When I was presented with the opportunity to write a piece for SheMD, I was immediately excited to sign up for the task. My husband knows this well, he has heard me say it for only the last 10 years or so: I want to write. I really want to write. I want to write about so many different things. And with the exception of grade school poetry, college term papers, the occasional essay exam question, and one review article I had published in 2006 in a medical journal, I have never written any sort of lengthy, creative or expressive piece. But I have much to say, at least, I think I have much to say. My hesitancy has been partly not knowing where or how to start, but more significantly, if I would be ridiculed for the product. What do I usually do when I am worried about something? I talk about it! Thus, it seemed apropos that I should write about exactly this: my fear of ridicule, failure, imposter syndrome, call it what you will. It has many names, but it looks the same every time. It is my perception of how others do or will perceive me, and it is almost often never positive. I learning how to overcome these feelings, but interestingly, these feelings play a significant part in my story of becoming, and being, a dermatologist, which is where I will begin my story.
My promise to you, the reader: I will be authentic and vulnerable. I will do my best to not apologize for it. I’ve not only never written about some of these things, but I’ve spoken about them to only a few people. The side effect you may have to endure: my novice abilities and my verbose nature. You are getting a glimpse into my mind, and in my head, I am as verbose as I am in person. You can decide if it’s a good thing or bad thing, or somewhere in between.
I am a board-certified dermatologist, but I am also an Indian woman of the Hindu faith, an immigrant daughter to two immigrant parents, a wife to a Caucasian man of the Christian faith, and a mother to two young daughters of blended ethnicity and faith. I’d like to tell you the story of why I chose dermatology, and along the way, I hope I can successfully communicate my fear of failure and my challenges with imposter syndrome, because for me, these topics are intimately intertwined. And lastly, I am truly excited to share how both these journeys have fueled my growing passion for expanding diversity and inclusion in dermatology and beyond.
Most people familiar with the medical profession are keenly aware that the characteristics of a dermatologist don’t quite mesh with the concept of failure. Dermatology is one of the most competitive specialties in medicine, and students who apply are often at the top of their medical school class, with exam scores so high and an application so full of accomplishments it makes your head spin. Though I am proud of my medical school accomplishments, I most certainly do not feel like I “fit in” with many of my brilliant and accomplished colleagues, or the myriad of dermatology applicants that I review each year. You see, I decided on dermatology late in the game, and ever since then, I have often felt behind.
When I was 12, I had just returned from a summer trip to India, and I noticed an itchy red spot on my right upper arm. I still remember its appearance to this day. I had assumed it was a stubborn mosquito bite, as I had sustained dozens of those over the course of three months. But it didn’t go away like a mosquito bite, and instead, I started to get more of these spots. Over a period of a few months, I broke out all over my body in these dark red spots, that would get a little crusted, and then fade over a few weeks and leave behind a white mark. This was not good for an already shy, awkward, gawky 12-year-old, navigating the perils of middle school.
I saw a dermatologist, who prescribed me some steroid cream, which seemed to help make the spots fade. But it didn’t stop the problem. If I stopped using the cream, the spots would return. And I started getting stretch marks where I used the steroid cream. Given that these spots covered every part of my body, except my face, which was already covered with cystic acne, I felt so ugly. Ugly and horribly self-conscious. As it was, I had already experienced years of being bullied at school. A little brown immigrant kid in a fairly conservative and non-diverse area of the country was an easy target for bullies, and by the time I was 12, I had already accumulated a good deal of experiences at the hands of various not-so-nice peers. I had been made fun of and bullied over my appearance. I was spit on, I was pushed, I had things stolen from me. I was always that kid that got picked dead last in teams. The kid that didn’t get asked to come over to people’s houses or meet up for Friday football games. The kid that never got asked to a school dance once. In high school, I even got turned down, twice, for the turnabout dance (a dance where the girls ask the guys out). Like, come on people! (To this day, I still can’t believe I mustered up the courage to ask the two guy friends I had to this dance, despite all the self-esteem blows I had experienced thus far. But my husband always says I’m the most persistent person he knows, and I like to think of myself as fairly courageous, and I suppose these qualities don’t just start as an adult).
Please don’t mistake what I’ve shared with you as a pity party, or that I feel sorry for myself. I don’t feel sorry for myself at all, and relaying these painful experiences are crucial for relating the story of who I am today, how I got here, and where I’m going.
I’ve reflected on all these experiences over the years, and I am fairly certain this is where my fear of how I am perceived comes from. I believe these impressionable and very emotionally difficult years as a child and teenager struggling with low self-esteem is when the fear of rejection, of not being good enough, of not fitting in, really set it. If confidence is a seed that needs to be nourished, well, these experiences basically put that seed on ice.
