Dr Nabeela Kajee, Walking Through Places of Privilege

Is it possible to be a full human being when your profession demands so much of you? Does being a clinician require you to be removed from your patient’s experience, or from your own experience as you witness theirs? What is it that we need to protect in medicine? These are the questions that Dr Nabeela Kajee, medical doctor, writer, thinker, poet and Rhodes scholar, grapples with as she navigates the hallowed halls of academia.

In this episode of Awakening Doctor, we delve into her experiences at medical school and discover the hopes, triumphs, challenges, and twists of fate that brought her to Oxford University to pursue a PhD in Psychiatry. We reflect on the importance of self-awareness and intentionality in medical practice, and learn about the role models and mentors that have defined and shaped her commitment to humanising the profession.

Join us for an inspiring and thoughtful reflection on the intersection of identity, history, community and privilege in the quest to integrate the art and science of medicine.

Chapters

• 0:00 The Awakening Doctor
• 10:23 Twists of Fate and Medical Destiny
• 23:36 The Legacy of Medical Education
• 29:43 Medical Education and Human Connection Reflections
• 40:38 Journey of Reflection and Inspiration
• 51:20 Nurturing Resilience in Medical Journey
• 1:00:32 Reflecting on Personal and Professional Growth
• 1:06:32 Journey of Personal Discovery
• 1:12:36 Exploring Identity, History, and Community
• 1:18:44 Exploring Passion and Compassion Through Poetry
• 1:26:45 A Journey of Transformation and Sharing

Transcript

Dr Nabeela Kajee Guest

00:00

Part of this conversation is really to start the conversation, because there's so much about humanising medicine that begins with the way that people see themselves, and the way that people are able to reflect on their journeys. I think a big part of the work I'm doing and also, not just externally but even within myself, is to think about self-awareness, and is there a way we can bring a self-awareness to what we're doing and an intentionality behind the way we're interacting with each other? If you are a medical professional, the way you're interacting with the people that you work with, with yourself, with the challenges and the joys, and not only seeking the joys but also seeking the challenges and being willing to sit with what is difficult. I think in our society we often think that difficult means bad and I often think the things that have been difficult - grappling through the challenges of working within healthcare systems - those have been actually some of the richest experiences that I've had and I would never trade them. And I think that for those who are thinking of medicine, but deeply afraid, to realize that that is actually very much something that you can build upon and you can grow within and it doesn't have to define you or confine you. 

 00:17

 Medicine is a beautiful field and it has so much to offer people. I think that's something I really want to underscore. It requires the individual who goes down that road to be willing to grapple with those challenges. To be a clinician but not to be who you are too, is to lose something. And I think another part of the message is beyond just grappling with self and understanding that you as an authentic person can exist within medicine is to also understand that sometimes what we think is out of reach is actually quite possible. That is a hopeful message, and I want it to be a hopeful message, but it does not mean that the path will be easy. 

Dr Maria ChristodoulouHost

01:56

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. Joining myself and producer Amy Kaye today is Dr Nabeela Kajee. A medical doctor, a writer, a thinker and a Rhodes Scholar who is currently busy with a PhD in psychiatry at the University of Oxford. Nabeela's research is investigating the use of mindfulness-based therapies as a toolkit for the well-being of medical students. She's also the author of On the Edge of Destinies, an original collection of poetry and has published in various academic journals on the topics of medical education, medical humanities and the developmental origins of health and disease. Welcome, Nabeela, it's lovely to have you with us here today. 

Dr Nabeela Kajee Guest

03:00

Thank you, Maria, and to your listeners, such an honour. 

Dr Maria Christodoulou Host

03:03

I'm very excited to have you on this podcast because I think the timing of it in terms of my own life and career feels interesting. And what our listeners won't know is that you and I met - Gosh, you were a fifth-year medical student in 2015. And I actually went back and looked through my emails today and I found the email that I sent you after our first meeting. So Nabeela reached out and asked to meet with me because of a lecture I had given. And I finished my email to you by saying that, with passionate, dynamic and charismatic young women like yourself in the profession, I feel like my own heart can finally rest. That there is hope for transformation. And I still feel that way about you, so thank you for joining us. 

Dr Nabeela Kajee Guest

03:47

No, it's an absolute pleasure, Maria. I think we've come full circle, you know. What a special opportunity to convene and to have this conversation. We've had so many conversations in the past and just very glad we have the opportunity to open that up and for other people also to have the opportunity to listen in and to share. 

Dr Maria Christodoulou Host

04:08

So where do we begin to tell the story of Dr Nabeela Kajee? 

Dr Nabeela Kajee Guest

04:13

Oh, I would love to tell some stories. I think this is a great opportunity. It's sort of a virtual fireside chat. As it gets colder in South Africa, I think that metaphor maybe rings very true, but I would love the opportunity to share a little bit. I think maybe talking a little bit about where I come from is really important to me and sort of honouring the people who've walked the path before me. I wouldn't be here today if it weren't for a whole host of people, both here and not here, who paved the way for me. 

