OPINION: Where Service Begins

by Sophia Malik

I spent my earliest years running barefoot through freshly cut grass. The border between my Brown skin and the brown earth was indistinguishable. My unruly dark hair billowed behind me, curling in no particular pattern, as did the branches of the oak tree holding my treehouse. My father was usually doing yard work nearby. A post-war child, born out of Partition, who was trying to nurture seeds in a new land, his eyes were often heavy with worries he struggled to communicate about. Sometimes he shared painful stories with me. Other times he chose to say nothing, bringing my attention to the present beauty around me while sharing a box of oranges or mangoes as we rested under the shade. In the evenings, he would walk with me on his shoulders, helping me touch the sky and understand the stardust we all are. He found healing in the nature around us, and encouraged me to do the same.

My mother was an artist with a deep knowledge of ancestral traditions. She brought an element of subtle transcendence to the most mundane tasks. A true village auntie, she constantly shared unsolicited advice with others in hope of uplifting those around her. She had a recipe or remedy for any illness, emotional or physical. Neighbors recalled, with gratitude, her teas brought in the dark of night to their home to aid a sick child. She had learned love and service from her mother and, with her actions, was beginning to pass teachings down to me.

In my adolescence, I lost both my maternal grandmother and my mother to cancer. I fumbled my way through this already inherently challenging time of life. With their eternal prayers, supportive friends, and pure luck, I got into medical school. As a chronic daydreamer, the studies were really difficult for me. When I transitioned to the practical, hands-on part of my training, I was so overwhelmed by white medical culture, that I've considered labeling my memoirs of that time "The Angina Monologues." The culture prized speaking loudly and with authority, having a firm handshake, hiding doubt, and assumed all things could be known, fixed, proven, and plugged into an algorithm if we obsessively intellectualized and collected enough of a specific type of data. There was no space for the unknown. I was encouraged to fake it 'til I made it, but to my own detriment, I have a distressing inability to be fake.

Disembodied in the hospital environment and with diaspora and death disconnecting me from ancestral wisdom, I sought refuge and answers in community. The presence of youth, elders, and everyone in between was like a warm bath washing away the layer of chaos that kept me separated from myself. Whether I was at a community meeting, block party, or having a heart-to-heart with another sister or a traditional healer, the message stayed consistent: Healing is difficult but possible; it takes time and starts with knowing who you are, then grows outward to supporting others.

After completing my training and moving into full practice as a family physician, it was really hard for me to bring this way of knowing into the exam room. It felt like who I wanted to be and the care I wanted to provide was on the tip of my tongue and at my fingertips but wasn't coming through my words or my hands. My attempts to speak about the mind-body connection sometimes landed as not taking patients' medical concerns seriously. There were times I truly did fail to make a diagnosis, and I didn't have the skills or opportunity necessary to repair the relationship with the patient. For the most part, I had good rapport with patients, but when, on occasion, a patient would express uncontrolled rage, I took it all, unfiltered, unable to set a healthy boundary. I didn't know how to let them have their feelings while also providing for my own safety. Similar patterns played out in my personal life. I sometimes confused humility for low self-worth, and defensiveness with confidence. Even though I had experienced racism as a person, patient, trainee, and doctor, I didn't know how to talk about it with patients openly and preemptively. In a couple of particularly painful cases, patients felt my care was racially biased.

The emergence of Diversity, Equity & Inclusion (DEI) as a new wing of academic medicine further complicated things for me. My attempts to discuss justice as it relates to health were met with either intense resistance or suffocating silence. If I did receive a response, it took the form of being asked to take the lead on fixing problems that those I was challenging had failed to address effectively. I felt the weight of the expectation that strong, intelligent Women of Color should clean up after people who are unable to demonstrate their own accountability. If I had chosen to accept this narrative, it would have left none of my own power for myself. Entering this dance can seem like an invitation to finally heal unresolved racial trauma. But the dance has a very specific choreography of opening old wounds and keeping them open until people decide to walk away.

I became very curious about whether these wounds can actually heal. I posed this question to pretty much everyone I came across. I searched in medical journals, the library, and social media. My friends listened to me for hours with loving patience as my search brought forward more questions, doubts, and complexities. I was years into this inquiry, unsatisfied, before I came across the work of Resmaa Menakem and Gabor Mate. Their offerings explain what trauma is, how it can be understood, and how to heal it.

