As long as I can remember, I knew that I was gay -- I am not one of those people who was ever able “pass as straight.” My ethnic background and cultural heritage is quite complex so suffice it to say it is often hard to determine where my obstacles and barriers occur, and opportunities exist. I was born in Ethiopia to a Mexican-American father (who was in the U.S. military) and an Ethiopian-Italian mother whose family had fled Italy during Mussolini’s fascist rule. I had full Ethiopian citizenship until I was naturalized with my mother when we came to the United States. I am a by-product of a multi-cultural heritage embedded in a military family that traveled around the world, and I grew up speaking three languages. Ironically, I always simply considered myself “American” when I lived overseas on military bases. However, back in the United States, the answer was less clear. It has never been easy for me to simply “check the box” that defines my ethnicity or race; and sexual orientation was never even a checkbox that was available until fairly recently.
Isolation. As a medical student in Boston from 1987 to 1991, I experienced overt homophobia and racism. It was prevalent within my medical school and affiliated hospitals, as well as the local Boston environment. There were very few people from under-represented groups in my class, and I was also the only openly-gay man. Needless to say, my medical school experience was not optimal. I had no mentors, no role models, no one to support me – I felt alone, isolated and abandoned. I was often the target of outright aggression by physicians and staff with no pretense of civility. Many of my classmates who were Black and LatinX really struggled as well -- only three of the seven of us graduated on time.
Mentors. When I arrived at Yale for my anesthesia residency in 1992, I was really hoping history would not repeat itself, and would be different from my medical school experience. From the onset, things seemed different at Yale. The anesthesia faculty was extremely friendly – they encouraged us to call them by their first names, they asked questions about our family, our spouses, and our “significant others.” That struck me as odd that they would even think to word it in those terms. Initially, I thought this must just be a façade of kindness, but it was truly genuine. I soon learned that our Chairman, Dr. Paul Barash, was extremely intentional in his words and his actions. He sought ways to identify the unique aspects of people and bring them to the forefront; he wasn’t afraid to acknowledge diversity. When he interacted with the residents, he could always make you feel as if you were special and “worthy.” He always encouraged us to seek paths less traveled and identify an area or passion that only “you could own.” He often said you will not stand out or be a trailblazer if you didn’t explore things that were unchartered territory. I believe his actions set the tone for the entire department, and I found the culture within the Yale Department of Anesthesiology to be extremely nurturing and supportive.
I soon identified Dr. Roberta Hines (who would later become Chair during my residency) to be my mentor and role model. No – she was not a man, or gay or Latinx, or Ethiopian; I know what you are thinking – how can she be a role model and mentor when she doesn’t represent a part of you. But Dr. Hines was a physician who reached out to me and sought to develop my talents and interests. She saw something in me that I myself could not or did not recognize. She was such an inspiration to me because she had been breaking barriers of her own – mostly “glass ceilings” as they pertained to women in medicine. She was the Director of the Cardiac Intensive Care Unit, an accomplished researcher, a lauded clinician and a superhuman “Wonder Woman.” I thrived under her guidance and mentorship and developed my unique sets of skills that I could own. Over the course of four and a half years as an anesthesia resident and faculty member, I grew as a person and as a doctor. I made a conscientious decision to help others based upon my role models at Yale. More importantly, I learned to be true to myself and not compromise my ideals or who I am and what I represent. To this day, Dr. Hines is still a mentor to me, a role model and most of all a trusted friend. I owe her and Dr. Barash a debt of gratitude, and I hope that my career has been a means to “pay it forward” for others.