 04:48

 I like to think that I stand on the shoulders of giants from the time I was very little and asking all the very deep but unanswerable questions. As a young child, I would love to honour my family, my parents, for not only bringing me into this world safely but for ushering me through life and guiding me, for being a lamp in my life, and oftentimes, when I am unsure of what to do, I often think, what would my mother say? I sit with that, and so I really want to honour my mother for the enormous belief that she's always had in me, always seeing the good in me and believing the good in me. For my father also, for holding me accountable and always reminding me that - my father always liked to say that toughest steel is forged in the hottest fire, and I always think that's quite ironic because he's worked most of his life in the steel industry, so it's something that comes from lived experience. And then to the women in my life, the female friendships especially, but also the male friendships in my life that have reminded me of who I am and given me the opportunity to really be myself. And my greater family as well, my grandparents, who struggled and sacrificed so that future generations could have a chance at all kinds of opportunities and education. Freedoms that they never had. Everyone in my family has played a key role in helping me to be who I am and encouraging me along the path. And then professionally, Maria, you've played such a big role. It's an incredible thing when you reflect back and you're able to think about the ways in which people have shaped you and influenced you. I remember sitting in your class and I remember thinking what an incredible role model. And I still feel that today, that you've played such a key role in my life and I know many other colleagues, in what it means to really show up for patients and also for yourself and not to see those things as separate, but really part of the same continuum - care. Thinking about other people in medical school who really not only made my days more fun and interesting and passionate, but also were able to really see the parts of me that I wasn't able to identify as talents. 

 06:58

 Names that come to mind: Tracey at the Tygerberg medical library deserves a huge shout out for making many, many, many a study session more interesting and enjoyable and always, always being so curious about what I was learning. Franklin, also at the Tygerberg medical library. Elize Archer at the Clinical Skills Laboratory. Countless other people at the Faculty of Medicine and Health Sciences at Stellenbosch University. From the computer lab, all the way through Prof Iris and Prof David, and then, of course, Prof Jimmy Volmink as well, who encouraged me towards my postgraduate studies where I am now and seeing that possibility in me. I like to imagine them as part of the chorus of my life. 

 07:38

 I love Maya Angelou's quote, I stand as one, but I come as 10,000. You're definitely one of them, Maria, and I'm sure a lot of people listening to this podcast might also be. I love that image of you're never alone. You know, the people that have believed in you and breathed life into you and sustained your spirit - that they stand with you. I really love the idea also of ancestors and how your ancestors have also played a role in who you are. There's a very important family member who I'd love to talk about as well. 

Dr Maria Christodoulou Host

08:08

Absolutely. In fact, I think you mentioned when we initially spoke about doing this conversation, you had an uncle, I think, or was it your grandmother's brother? 

Dr Nabeela Kajee Guest

08:18

Yes, my grandmother's brother. Where I come from, we call, like every older gentleman, an uncle. This particular uncle is my father's uncle, actually. Granny's brother. His name was Ahmed Ibrahim Kholia, and sometimes it's the stories that sort of slip into the annals of history that really deserve to be brought up and given new life. He grew up in Durban and attended medical school in the 60s in South Africa. It was a very difficult time to actually be in medical school as a brown person. He was one of three paediatricians who were non-white to graduate in Southern Africa, and he was a top achieving medical student in his class. My grandmother still has all of his pictures and letters. He had a very difficult time in medical school. He used to write letters about his time in medical school. He had TB during his stay as a medical student and it was very hard. He was forced to sit outside of medical school lectures, sometimes on the floor. He was not allowed into dissection halls to dissect cadavers. He faced a lot of difficulty and oppression during the time he was practicing medicine as a doctor. A lot of shame, I think, for the colour of his skin and for his background. And yet, despite the odds, he pushed on and he not only graduated but he managed to really make not only himself proud, but his community proud, and show that it is possible sometimes to conquer odds that seem incomparable. My grandmother smiles and tears come into her eyes when she talks about her baby brother and how proud her family was to have a paediatrician in the family. She hadn't even gone to university or finished high school, so to see one of her own family members able to reach a level of education like that, and do so at a very high level, was incredible accolade for the family to see that that was possible in the community. He was actually a close friend in latter years after that with his medical school dean, and the medical school dean wrote the most incredible letter to him that my grandmother still holds on to, about his personality and what sort of person he was as a paediatrician and how he worked with children. 