It didn’t help that in my Indian culture, criticism is very prevalent. The “aunties” I grew up around, which is what we called the women who were our elders, community friends of my parents, would not miss an opportunity to tell me when my acne was flaring, if I was looking too skinny, or too chubby, or if my eyebrows were too thin, or too bushy. One could never just be, and that be good enough.
Fast forward to the end of my 3rd year of medical school, when me and my best friend Joelle were sitting around my living room wondering what the heck we were going to do with our lives. I remember asking Joelle, what sort of topics do we find ourselves reading about without being asked to? What do we like? Forget med school rotations. Let’s just think about topics we are passionate about and interested in. I remember telling Joelle, “I’m always reading about skin” (I still had my skin condition, which many years prior was diagnosed as pityriasis lichenoides chronica). I remember Joelle telling me “ I love math”. We, almost simultaneously, uttered the words” dermatology” and “radiology”. We both knew how competitive these fields were, but we both had achieved good grades throughout medical school, so we decided to further investigate our respective fields. I signed up for a dermatology elective for the second month of 4th year.
During the rotation, interacting with patients who were struggling with skin disease and the emotional ramifications of this really struck a chord within me. There isn’t any one patient that I can point to that stands out to, rather, it was the collective experience. I could feel so much of their pain. I knew that sting. It was the first time in medical school that I felt so connected to my patients, and I wanted to help these patients, just as I had so wanted help myself all those years. I never felt that my dermatologist really ever listened to me, and I actually had the opportunity to be this person for countless future patients. My choice of profession was as clear as day to me: I would apply to dermatology, and the realization of this was exhilarating.
I had no idea when I applied that year exactly how competitive dermatology was. I was wholly unaware of the application credentials of my fellow dermatology applicants. I was not elected to Alpha Omega Alpha (AOA), which I was so disappointed about given that I thought I had performed well enough in medical school to get this honor. I remember being confused about this, but knowing it was vote-based, wondered if this was another popularity test that I had failed.
Additionally, during my 4th year dermatology rotation, I was struggling through my first episode of anxiety and depression. It had taken hold a few months prior, and I was in the thick of it as 4th year started. I shudder to think of the evaluations the residents and my attendings may have given me on my dermatology rotation. Even I wouldn’t have given me a good evaluation. I was distracted, scared, and distressed that I was on this rotation in a field that on the inside, my heart knew was the one, but on the outside, I could not communicate appropriately about.
In retrospect, I can confidently say that my application to dermatology residency was not up to the standards of my co-applicants. I was always so shy, and though college and medical school helped me come out of my shell a little, when faced with new and uncertain circumstances, I defaulted to the part of me that comes out in fight or flight mode: self-conscious, not confident, fear of doing or saying the wrong thing. What feeling this way does to you: it holds you back. You are a shell of your whole being. The potential inside is locked away and hidden from the rest of the world. Fear of failure leads to an incapacitating lack of action. This fear is almost always rooted in a complex history of experiences and emotions, and overcoming this fear is very, very hard.
I applied, and I received only 2 interviews: my home school and the one program I did an away rotation at. I did not match that year. I cried so much. It was really painful to not be celebrating with my peers on Match Day. I knew I wanted to reapply, and I was given conflicting advice about the best path to do this. An individual whom to this day I consider as one of my mentors clued me in on applying to a clinical research fellowship. She’s an amazing woman and I would not be where I am today if it wasn’t for her. But other individuals actually discouraged me from applying to a clinical research fellowship, advising me to just scramble into an internal medicine program. I was not going to give up on my dream, so I did apply to a clinical research fellowship at the University of Minnesota. It was the inaugural year of this fellowship, because as dermatology was becoming increasingly competitive, the demand for other avenues to enhance a candidate’s application was increasing.
I reapplied the next year, and I received a grand total of 3 interviews, the same two as the year before and the one at University of Minnesota. It was such a humbling experience, going on interviews with students who had been on 12, 15, even 20 interviews. I swallowed my pride and did the best I could on those 3 interviews. I was honest, vulnerable, and hopeful. I matched. I matched at my medical school, SIU. I cried so much. I literally cried tears of joy and disbelief that I would get to be a dermatologist.
This was how I came to the doorstep of the world of dermatology. There’s so much more to share with you, such as my reflections on this process, how it impacted me, where I am today, and hopefully, where I’m going. It is truly a privilege to be able to share with all of you what has been in my heart for so long. You may not even know how impactful this experience is for me. Or maybe you do know, because you’ve been there too. Regardless, I am truly looking forward to communicating with you, the readers, about our collective experiences, challenges, and dreams.
Thank you, each and every one of you reading this, for joining me in this journey. Thank you for being a part of my story.