There I was, crying once again all the way from the hospital’s parking lot to my apartment, into the shower, and while trying to fall asleep. This had become the norm during my internal medicine residency. For years, I tried hard every day to be someone else to fit in. It started with off-hand comments like “Look at her red shoes,” “You are so colorful,” and “You are so Latina.” These comments later escalated to being interrupted during presentations with comments about my accent, being told that my medical school training in my home country was inferior to my U.S. colleagues, and being assigned all Spanish-speaking patients because “They are your people.” Some of those comments and interactions were unintentionally harmful but led to feelings of isolation; over time, I began to feel like an outsider.
I came to the United States with the dream of becoming a physician investigator, leaving behind family, friends, and everything I knew. Over time, I felt pigeonholed into a constricting stereotype due to my ethnicity and accent. Back home, I was one of many, but in this new setting, I was one of a few, and in many instances, I was the only Latina in the room.
Narjust Florez (Duma), MD
I was raised by divorced physician parents in Venezuela; my childhood years were often spent in the clinic waiting for my mother to see that one last patient or outside the operating room waiting for my father to take me home. The hospital felt like my second home, growing up snacking on graham crackers and drinking the infamous hospital’s 1% orange juice. “She was raised in a hospital,” my mother used to say.
Sadly, that feeling of being at home in the hospital changed during medical training, as I felt isolated and like I did not belong, making me question my dream and the decision to come to the United States. I remember calling my family and crying as I asked: “Why did I leave? Why didn’t you stop me from coming here?” and seeking permission to return home. I felt like I was disappointing them as I was no longer the vivid, confident young woman who left her home country to pursue a bright future.
A Turning Point
I remember one colleague, Valerie (pseudonym), from Connecticut. Valerie attended medical school in the United States, did not have an accent, and was familiar with the American health-care system. She understood how the senior resident-intern relationship functioned, a hierarchy that continually confused me. Over the following weeks, I took a closer look at how my colleagues and other hospital staff interacted with Valerie. I noticed that people did not comment about her clothing or personality. She was “normal” and fit in. I remember my senior resident asking me, “Narjust, why can’t you be more like Valerie?” Ashamed, I mumbled that I would try and then ran to the bathroom to cry alone. That interaction was a turning point for me; I got the message. I needed to change; I needed to stop being who I was to be accepted.
I learned that happiness lived within me as a whole person—hiding my accent, cultural background, and past experiences was also hiding the light and joy inside me.— Narjust Florez (Duma), MD
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As the years passed, I kept key pieces of my personality hidden, hoping I could earn the respect of my colleagues. I refrained from sharing my personal stories, as they were different from those around me. I grew up in a developing country with a struggling economy and an even more challenging political situation. It was clear that we simply did not share similar experiences.
When I sought help from my senior residents and attending physicians, my feelings were often minimized or invalidated. I was told that “residency is tough” and that I should “man up.” A few even suggested that I mold my personality to fit the box of what a resident physician was supposed to be. I slowly realized that my clothing changed from reds and pinks to greys and blacks because it was “more professional”; my outward appearance faded, as did my once bright sense of humor and affability.
All these issues led to depression and an overwhelming sense of not belonging. A few months later, I was on antidepressants, but the crying in the shower continued. Rotation by rotation, I looked for a specialty that would help me feel like I belonged, and I found that in oncology. My mentor embraced my research ideas; my ethnic background or accent did not matter; we had the same goal, improving the care of our patients with cancer. I got to travel to national and international conferences, presented my research findings, and received a few awards along the way. From the outside, it looked like I was thriving; my mentor often called me a “Rising Star,” but in reality, I was still deeply depressed and trying to fit in every day. My career successes led me to believe that not being myself was the right thing to do. I felt isolated; I was trying to be someone I was not.
A year later, I matched at my top choice oncology fellowship program; the program had the balance I was looking for between clinical care and research. This meant I needed to move to the Midwest, farther away from family, and to an area of the country with less racial and ethnic diversity. After 2 years on antidepressants and the 10 extra pounds that came with it, my white coat did not fit. My white coat felt like a costume that I would put on every day to fulfill the dream of being a doctor. I would often wake up in the middle of the night exhausted and depressed. I had all the responsibilities of a hematology/oncology trainee and the additional full-time job of trying to fit in every day; I was using all my energy trying to be someone I was not.
At Home in Oncology
Regardless of my fears, I felt in my element when talking to patients and interacting with my cofellows. Despite having a different skin color and accent, I felt accepted by my patients with cancer. I remember when one of my patients requested to see me while in the emergency room because “Dr. Duma just gets me.” She had been evaluated by the head of the department and attending physicians, but for her, I was her doctor. Tears of happiness accompanied my bus ride to see her; at that moment, I knew I was an oncologist, and oncology was the place I belonged.