 10:23

 It just so happened that during the time he was in medical school he developed ulcerative colitis and for our listeners who don't know what that is, it's a form of bowel disease that is inflammatory. The bowel becomes quite irritated and one develops quite severe disease in the bowel that leads to bleeding and injury to the bowel, and oftentimes, people who have ulcerative colitis may need surgical intervention to remove the affected portions of the bowel. At the time when he was diagnosed in the 60s, there really wasn't much in the way of the newer medicines that we have to treat ulcerative colitis now, and so the surgical procedures were still in a very infant place. He'd actually disclosed to his medical dean and others that he had ulcerative colitis and he was suffering from severe anaemia at the time, because of blood loss. His medical dean actually suggested that he goes up to the University of Oxford, which had a team of researchers that were doing the very first procedures - colectomies with colostomy bags. 

 11:20

 He ended up having to go to Oxford for what was going to be considered quite a risky, novel research procedure, and so he said goodbye to my grandmother, went on a boat to the University of Oxford and he went to the John Radcliffe Hospital. At the time, the Radcliffe Infirmary, and he had his procedure and he survived his procedure and he wrote a letter and even recounted a note to my father, who was four years old, and said successful procedure, was such a delight to come out of. 

 11:49

 The whole family was so incredibly happy that he survived the procedure. By twist of fate, a week later he developed post-operative pneumonia and he subsequently passed away of that pneumonia, in Oxford, and in fact he's buried in the United Kingdom. Even recounting it makes tears want to come to my eyes, thinking about him and thinking about what he was able to accomplish in his few years of life. The medical school at KZN subsequently named a prize in his honour, in memoriam, the Ahmed Ibrahim Kolia Prize in Paediatrics, which still exists today, and it's something that, listening to that story from my grandmother, for many years made me want to know what it is to have met him or to at least have spent some time in his company. 

 12:36

 I never knew that I would end up down the path of medicine, but certainly he is someone who has walked this path with me and my spirit and I'm very grateful to him. The foundations that he was able to lay, that gave me the courage to do what I have done, and certainly his memory lives on. That's quite a story, and I'm struck by the 'synchrodestiny', I guess, of you finding yourself at Oxford all these years later. 

 13:04

 It's a fascinating one because I certainly wanted to go to Oxford. One, because he was actually operated on by a surgeon that is rather famous in the area of ulcerative colitis, such that the ward in the Radcliffe is named after this particular surgeon. I actually worked in the ward that is named after him. But to have worked in that ward when I went on my medical elective in my fourth year and to walk into that ward named after the surgeon that operated on my father's uncle; to know the progress that came about as a result of that, and thereafter, the procedures that could be offered, and the survival rates, and how that's changed. It really impacted me, not only when I worked with ulcerative colitis patients but when I was also able to work with surgeons in realizing how research drives innovation and how we really can offer people more, the more that we understand. 

Dr Maria Christodoulou Host

14:04

I'm finding myself at a bit of a loss in terms of there's so much in your story that we could talk about, and you've opened up a particular avenue now in talking about the influence of the ancestors and the way that they inadvertently shape our lives, even if we've never met them. And I'm curious about what led you to study medicine. 

Dr Nabeela Kajee Guest

14:28

A big part of it was, my mother applied to medical school when she was much younger and she got into medical school and it just so happened that my mother didn't pursue medicine. In a twist of fate, she ended up getting married and having children, and so I always thought well, yes, medicine isn't really on my path, because I don't want to live in my mother's shadow or her dream. And so for a long time I think, I pursued many other pursuits and interests that I had. Creative pursuits. I love writing and I love storytelling and I love engaging in the way we grapple with identity in the world. For a long time I thought I might be interested more in journalism or in education broadly, or perhaps even philosophy and law. For a very long time I job shadowed in all of these areas at the Cape Argus newspaper, and in television. 

 15:20

 I explored all of those options very deeply, but it's an interesting twist of fate that throughout the time I was in high school, people would often drop little hints that I actually noticed but didn't take complete note of. My biology teacher, when we were dissecting sheep kidneys, said to me that that was one of the best dissections he's ever seen of a sheep kidney. So my biology teacher said Nabeela, you are absolutely made for medicine. The way that you interact with science and people is exactly what medicine needs and is about. And I thought, oh, that's nice of him to say, but at the same time, I always thought people always say things like that. Like, you're intelligent, therefore you should do medicine. Or you're articulate, therefore you should become a politician. Like, very rudimentary stereotypes you often attribute to certain things and so I thought no, I don't want to just go down the beaten path. 

 16:13

 I don't want to just do the thing that people think I should be doing. I really stuck with what I thought would be my path - the social sciences and humanities. Until I needed to get to applying for university and one of the requirements was to do community service, or at least favourable components, and so I thought, well, this would be good to help me in my application process. I really should be doing some formalized community service. I looked around at opportunities near where I was living, and one of the very few opportunities close enough to me was at the Red Cross Children's Hospital. I took up the opportunity to do play therapy with the children on a Saturday once a week. I thought, well, this will just be nice to pass the time and this will be great, it'll give me an opportunity to help and do something useful, but also it'll be very straightforward for me to be able to show that I've been of help. 

