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"I’m going to make waves..."



"Some people might be more *stable* in their identity. I’ve come to the end of the journey of discovering who I am and how I identify gender-wise. I’m nonbinary, specifically, agender or genderless. That’s really me just trying to say that I’m human. However I decide to present myself is up to the whim of what I’m feeling that day and my financial ability to purchase items like the ones on Pose.


I was born and assigned male at birth. I grew up as a cisgender, heterosexual man. I didn’t really start identifying as someone under the queer label until I was about 23 or 24 years old. I don’t know if it was a lack of exposure or if it was because I grew up in a religious household that viewed, and to an extent still views, non-heterosexuality as a sin.

There were some things going on in my life -- and they might have been normal hormonal teenager things -- but I remember having dreams about men, in particular. I remember thinking at the time that those were weird and that I wasn’t gay. Once I graduated from college in 2015, I lived in Indonesia for a year. During that time, I was finally seeing what the world has to offer and what the world is about outside of where I grew up and where I am now. I wanted to see what the world was about and take time to explore. For me, from a religious and spiritual perspective, I wanted to take that time to interrogate my beliefs and how I wanted to continue seeing the world.


It was during this time that I started thinking about the fluidity of sexuality, realizing that I could be pleased by a man or a woman. If I closed my eyes, I wouldn’t know the difference between two people. From there, I really started to explore and seek information -- when I saw a person or felt attracted, I really tried to pay attention to my body and what it was telling me. I went from being straight to bi. Then when I started to understand a little bit more about gender, I threw away the binary and started to identify more as pan. That’s something I sat with and was comfortable with for a long time, but within the last couple of years, I’ve used pansexual less often and just use queer. I think there are a lot of nuances within 'queer', and I like the broadness of it. There are different types of people and bodies I’m attracted to depending on their presentation.


I’ve struggled with that because I’ve never had sex with someone who identifies as a man. For several years, even to this day, I struggle with that -- thinking I don’t belong or maybe I’m not queer. I think that’s important to wrestle with -- I think a lot of times people want to identify within a marginalized community because these communities have different access or try to protect themselves from the general public in queer-specific spaces. I don’t just shrug off these questions. I think it is something I should continue to interrogate until I experiment and explore my sexuality in a more physical way. However, at the same time, there are people who are masculine who I’ve had romantic relationships with. I don’t need to doubt myself. That’s why the term queer has become so important to me. I’m just queer -- I like people. People are attractive in many different ways for many different reasons. There are some people I think I’m more romantically attracted to versus physically. There’s so many nuances that it’s difficult to encapsulate that within one term. I think queer does that, though.

 

In terms of how I became interested in medicine, I was taking an anatomy course my junior year of high school with my two best friends. We’d grown up together; we’d grown together. A lot of the conclusions and thoughts that I have are a result of all three of us challenging each other, but also supporting each other. Anyways, we were taking this class in high school, and I really liked it. I think at that point in time I wanted to be an orthopedic surgeon. For me, where I grew up, I was the first person in my immediate and extended family to go to medical school. Really the only other person was my brother, a physicist, and my cousin who was an immunologist for several years and is now pursuing medicine. Besides those two, until recently, there was no one else in my family who was remotely in medicine. I had no idea about medicine! So when I realized I liked science, my first thought was 'I want to be a doctor.' I didn’t realize that science is such a broad field. Literally everything has science in it; it’s everywhere. Seventeen-year-old me decided that if I liked science, I wanted to become a doctor, though.


So I went to undergrad for biology with the intention of going into medicine. Over the course of my undergraduate career, it became very obvious to me that medicine is a fraction of what science has to offer and you don’t have to be a physician to be a part of the medical field. Becoming a physician and going to medical school was always on the table, but other things came on at the same time. I had a lot of back and forth. Did I want to do a PhD or MD or DO? Do I want to go into medicine or public health? Do I want to go into public health then medicine? Do I want to be a PA? What is it about being a doctor that really captivated me, that stuck out from the rest? Why this and not other things?


