What made you choose medicine and why the specialty of Infectious Disease specifically?
When I was 8 years old, I visited my doctor for a well-child visit. I don’t remember if I was scheduled to meet with her or if I requested the appointment, but I recall feeling the weight of the world on my shoulders as I contemplated life’s biggest mystery: what is my purpose? It may seem strange that an 8 year old was concerned with such deep “grown-up” issues, but I felt a calling towards the biological sciences and I wanted to plan my life well. During that visit, I remember asking: “Dr. Etienne, I like children and I like science – what should I be when I grow up?” I had always been a high-achiever, so I’m sure it came as no surprise to her that I would ask these questions, although at my age it was probably still amusing to hear. She considered my interests for some time and said finally “Well, you could be a science teacher, or you could be a children’s doctor.” I quietly thought about those choices and then said “I have no patience to be a teacher, so I’ll be a doctor then!” From that moment onwards, every class I took, every decision I made was taken with that goal in mind. I went on to complete my Bachelor of Science Degree in Biology & Chemistry with a Diploma in Forensic Science at St. Mary’s University in Halifax, Nova Scotia, and thereafter went to American University of Antigua College of Medicine for medical school.
For a very long time, I was planning to be a pediatrician. I had it in my mind that I would become a pediatric neurosurgeon, because the brain was fascinating to me. As I progressed through medical school, I did my pediatrics rotation and learned that while I still loved children, I preferred taking care of adults, who more often than not, could tell me exactly what bothered them so that I could help fix it. Though I had great respect for surgeons, I also learned quickly that I preferred the pace of Internal Medicine. When I was an Internal Medicine resident, I briefly considered Oncology, but realized that the oncology patients I enjoyed the most were the ones with infections. When I speak to friends/colleagues around me, and speaking to my family, it was obvious to everyone else that I was destined for Infectious Diseases long before I even knew what that specialty was. Here’s why:
When I was around 10 years old, we had a science fair project. Most people did the typical science-fair-y projects – volcanoes, windmills, etc. I had no interest in these types of projects. I launched into a full-scale epidemiologic investigation of mosquito-borne illnesses on my island of Dominica. I contacted the Ministry of Health, my physician, other scientists on the island for their input; I scoured the library for information on these infections, treatment, and prevention. When I was done, I created an elaborate presentation on Manila paper poster-boards, a detailed booklet with the same information on the posters, complete with life-cycles and mosquito-reduction intervention ideas, and crafted an expert oral presentation to accompany these materials. My project won first place, but aside from that, the experience of learning about how these diseases affect human life, and how we as humans can affect disease outcome lit a fire of excitement and passion for Infectious Diseases that still burns within me today.
As a black woman in medicine, what have been your biggest challenges?
My experiences as a black woman in medicine have a pre and post- North American perspective, that I believe helps me with some of the challenges I’ve faced. Growing up in the Caribbean, it never occurred to me that I could not accomplish this big dream because I was a little black girl, because there were women in positions of leadership, women in medicine who looked like me. Dr. Etienne, the physician who encouraged me to go into medicine was a woman, a leader in our community who would go on to become the Director of the Pan American Health Organization. I never stopped to consider that I was “not good enough” or “would never get in”. I knew what I wanted and I went for it. I approached things the same way when I moved to Canada, and my confident, assertive attitude was quickly met with resistance. I was one of about 6 black students in my classes. Suddenly I was described as “bossy”, and “arrogant”. I was still a top student, but became more apologetic for my successes, and did not raise my hand in class. I regressed in group assignments as I struggled to find a balance between being a leader and being labeled as another “B-word”. My friends and I were constantly met with passive-aggressive tones from our professors and classmates alike.
I didn’t realize all of these things were happening at the time. I didn’t know the word “microaggression”. I just thought University was hard, and it was like that for everyone. Later on in residency I was one of 6 black residents, and during fellowship training, I was the only black ID fellow. I became used to being “the only”, but one day when a colleague commented that I would “probably get a job over him (a white male)” because I was black, I realized that I had become too comfortable being “the only”. (By the way, he got the job). I learned that while women make up anywhere between 36-52% of Infectious Disease Physicians, only 3% of Infectious Diseases physicians are African American. From that day onwards I found my voice again and actively sought opportunities to find, mentor and collaborate with young women and especially young black women, and one of my friends and I co-founded the Trainee Diversity and Inclusion Committee. Now, again I’m the only person of color on faculty in my division, but this time, I’ve made it my mission to use my influence as an attending and leader who happens to be a woman of color, to advocate for diversity, inclusion and equity in my specialty, and fortunately, my division leadership is supportive of this mission.
What 3 lessons would you impart to the up and coming young black female physician that you wish you had known in your training or first few years as an attending?
- Know your worth. You are smart, you are kind and you are good at your craft. Period. Don’t let anyone diminish your worth.
- People need to hear your voice. Speak up! You may not be able to fix the problem of being “the only” right away, but the only way they will be able to hear YOU is if you speak up.
- Be inspired. Set goals. Achieve goals. Inspire others. Find women like yourself (can also be outside of your specialty), and reach out to them. Form a sisterhood. Learn from women who have achieved those goals. Mentor and Sponsor other young women to help them achieve those goals.