 17:02

 When I walked into that hospital Maria, I can't describe it. There was just this flood of feeling. This was home. The smell of the disinfectant, the feel of the air, the movement of the nursing staff and the doctors, the patients, everything about it somehow clicked. I felt a real sense of belonging, without really being able to explain why. And later that day my mom had said did you enjoy it? Did you feel like it was very strange and cold, but I just loved it. I couldn't wait for the next Saturday. 

 17:37

 I was up early the next Saturday getting ready, thinking about what the play therapy session would be like and the debriefing afterwards, with the staff. Working with the kids, talking to them about why they were there, seeing the kids with their bald heads in the cancer ward and talking about them and with them, and understanding what led them to be there, and how long they were going to be there, and what would happen after they left. And I found myself thinking about my patients in that community service also afterwards, and I thought, well, maybe I should apply for medicine as my second option, because this is not how people think about medicine. Oftentimes, people think about medicine as the only option, the first option, the last option. In my instance, I thought, well, I need to have more than one option, because I don't know what I'm going to get in for, what I'm going to get funding for, and so I said, well, I have an idea. I'm going to apply to one university and apply with one paradigm and I"apply to another university with another paradigm. That'll help me make my choice, because then, whichever one I get funding for and whichever one lines up, I'll take. It just so happened that I got in for both, I got funding for both and then I was stuck. 

 18:45

 And so I went to one of my very good mentors in high school, Mr. Jeremy Gibbon, who also, incredible renegade. He said to me something that I've never forgotten and I've passed on to many people, which is that when you have to make a choice between subjects in this way or studying, sometimes it helps to think about it in terms of what will be the harder thing to do second. If you can do the thing that is harder first, then if you want to do the second thing and it's easier, you'll always have that opportunity to do it. And he spoke to me about it. He said you're going to want to do medicine, you'll need your mathematics skills to be really sharp, you'll need other areas to be really sharp and so with time that may become more difficult to do second. But if you always want to come back to an angle of journalism or humanities or social science or teaching. You can always find a way to do that as a second choice again at a later stage and integrate that into your life and actually that was really good advice for me. 

 19:40

 I landed really well in medicine. I loved my time in medical school, I think really, I felt I belonged and I found a house in medicine that I never thought I would have. There are parts of me that have continued to love those other things that are my so-called second choices that I've integrated in my work. 

Dr Maria Christodoulou Host

19:57

I'm intrigued to hear you talking about how much you loved medicine or medical school and felt at home in medicine, because that was so not my experience. But I also remember you sharing that the lecture that I gave you was the first time you'd actually been exposed to a lecturer who made themselves vulnerable. So tell me a little bit about that, because, if I remember correctly, you said that at that time you were starting to question what you were doing and whether you should stay on at medical school. 

Dr Nabeela Kajee Guest

20:25

Ja, once I was in medical school I knew I wanted to do this. I don't think I necessarily was questioning whether to stick in it or to continue, but I was questioning what kind of doctor I could be and if it were possible to be a full human in medicine. Your lecture, Maria, just opened my eyes completely. It actually was almost a shock in a way, because I remember thinking to myself weeks before that, how is it possible to be a full human being within a discipline that demands you to be so many things? 

 21:02

 And also sometimes to put aside certain parts of yourself. I was grappling with this concept. What does clinical mean? What does it mean to be a clinician? And does that mean I need to be emotionless? Does that mean I need to be removed or dissociated to some extent from my patient's experience, or from my experience witnessing their experience? 

 21:22

 I remember sitting in Huis Francie van Zijl, this is the residence that I was staying at. I made myself a pie chart of all the things that I would need to do in my day as a medical student and then, like thinking about as a doctor and like everything from like laundry, cooking, going to hospital, calling my family, managing finances. Everything was in this pie chart and I added up how much time I thought I would need for each thing, and I remember adding it up to something like 36 hours and this was like per day, you know. I remember calling my mother and saying I don't know how this is possible because I don't have time for any of the things that I need to do, and she said you know what? Don't count the time. Spend the time as you need, but don't count the time. 

 22:06

 Coming back to your lecture, because this was just a few weeks before I was sitting there and I remember how you presented what you presented. Your experience in medicine, but also your experiences throughout your career and how that trajectory changed you and the way that you see medicine in the world and your identity within that, and also thinking about your attention and how your attention and your priorities within medicine shifted. And actually it was the first time that I'd heard a doctor openly speak about burnout. Speak about what it is to feel lost or even confused within the field, and to question. And so that show of vulnerability is really the first time that I'd seen that. Usually I'd seen clean cut lectures around glomerulonephritis or chronic heart disease and it would be very clear-cut diagnostic presentations, but never really the true crux of the human who is behind that diagnosis or behind that white coat, and so there was an unmasking that I experienced in that session, Maria. Definitely. 