The next day, I realized it was time to be myself: Narjust from Venezuela, a Latina oncologist who was her true self. I searched the bottom of my closet for the last piece of colorful clothing I had saved, a yellow dress. I put on that brightly colored dress for the first time in 5 years and finally felt comfortable being my authentic self; the yellow dress represented freedom and embraced the culture and colors I grew up seeing in my hometown. I finally understood that I brought something special to the table: my unique understanding of the challenges faced by Latinx patients and trainees, my advocacy skills, and my persistence to endure the academic grindstone. Psychotherapy was also an essential part of my recovery; I learned that happiness lived within me as a whole person—hiding my accent, cultural background, and past experiences was also hiding the light and joy inside me.
Paying It Forward
Along the way, I found colleagues who faced the same challenges and validated that my experiences resulted from an environment that excludes the difference and values homogeneity.1,2 This route to self-discovery helped me find my calling to support others in situations similar to mine.3 I learned how to incorporate and celebrate my ethnicity in the world of academic oncology by teaching others the power of cultural humility, diversity, equity, and inclusion.
For all minority medical students, residents, fellows, and junior faculty, we belong in medicine, even during those moments when our identity is tested.— Narjust Florez (Duma), MD
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Together with new-found friends and colleagues, I cofounded the #LatinasinMedicine Twitter community for those who face similar burdens during their training and careers. The #LatinasinMedicine community was created to share our stories, embrace our culture, and amplify other Latinas in medicine—to create connections that alleviate the sense of isolation that many of us have experienced and serve as role models to the next generation of Latinas in medicine.4
To help drive systemic change, I founded the Duma Laboratory (now called the Florez Lab), a research group that focuses on cancer health disparities and discrimination in medical education. Through research, the Florez Lab has shown that my experiences are not unique but rather an everyday reality for many international medical graduates and other underrepresented groups in medicine.5-7 The Florez Lab has become a safe environment for many trainees; we seek to change how mentorship works for underrepresented groups in oncology, with the hope that the isolation I felt during my training is not something that future physicians will ever have to endure.8,9
After years of depression and self-discovery, my white coat now fits. However, this is not your regular white coat; it has touches of color to embrace my heritage and the ancestors who paved the way for me to be here today. The face of medicine and oncology is changing around the world; young women of color are standing up to demonstrate the strength of our experiences and fuel the change that medical education needs.
For all minority medical students, residents, fellows, and junior faculty, we belong in medicine, even during those moments when our identity is tested. Through my journey, I learned we can and must challenge the status quo. I hope to inspire others to join me in this path of advocating for diversity, equity, and inclusion, because the time for change is now. I was finally free the moment I realized I could not be anyone else but myself, a proud Latina in medicine and oncology.
DISCLOSURE: Dr. Florez has served as a consultant or advisor to AstraZeneca, Pfizer, NeoGenomics Laboratories, Janssen, Bristol Myers Squibb/Medarex, Merck, and Mirati Therapeutics and has served on the speakers bureau for MJH Life Sciences.
REFERENCES
1. Forrester A: Why I stay: The other side of underrepresentation in academia. N Engl J Med 383:e24, 2020.
2. Humphrey HJ, Levinson D, Nivet MA, et al: Addressing harmful bias and eliminating discrimination in health professions learning environments: An urgent challenge. Acad Med 95:S1-S4, 2020.
3. Flores GM: Pursuing medicina [medicine]: Latina physicians and parental messages on gendered career choices. Sex Roles 81:59-73, 2019.
4. Christophers B, Duma N, Mora Pinzón MC: #LatinasInMedicine: Using the hashtag to build community in medicine. J Grad Med Educ 13:332-334, 2021.
5. Duma N, Durani U, Woods CB, et al: Evaluating unconscious bias: Speaker introductions at an international oncology conference. J Clin Oncol 37:3538-3545, 2019.
6. Velazquez Manana AI, Leibrandt R, Duma N: Trainee and workforce diversity in hematology and oncology: Ten years later, what has changed? 2020 ASCO Annual Meeting. Abstract 11000.
7. Balanchivadze N, Passalacqua KD, Askar S, et al: Self-reported gender bias encountered by hematology and oncology fellows. 2021 ASCO Annual Meeting. Abstract 11017.
8. Olazagasti C, Bernabe C, Patel S, et al: The Duma Lab seeks to change how mentorship works for underrepresented women in medicine. Cancer Letter. Available at https://cancerletter.com/guest-editorial/20210702_2/. Accessed October 12, 2022.
9. Duma N: Changing the status quo for women of color in medicine. Medscape. Available at https://www.medscape.com/viewarticle/956075. Accessed October 12, 2022.
At the time this article was published in the Journal of Clinical Oncology, Dr. Florez was Associate Director for the Cancer Care Equity Program at Dana-Farber Cancer Institute, Boston.
Originally published in the Journal of Clinical Oncology 40:3344-3345, 2022. © American Society of Clinical Oncology. All rights reserved.