What is a typical day like for you?
Every few months I spend some time doing the inpatient Infectious Diseases service at Nebraska Medicine in Omaha, Nebraska. This is a teaching service and I thoroughly enjoy teaching the residents, ID fellows and medical students rotating on the service. It is a busy service but one of my favorites. I also provide HIV care at our outpatient Specialty Care Center twice a week, and I have the opportunity to teach trainees in that setting too. I spend most of my time working on clinical research and quality improvement projects related to Antimicrobial Stewardship.
I am the Associate Medical Director of Antimicrobial Stewardship at Nebraska Medicine, in Omaha Nebraska. I am part of a group of three individuals that perform prospective audit/feedback to antibiotic prescribers in the hospital, which means I call teams to discuss with them in real-time the best ways to ensure that their patients are receiving the best care for their infections. Sometimes that means getting an Infectious Disease consult, and other times it means guiding their choice of the right antibiotic, appropriate dose and appropriate duration for their infections, including stopping antibiotics when not needed. One of my personal goals as a Stewardship director is to transform outpatient antimicrobial stewardship at my institution – this is a priority as the majority of inappropriate antibiotic prescribing occurs in the outpatient clinics (usually antibiotics being prescribed when they should not be), and this widespread antibiotic use has led to development of bacteria that are resistant to our antibiotics. If we allow this to happen to its fullest extent, we will catapult our generation into a post-antibiotic era where once again people will be at the mercy of serious illness from simple infections (like a cut, or strep throat), only this time, penicillin won’t be able to save us.
Infectious Diseases is an amazing specialty that touches every single facet of medicine, and every single patient in this world is affected by infections, whether personally, through friends/family or by simply living in a community where other people receive antibiotics. The reach of my specialty is broad – it is treating/curing their infections in the hospital, helping to prevent antibiotic side effects or long-term complications, or managing persons living with HIV, whose lives have been changed drastically with antiretroviral therapy. I consider it a privilege to work at a time where I can truly make a difference in so many people’s lives.
What is your biggest accomplishment?
It may be cliché, but my biggest accomplishment(s) are my sons. There was a point in my life where my career was more important than anything, and everything had to be on a schedule, including child-bearing. Then my first son came and completely interrupted that schedule I had made for myself, and I realized that he was exactly what I needed to really find myself. I am still a career woman, but these boys changed me for the better. I truly believe I am kinder, more sharing, more compassionate, because of them; because I want to model to them what it means to be a good person; and when I hear my son being kind and using manners and watch his drive to succeed, I know my husband and I have done a good job.
What is your greatest or proudest moment?
I’m not sure if I have “the one” greatest or proudest moment. I have a series of great and proud moments that I try to recall whenever I am feeling stalled academically or feeling “mommy guilt”. When I graduated from American University of Antigua, a Caribbean medical school, most people had never heard of it. I suffered with a serious case of imposter syndrome when I matched at my #1 choice, Mayo Clinic for Internal Medicine Residency. It took me a while to stop looking over my shoulder. I knew I deserved to be there, after all I graduated summa cum laude from med school, and I was valedictorian of my class. But still, I felt like an imposter; until I went to a Student National Medical Association (SNMA) fair in Iowa one year and met with some students. We were recruiting for the IM residency and as I chatted with them they asked me where I went to medical school. I told them where, and (after explaining exactly where in the world it was), their eyes widened and one guy said “wow, you must be very smart to have matched at Mayo from a Caribbean School”. Since then, whenever I feel the imposter trying to creep back, I think back to that moment to remind myself that I need to own who I am and not stand in my own way by thinking I don’t belong. If that doesn’t work, every single moment my son said to me “mommy, you’re the best mom in the world”, has been stored in my heart and mind and that is all I ever need to pick me up when I’m in a rut.
How do you find balance?
Balance is difficult for a working mother; it is even more difficult in a two-physician household. Fortunately I am married to a man that was chosen for me by God himself, even before I knew what kind of man I would need to support me and my big dreams. My husband Alberto Marcelin is a Family Medicine physician. He is also a superdad, and as my partner, my biggest advocate and the love of my life. Together we have a system to keep the family going that often requires no prompting. One of us picks up one or both kids, and the other starts dinner at home; on days where the late hours switch, we exchange roles. We take turns with cooking on weekends, doing laundry, putting the kids to bed. We always try to touch base with each other throughout the day to make sure the other is doing okay. We run every single major decision by each other and most minor decisions too. With our reciprocal support and advocacy for each other, we can feel unrestricted to pursue our dreams, big or little.
What do you like to do outside of medicine?
I love spending time with my family. We play outdoors, and enjoy board games inside. My favorite activity with my kids is reading to them. Other than that, I enjoy writing. I am one of the co-administrators of my division social media platforms, and write for our Infectious Diseases blog (check out my blog posts on Pioneering Women in Infectious Diseases and Black Women and Men in Infectious Diseases). I have also begun writing for leisure, and hope to write books one day (soon). I’m active on twitter @DrJRMarcelin, where my top interests and favorite hashtags are Medical Education (#MedEd), Racial/Gender Diversity in Medicine (#BlackWomenInMedicine, #NoticeHowSmartSheIs), and of course, Infectious Diseases (#AntimicrobialStewardship).