Dr Maria ChristodoulouHost

23:22

And you know, having you give me that feedback a few years later, when we met up - by the time we met, my role had shifted. I was no longer teaching integrative medicine and I was now working as a coach, and my mandate was very much around transformation. And at the time that we set up our coffee meeting, I was, I think, a few weeks away from quitting at the faculty and I hadn't told anybody yet, but I was holding that as a possibility in my mind and heart and feeling quite disappointed in myself. I'd come back to the medical school with this idea that I could make a contribution, that that contribution had something to do with medical education, mental health, the wellbeing of doctors, and I felt like I wasn't getting it right. There were too many obstacles, there were too many challenges, both social, socioeconomic, political, academic. I mean, there were so many things that were getting in the way and I felt like I was going to have to walk away from this dream. I just knew that I was giving up on a dream, giving up on the idea that I could be a part of that kind of change. And then I sat across the way from you and you were one of the few people I interacted with at that stage because, in my role mostly, I was seeing people who were going through lots of difficult times and struggling and not coping. So every conversation was just reinforcing that medical school is hard and people are struggling. 

 24:45

 And there you were. You had just published, not your anthology, but you had published your poetry in a journal and you spoke about your life in a way that really gave me a sense of how you were integrating all parts of you and that my lecture had been a part of that. And there was a moment, while you were speaking to me, where this realization dawned for me that the legacy - it wasn't about me changing the world. It was about planting seeds that would eventually create a foundation upon which other people could build in order to change the world. 

 25:22

 I felt like my work was done, that you were going to be one of those shining lights that was going to continue to do this work and was going to bring humanity to medicine and medical education, and it completely shifted how I thought about resigning. It went from I'm failing and it's pointless, I'm going to give up and I'm going to walk away and I can't change this system to there is a new generation of young people in the system who have the right mind and heart and who will be part of that transformation. And my one lecture, you were in second year, I think, when I gave that lecture, or fourth year, I don't remember now. That that one hour lecture had planted seeds that you were still nourishing and nurturing. And here we are all these years later, because it's almost 10 years. 

 26:06

 And your research is about mindfulness-based interventions supporting the well-being of medical students, and you've published and you're writing about it and I have no doubt you will be teaching about it. So for me it is also that thing of lineage and ancestry and how the effect that we have in the world ripples out in ways that we can't even begin to imagine. 

Dr Nabeela Kajee Guest

26:31

Absolutely. I want to almost just take a minute to just let that sink in Maria. It's, I think anyone listening can relate to this, that you're never truly alone in your pursuit. I think sometimes we almost convince ourselves that we're alone and isolated, and it almost takes a certain soul reminder to just actually remind ourselves. We're never the only person thinking about something. 

 26:56

 We're never the only person feeling something. We're never the only person wanting something or experiencing something. So, just reminding yourself that the human experience is a universal one. You were walking this path of, I am trying to bring about change, cultural change within medicine. I'm trying to bring about a foundational change within medical students so that medicine can be stronger, so that care can be stronger, so that we can have a more compassionate approach to medicine, to ourselves. You were thinking that, but actually somewhere deep inside me I was also thinking that, and I'm sure many other people out there are thinking that right this minute too. 

 27:35

 Remembering that we are this collective species of people, when we do meet like-minded people, it's something really affirming. I love hearing your story because actually, when I met you that day in Cups and Saucers at the Faculty of Medicine, in the coffee shop, I remember thinking, oh yay, there's Maria. When you've been taught by people and you really respect what they've shared and how they've shared it with you, there's a part of you that really wants to observe those people. I know this is probably where celebrity culture comes from maybe, I don't know, but you kind of want to watch them or observe them, and I think little children do it, but we do it even as adults, where we look out into the world and we observe people and we try and find parts of them that we also appreciate in ourselves. We emulate those parts or we develop those parts. I personally think, Maria, your work is not done. 

 28:26

 I just want to say that. But I certainly also feel that my work is far from done and I think a little bit like a torchbearer. The Olympic flame. I think in some ways in medicine, but also in other professions, there's the sense of that we have to be able to pass it along and we have to be able to nurture that flame. Really protect it. What do you think we need to protect in medicine and medical professionals? 

Dr Maria Christodoulou Host

28:56

Hmm. It's a good question. What do we need to protect? I think it has something to do with your question about how is it possible to be a full human being in medical school. Even as I say that out loud, I find myself asking it. Is it possible? And maybe, since it's a question you're asking and since your research is about the well-being of medical students, what are your thoughts all these years later about whether it is possible to be a full human being in medicine? 

Dr Nabeela Kajee Guest

29:27

Oh, so beautiful. Also, I love how you pass that back. 