During my time in Indonesia, I had a lot of time to think it through and reflect. It was during that time that I realized medicine, particularly being a physician, was going to be my first choice. If I didn’t get into medicine that way, then I would find other avenues to contribute to the community. A lot of it came down to the power that comes with being a physician and all the different avenues I can pursue with that degree. It’s about broadness -- we can go and do benchwork for the rest of our lives, we can go and practice clinically, we can do administrative work or health policy, we can be a community physician or do international work, or we can go back to our hometown and start a private practice and go from there. There are so many different things that are available to someone who has a medical degree. That flexibility is really attractive because there are a lot of things I want to do.


I’ve really settled more into preventative medicine. When I think of preventative medicine, I think of healthcare policy, administration, and infrastructure development. It is not just for people in the United States, but for those around the world. That idea of developing infrastructure for the world happened when I was in Indonesia. I remember when it just clicked -- this, this is my goal. What will get me to that goal the fastest, in the best way and a way in which I would be the most prepared? I applied twice -- once my senior year and then a couple years after that -- and if that didn’t work out, I’d get a Master in Public Health and pursue my goals that way. Similar goals, but with a different aspect and lens of training.

 

Because my queer identity didn’t really come into existence until my 20s -- a few years prior to me entering medicine -- I think they really intersected during my first day of school. In the weeks and months beforehand, once I found out that I had been accepted, I had reached out to a friend who was a year above me. I said, 'I’m going to make waves.' Knowing what I know about the atrocities and all the different ways the systems are failing us -- they’re working as they were created, but they’re failing us, nonetheless -- I’m not going to be able to go through school, keep to myself, not speak up and not be who I am.


We think about National Coming Out Day and how there are so many people who are still unable to reveal who they are. It’s heart wrenching that people feel like they need to do that because of discrimination or retaliation. For me, I know that even though I’m queer and nonbinary, I’m still white and I still apear like a man to most people. That became more real during my clerkships, where I would have a certain experience versus some of my other classmates in the same area. To think on that -- why was it? Was it maybe because of my personality? Potentially, but more often than not it’s probably about who I appear to be and that gives me a lot of privilege and a lot of power. I promised myself that, when I was starting, I would try to utilize this power I was given, by just being born and just by the way I look, to instigate change and to amplify other voices.


I think that first clash or first intersection was when I first started medical school -- I wasn’t just going to go through it quietly. I was unsure if that was the right decision or not. My friend, and I’m so thankful she said this, said, 'No, please make waves.' I reached out to her a couple of months ago and thanked her for that because it really did set the tone for my life in medical school. It’s been shitty at times, but also incredibly rewarding. And I think a lot of that had to do with the -- I walked in day one with rainbow colored hair -- mindset, and that is who I’m going to be.


I still can’t believe I did this, but I showed up to our first gross anatomy exam in a frilly rainbow dress. I was so excited the night before and the morning of when I put it on. My roommate helped me pick it out and thought I looked so cute. Then I walked into school and didn’t know what I was doing. I was already stressed because gross anatomy has a lot of information. What if someone says something? What if someone looks at me a certain way? It’s going to ruin me, and then I won’t be able to perform. Then if I don’t perform, I will struggle and then maybe I get kicked out and then maybe I can’t go forward anymore. If the goal is to do things from a medical/clinical perspective, you can’t really do that without a medical degree. And I think that’s shortsighted -- there’s many things you can do beyond just having a degree -- but nonetheless it was something that could have been very traumatizing.

Later, I realized people were saying things that were quite nasty about me as a result of that. However, I walked in to get my paper from one of the faculty members, and he went to hand me my seating assignment, pulled it back, looked up, looked down, looked back up, and said, 'I like your dress.' Ever since then, any time we had exams, I would wear something flamboyant. I have rainbow unicorn yoga pants; I bought a tutu specifically to wear to exams. A lot of people would come up to me after and say, 'James, I really appreciate you doing that,' because we’re all so stressed during exams. We made it! This is the point where we’re supposed to be finishing this aspect and where we've mastered this material.