Menakem describes concepts similar to Peter Levine's work, but does so with a necessary perspective of racial identity. He explains that when we experience a perceived threat, and do not release the energy and emotions arising as a response to the threat, we don't return to our baseline neutral state of safety. We stay activated at a new baseline. The traumatized state persists, incomplete, as if the trauma is still happening in the present moment. Mate explains the original threat occurred very early in childhood for most of us. For some children, it can be extreme circumstances of abandonment or abuse. For others, it's a subtle lack of attunement with, or acceptance from, their parents. New threats later in life are experienced as the original unresolved injury, and we feel stuck in recurring patterns. This response is a natural way of trying to cope and protect oneself. The effect is exacerbated when shared societal traumas are not processed. Over time, as an unbearable amount of pain accumulates, a person can forget what it means to be themself, as they learn to live with an armor of protection or numb out to the world around them.

With this new understanding, I was able to see that although my parents tried their best, were gifted, and loved me, the intergenerational and societal struggles they endured in their own lives prevented them from being able to consistently be aware of or meet my needs. They lived in a culture expecting an unrelenting and unforgiving "immigrants get the job done" work ethic and an Alhamdulillah-for-everything attitude. They didn't have a framework for supporting me in expressing or processing negative feelings. Over time, I either blamed myself for those feelings, or rejected them — a process of disconnecting from my intuition. No amount of external validation could alleviate my sense of shame or catalyze reconnection. I developed defense mechanisms to survive in an unwell world. A graduate of the school of hard knocks, I was always ready to fight. I dealt with an overload of responsibility by daydreaming. What I used to think was a quirky tendency towards imagination or lack of effort to hold attention was my body's coping mechanism for drowning out excessive stimulus. Sometimes, when things felt off in relationships I cared about, I overcompensated with sweetness, or took on emotional labor that wasn't mine to do, wanting to make things feel better right away instead of sitting with what was.

I felt both relief and incredible sadness to understand what had been holding me back. From a place of clarity, I could begin to see and accept myself as I am right now, not who I hope to be, and with or without what I wished to have. This beginning came with risks, losses, and fear. Hopes that originate from an unconscious place are fantasies. To truly dream, you have to be awake.

I don't think "impostor syndrome" is an adequate phrase to encapsulate what it is like to be a Woman of Color trying to come into her own as a healer. Before you can believe you belong among others, you have to believe you belong in your own body. This requires a slow process of building the skills for clearing trapped energy and developing the attunement to yourself you did not receive earlier in life. The works of Audre Lorde, Maryam Hasnaa, Adrienne Maree Brown, Ken Jover, and Chilan Mustain guided me to see that if I don't know how I want to feel, then I have no business helping others who aren't feeling well. I am not proposing it is possible to live a life free of pain, but when we can acknowledge our pain, we can consider what it needs and try to find a healthy way to meet that need. When we have a method of addressing our pain, we can differentiate those painful feelings from the inner calling of purpose. Our purpose then has space to grow, and we grow with it as an embodiment of our values, in possibilities and power.

For every person, the tools necessary for addressing their pain will vary. I was lucky to find a skilled therapist of culture, knowledgeable about the impacts of culture on my development, and I have the time and resources to engage with her care. I have a cultural and spiritual practice providing rituals for healing, relief, and enjoyment — both as an individual and in community with others. I have access to healthy food, a safe place to exercise, and childcare. I try to limit digital consumption so I can improve my ability to use the older technology of the body. I have a partner who is also a seeker. Each step of confronting myself rippled confrontation into our relationship. Islam teaches that your spouse is a garment to cover your faults. I found, instead, with my spouse there was nowhere to hide my flaws. In this way he is my clearest mirror.

Different teachers and resources may find us, depending on what our life curriculum is meant to be at a given time. Treasured teachers for me, at this time, are my children and my patients. My daughters question and challenge me every day. In those moments when I fall short, I find new information about myself to explore. Now, when patients call me out or when I have my own disappointment about the care I provided, I can take their feedback and consider how I can improve, without an unhelpful freefall of doubt about the core of who I am as a human being. I also know I'm not for everyone, and that's okay. Not everyone understands me or sees me for who I am, and that's none of my business. When I meet someone, what I am offering in that moment may not match what they need or what they are looking for, and I hope they are able to find it elsewhere. I'm also more able to accept love and gratitude. I will never be a finished product, but in the process I find my balance.

I don't spend much time barefoot anymore. As my connection with myself and my body has transformed, so has my connection with the Earth. When I sit with patients, I can feel the Earth supporting my feet. I have had to grieve that no matter how much we take from her she continues to give and support us before I could see how all these years she was always there, holding me up. Now I can feel Mother Earth supporting me and, as I grow in my capacity to hold myself and my own feelings, it is more possible for me to make space for the healing of others. In this space, service begins.

Featured image by Sophia Malik.