Dr Maria Christodoulou Host

29:32

I feel like together we can figure out an answer that will make sense. 

Dr Nabeela Kajee Guest

29:36

We will. We can figure out quite a lot here. I'm telling you. We underestimate what is possible. I will reflect on that by looking at my 12 year old self. So when I was 12, I was queued up to give a speech at a public speaking competition and they gave us a whole selection of topics and the topic I picked - when I look back I laugh at this. It really says a lot about me. I'm a total nerd. But the topic was Utopia by Thomas Moore, a realistic reality or a daydream? I remember thinking, wow, what a question. This question seems like a juicy one. Let me try.

 30:12

 So for those who don't know, utopia means, it conceptualizes this perfect place, philosophically, like where there is no bad, there is only good. It's this ideal reality. But actually the word utopia, the etymology means no place. So Thomas Moore who conceptualized this, there's this irony of this definition and then the actual meaning of the word being two different things. And I grappled with that in my speech and I stumbled across the marking rubric of that speech I gave, and it said there, fascinating thoughts about what is really reality and what is not reality. 

 30:46

 And what I conceptualized at that age was that we often think of utopia as this concept outside ourselves. That the world has to be a good place in order for us to be well. I think at a young age I realized, and I think because I was so besotted with storytelling and imagination and creativity, I realized that actually at a very young age, the mind has its own recollection and the world and the mind are two separate things, and that we construct meaning from the world. But when I was really young I couldn't put that fully into words, and so what I conceptualized in that speech was that all we can do is pursue what we believe to be the best and to be the right and to be the good, and in that pursuit we may fumble and others may fumble and we may never get to that place. But if we are in the pursuit of that place and in our mind we exist in that place, that actually carries to what I even believe about medical education and about the problems that we see and also the good things that we see in training medical students 

 31:51

 in the current realities we find ourselves in, is that we may never enter a purist place. Maybe we shouldn't. Some argue that our vices grow us, that they challenge us, that they make who we are, equally our shadow parts. I'm an optimist, but I think there's a big part of me that has come to realize that reckoning with reality is important, and it's what's made me want to embrace looking at clinical communication skills and well-being and medical education. Grappling with the realities that we find ourselves in. And a big part of me also realizes that there are solutions that we may be able to find through research, and so I'm really curious to explore avenues such as the contemplative sciences, mindfulness training, cognitive behavioural therapy. These areas are areas that we have seen glimpses and very real positive effects. We need to understand their harms and we need to understand for whom and how they work and if they don't work in certain groups. It's certainly not a panacea, but I think my approach is to look at medical education with an inventor's hat. This is where I find myself now in the research chair, as something of an inventor. 

Dr Maria Christodoulou Host

33:03

What are you hoping to invent? 

Dr Nabeela Kajee Guest

33:06

Ooh, if I knew that. I think it's more an Edison story. Let's keep trying until we know. 

33:14

 My hope with medicine, similar to yours, Maria, is that we can really come very close to the humanizing parts of medicine. Stay close to those parts even as we develop artificial intelligence and tech bots and other areas of technological advances. That we can stay very close to the heart of the human parts of medicine and the art of medicine, and my hope is that we'll be able to really appreciate patients deeply. Talking about ancestors and someone who I've never met, who's not in my lineage, family lineage, but someone who I certainly hold in high regard, is Sir William Osler, and you may know him as a physician who traversed many places. He found himself in Oxford. I've always deeply admired the ways in which he's promoted and really valued the respect of the patient story and bedside medicine. As a young doctor, I feel very encouraged by what he has put forward into the world and what continues to be. But what we need to practice more, which is really listening to patients and being aware of them. 

 Dr Maria Christodoulou Host

What do you think gets in the way of that?

 Dr Nabeela Kajee Guest

 I think we get in the way of ourselves. I think doctors get in the way of doctors. This is partly why I'm so interested in cultivating awareness and cognitive skills around attention, because to be a good doctor means to be a good observer of the self, but also of the other, and I definitely think we are a big obstacle in our own ways, but there are also other obstacles right, and those obstacles sometimes divert our attention. Whether they're structural issues, cultural issues, time restrictions, emotional challenges that we need to overcome. Sometimes, as doctors, we have the need to fix. This is something I've seen across the board. We have the need to fix, to fix, to fix, and if we can't fix, then we often feel obligated to find a way to fix things. 

Dr Maria Christodoulou Host

35:22

Or we feel like failures, which is where I was at when we met. 

Dr Nabeela KajeeGuest

35:25

Exactly exactly, but sometimes we can't fix things and I think that is something that is hard to reconcile. That actually, in some instances we are powerless. And reconciling with that and owning that and being able to meet that where that is, is a big part of what medical professionals need, and what we need to cultivate is being able to do what we can do, feasibly, with kindness, and what we cannot do, to also be kind to that. 