 

My pronouns are they/them. There are a couple of faculty members that have really struggled to respect and use those in conversation. Most recently, I was with a friend and we walked into a faculty member’s office. We were talking and in the conversation he used they for me -- he used the proper pronouns. I heard him, and I was going to congratulate him later, because that was the first time in casual conversation that he had gotten it right. Not even three seconds go by and he interrupts the conversation, 'Did you hear me? I got it!' He was so happy and so proud of himself. Obviously, it’s not about him, but in that moment he was so proud of himself that he was able to do that, and that made me feel very seen and loved and respected.


That’s the foundation -- it shouldn’t necessarily be celebrated, but it is. We can go back and forth on whether or not we should, but moments like that are something to celebrate and be proud that someone has grown. Even this year during orientation for the first years, faculty members and administrators were introducing themselves with their pronouns. That has taken a lot of work, and I take a lot of pride knowing that I was a catalyst for pretty much all of that. It’s pretty cool to see that the culture of the school is changing and people are excited about that.


This year is the first year that the school has offered a fellowship in social justice, leadership equity, and administration. It was created in response to a resolution that our student government passed in response to the BLM movement and protests surrounding George Floyd’s death. These are opportunities for students to get paid to pursue projects that will affect the culture of our school. I was one of the recipients and my project is creating a learning environment conducive for LGBTQ+ members. I’m looking at the physical environment, residencies and departments, community engagement, and curriculum to understand how we can be better. Until this year, I was unaware of how many single-user restrooms we have -- we have quite a few within our building. In my mind, I’m like, 'Where’s all the gender inclusive stuff?' It's there; it just wasn’t broadcasted. So making sure that’s a little more well-known, having people use pronouns in their signatures, all these little things that make the physical learning environment known to people that Hey, we’re thinking about you.


Another project that I’m working on is EMR and patient presentations and how we do that -- the one liner. Do we even need to have gender in that first line? And if we do, do we need to expand on that? Recently, people have been pushing -- and have been successful -- in removing race from that statement. I’m tired of seeing someone walk into a patient's room and have a shocked expression when the gender doesn’t match the person they're presenting as. I’m tired of people being triggered by that. These have been those really satisfying and fulfilling moments of like, 'Hey, this is really cool' or when people come up and say they’re waiting for my next dress.

 

In addition to these experiences, there is a discrepancy between AMCAS (the medical school application portal) and ERAS (residency application portal). AMCAS has this whole list of gender identities and sexualities that people can identify as on their application. For ERAS you can be Male, Female, or Prefer Not to Say. We have approached them about that -- their response was creating an Other. It’s still awful, but that was their response. The AAMC, their excuse … I understand that people are uncomfortable with declaring their gender identity -- in the sense that there are people who don’t want to out themselves -- but there are options to not out themselves. Those options need to be there and no one would question that, but having more identity options might allow people to be brave and live more authentically.


I know that medical school debt is atrocious and we need a job that pays medical school debt. But for me, if I’m identifying as nonbinary and queer and someone doesn’t like that, they won’t even offer me an interview. I don’t want them either! We’re saying that we’re progressing or moving forward, but in many ways we’re not. People in power are unwilling to even give people the opportunity. People are unwilling to stand up to others -- they are afraid of litigation, first and foremost, and that is a failure of our system, that it allows these sorts of things to exist to begin with. Even the ACGME (Accreditation Council for Graduate Medical Education) is super vague. The requirements should be that there needs to be such and such curriculum to be accredited, and if you don’t teach it, you’re not accredited. But no one at AAMC or other accrediting bodies will be that way. No one is going to stand up to that. They’re afraid of...I don’t know what. I understand being nervous about causing problems -- some people just don’t like conflict. But when that conflict, or that unwillingness to have conflict, affects people and harms people, that’s where the line needs to be drawn. People are unwilling to cross the line. And what happens? Our lives are lost; people die because people don’t care or are unwilling to.

 

If I could give any advice, I would say be yourself. I think there are many times -- even for someone like me who does try to live very authentically -- where I have hidden or restricted myself and caused a lot of harm to myself. There’s always more we could be doing, but for me I think that is being more myself. The person I’m turning out to be is someone I love, and I wish I could’ve gotten to know me earlier." -James Lioi, Medical Student, Buffalo, NY (they/them)


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