Allies. After leaving Yale in 1996, I embarked on a unique venture to start an anesthesia group based out of a Catholic hospital in Florida. To say that challenges existed would be an understatement – however, I looked at it as “opportunities” for growth. While serving as the President and CEO of the anesthesia group, I was intent on creating alliances with other leaders who could help augment the care of persons our hospital served. At that time, we were well into the AIDS crisis, and there was a large LGBTQ community in our hospital’s backyard that needed complex services. With some trepidation, I approached the hospital CEO (who was an older, white, devoutly religious man) about developing more assertive public relations, media campaigns, and medical initiatives to build a bridge with our local communities. Was I crazy to think he would help the cause? I expected to be turned away with my requests. As it turned out, he not only said, “yes – let’s do it,” he welcomed the opportunity for me and others like me (meaning LGBTQ persons) to work with him. We conquered many obstacles with a team of passionate physicians and staff – we developed stronger relationships with our LGBTQ community, along with other marginalized groups such as immigrants from Caribbean countries. In the process, we improved care and displayed qualities consistent with ethical and culturally competent care. I continued my quest to slowly build bridges with other medical facilities and expand our business model. I slowly expanded our anesthesia workforce to include physicians who were women, Black, LatinX and LGBTQ. I wanted our anesthesia group to resemble the population that we served – to make us approachable and representative of the south Florida melting pot. My group’s approach was intentional – it did not happen by accident.
Synergy. Fast forward to 2016…. I joined the Southern California Permanente Medical Group (SCPMG) and work at Kaiser Permanente Los Angeles Medical Center. My work-life balance became optimized, and I became an extremely active member of the CSA, as well as SCPMG. My involvement in both of these organizations has been expanded, amplified and facilitated by synergy – a combination of organizational infrastructure, frameworks and most of all role models, mentors and leaders who forged platforms to develop future leaders, embrace diversity and explore new paths.
Within Kaiser and SCPMG, the Area Medical Director at Kaiser Los Angeles Medical Center and the SCPMG Executive Medical Director are both openly gay men – when I see them, I know that countless barriers and “rainbow” glass ceilings were shattered. I emphasize the word “openly gay” because I have often worked alongside LGBTQ people who remained closeted and lived in fear that they would be “outed.” So to break barriers when your sexual orientation is on full display and embraced is not as common as one might think, especially in medicine. It is very meaningful to finally see someone who resembles a big part of who I am and know that I (or someone like me) could achieve as much too. It gives us HOPE.
Within CSA there is a diverse array of leaders who actively seek to move our organization forward and expand our footprint and impact – people who truly lead and effectuate change because they care, are genuine, and sincere. But I really began to see change when women assumed the Presidency in the CSA (and in the ASA) – there was a palpable difference in tone, vision and intentions, and I say that with no disrespect to the many amazing male leaders who helped pave the way for women to ascend. CSA acts intentionally implementing change and weaving it into our organizational DNA. CSA represents all of our members and the patients we serve by our diversity of thought, and our broad mission, vision and actions. We continue to seek new avenues in which to develop allies, but most importantly, the CSA acts as a gigantic “role model/mentor/mentee generator” that makes quantum leaps at every turn. Suddenly, I feel like I am at the right place, at the right time, with the right people and it simply feels so invigorating to be in the midst of it all.
The future. As my career now enters its final phases, I know I am running out of time to do the things I want to do, and I often wonder at night if I made enough of a difference, or if my career path or trajectory would have been different if I had not been an openly Gay, LatinX physician beginning my career during the AIDS crisis in America in 1987.
I leave those thoughts in the past because I know the future is bright. There are so many opportunities to continue to break new ground and a new generation of amazing doctors who will lead the way forward. As a whole, medicine now deals more openly with things we never thought of discussing – sexism, homophobia, racism – to name a few. We intentionally open up difficult and painful conversations to gain insight and continue to improve upon addressing our struggles and deficiencies as organizations and as a society.
So, I end this conversation with all of you with several parting thoughts….
Follow your passions, own your unique authentic version of yourself and never forget to pay it forward.
Mentors come in many shapes and sizes -- do not be afraid to ask someone to be your mentor and more importantly do not be afraid to mentor others.
Allies do not have to look like yourself, but they do have to embrace who you are and what you believe in… but sometimes you have to knock on a lot of doors to be seen and heard.
Synergy is when the sum of 1+1 = 3. In my mind, CSA is 1+1 = 100.
This article was originally published in CSA's Annual Publication - Vital Times and can be found here: Vital Times 2020 (nxtbook.com)