 35:59

 As much as we sometimes have to judge between one situation and another situation, or one patient and another patient. For example, in dialysis, who will get this dialysis and who will not get this dialysis. That judgment is also a tool that could be a naughty schoolboy in some ways. We have to understand the critical lens can be a whip by which we harm ourselves, by which we harm our patients, and so I think a really big part of what I've started to understand about medicine is that there are many layers to care. Care has many parts. It's not simply a prescription or a diagnosis, but it's being able to relate to what's in front of you, be it a person, be it a situation, be it a challenge. Meet that with the fullness of who you are and also the reconciliation that the person in front of you and within you are both human. 

Dr Maria Christodoulou Host

36:58

Did you get that from medical school? 

Dr Nabeela Kajee Guest

37:01

Oh, interesting. I would say, Maria, that when I was coming into medicine I had a very curious mind that made me ask a lot of questions about myself and other people. I think in medical school, from my extracurricular activities, poetry especially, I certainly cultivated that part of it. Starting to think about me, others, how we relate. What is going on in my mind, what is going on in my body, being able to actually reflect and journal. Within medical school I certainly would say there were moments where I wondered and I questioned and I wasn't sure whether I was within a reality that could accept that, or if it was within a reality that that was not congruent. So in some environments I would find myself, it would feel so removed from the reflection aspect of medicine. It would feel very much go, go, go go. The emergency room, as a young medical student, trying to find your way around the various rooms, not knowing where the blood gas machine is, not knowing where anything is, feeling completely lost. In those moments I can't say that medical school gave me that. No, no, no. Those moments teach you survival skills, but they don't teach you the skills you need to embody your full self. But moments like your lecture, the Doctor as a change agent. Through mentors I had, like Prof Susan van Schalkwyk at Stellenbosch University and others who were able to sit with my questions, I was really able to grow. 

 38:42

 And I remember there was this wonderful time where I was completely confused. Confusion always brings about some kind of epiphany eventually, but I was completely confused because I was finding myself going from ward to ward to ward, seeing patients, managing all the various streams of information from various sources, and at the end of the day I come home and I think, what did I actually do today? Like, where was I? I would be so disorientated because I'd been in so many places and done so many things, but I wasn't fully present as a sequence of events, and at the end of the day it just felt like it was one blur. 

 39:17

 And I remember speaking to Ben who had participated in your teaching, and he'd said to me, Nabeela, when you are at the end of the ward and you're about to open the door to the next ward, just pause, put your hand on the handle, take a moment, realize where you are, just breathe, notice what you've done and when you're ready, open the door. And that stop and pause experience really changed the way that I interacted with the clinical environment. I no longer saw the clinical environment as managing me. I saw myself as myself, as an agent within that environment and I could choose when to start, when to stop, how to go. It sort of gave me a driving license, so to speak. It really felt very empowering to me and it really changed the way that I paced myself. 

Dr Maria Christodoulou Host

40:09

Any highlights that stand out for you about your time at medical school or your time after medical school? You've spoken a lot about twists of fate in the family. I'm wondering about things that have happened to you that you perceive to be twists of fate. 

Dr Nabeela Kajee Guest

40:23

Oh, wow, so many. So many twists of fate. I'm trying to think of just one. Wow. I definitely think one twist of fate was, I really wanted to do my medical elective at Oxford. I wanted to be there, so to speak, walk those roads, and to me it felt almost like a spiritual odyssey or journey to go there. And so, in that pursuit, I needed a letter from my dean of the medical school at the time, in order to actually be able to go, and I actually didn't know the dean very well at all. In fact, I think I'd just seen him. He was new at the time, Prof Jimmy Volmink. I'd emailed him and said here's my CV, this is what I do, this is who I am. I need a letter to state that I am actually at this university, and I thought I would get like this letter back saying, here Nabeela, three-sentence email letter. You are a student at the University of Stellenbosch, Thanks so much, Kind regards. 

41:15

 He really wanted to meet me and find out why I wanted to go to Oxford and what was the reason behind it and what was going on. And when I went there and I sat, and we chatted, it became very apparent that he was interested in what I was doing and who I was, more than just run-of-the-mill letter. And he actually, as I was leaving the door of his office, I still remember this very clearly, he said, you know, Nabeela, now's not the time and you know you're still very early days of medical school, but you're really the kind of person that should consider doing further studies in medicine, maybe doing something like a PhD. And at that time, to be honest with you, I didn't really understand the path of medical doctors doing PhD. To me it felt like a PhD was something that other people did, people in BSc's and BA's, and so it wasn't something that I had really even imagined for myself. To be honest, I hadn't seen past medical school in my mind. So, to me, it's a funny thing because it planted, as you said so well, a seed. 

42:13

 Years later, I had another conversation with a colleague and that colleague had very kindly told me something very similar, but in a different stream, which had said, you know, you really should consider applying to something like the Rhodes Scholarship. I think you'd really enjoy postgrad studies and potentially overseas somewhere, really to develop the way you think. You have a very intellectually curious mind. So I thought, there’s another one. I met with another friend, a couple actually, at the University of Stellenbosch, and they were a couple of years ahead of me, and they said, we’ve just gotten the Rhodes Scholarship, and you know, you really would be a wonderful candidate to apply. You really should consider it. At that point I then thought, huh, the signs are there. I really need to consider this.

 42:59

So when it came time, trenches of my internship at the time, anticipating community service I thought, well, I need a dream. Do I have a dream? And I really thought about and I thought, well, I would love to travel actually. I really would love to see a little bit more of the world. I would love to ask some questions that I've been wanting to ask in a more meaningful way. And that led to my applying for the Rhodes Scholarship, my then getting the scholarship and then going to Oxford and being now here doing my PhD, and being able to do work both in Oxford and South Africa through my work, which is a great blessing, so I hope that answers your question, Maria. As you said so well, fortuitous moments.

Dr Maria Christodoulou Host

43:20

 Fortuitous conversations almost. People have said things that have opened your thinking to something new or something you hadn't considered. You spoke about the trenches of internship. Tell us about that.

 Dr Nabeela Kajee Guest

43:52

I don't know if the listeners really need to hear about it, but I think there’s been a lot written about the process of internship and community service for junior doctors in South Africa. I think a lot of it is true. There's been a lot of good work done and activism from people. Not only in my immediate circles, but also people that I've met who are fighting for everything from safe working hours to prevention of transfer of TB, to making working environments safer, and also for women working in healthcare, to make those environments more equitable and also more gender friendly to other genders as well, and also just the inclusion and protection of marginalized groups within medicine, both patients and also healthcare professionals. But it's an interesting one, the trenches of internship. I ended up writing one of my poetry collections in my internship, and it's an interesting one because I was in the middle of my internship. I was on my internal medicine rotation, which anyone who's in medicine will understand what that means. It's a hectic time. 

 45:00

 I ended up getting chicken pox from a patient who had Varicella Encephalitis and had this widespread chicken pox. And I ended with two weeks of quarantine. This is pre-COVID. People didn't really quarantine for long with most things, but with chicken pox I needed to quarantine for 14 days because I was working with a number of patients, many of them immunocompromised for many reasons, and so I had to take the full 14-day quarantine and ironically, this is the junior doctor struggle, I found myself sitting at home thinking, what am I going to do with myself for 14 days, firstly. Secondly, I would so much rather be well and working with my patients. Classic medical doctor workaholic mindset. And thirdly, I thought I don't know what I could possibly do with myself. 

 45:48

 It's a funny thing how, during that time, I felt so incredibly unwell. Also thought wow, I'm super unfortunate to be an adult with chicken pox. 

Dr Maria Christodoulou Host

46:00

I've had it as an adult. It's awful.

Dr Nabeela Kajee Guest

46:02

I found myself wanting to write. It didn't really start intentionally. I actually started first just jotting down some words and some thoughts and it trickled and it continued, and it became more and more poems, and actually by the end of the two weeks I had a whole document filled with poems that I sent to a friend, Dr Wandile Ganya, who is an incredible person, and he's also a poet, and he read them and he immediately replied to me with lots of exclamation marks. You need to turn this into a book. This needs to be a collection. And so, it’s a funny thing. The poetry book's name is On the Edge of Destinies, and it's a book that came out of a really interesting time for me, which is, I was a junior doctor, worked very hard, found myself becoming a patient and an ill person, with chicken pox, as a doctor, and just the words flowing out of me and different parts of me wanting to write. And not just the doctor part of me, but the woman, but also the thinker and the writer and the storyteller. 

 47:02

 So all of those parts. I used to joke that it was my chicken pox for the soul, but it really felt fortuitous. I would never have had the opportunity to sit and write for that long, with that degree of intensity, unless I really had something like that. And since then I've tried to think about that really, which is, did I need chicken pox in order to start writing like that, and give myself permission to take time for that kind of intentional writing? And so since then I think, it's been something I've done a lot more. 

Dr Maria Christodoulou Host

47:37

What was it like to publish your anthology? 

Dr Nabeela Kajee Guest

47:41

Oh, ah, moving. It's an interesting thing when you don't see yourself doing something. I can't ever say that I saw myself one day having a book with my name on it, and having my thoughts captured in something and people wanting to read it and having access to it. It was a passion project. I really think it was this beautiful baby. I designed the cover, I learned how to do that on Adobe, I did all the images, I prepared all the writing, I did everything, and so it really, to me, felt so incredibly moving to be able to hold that in my hands and to be able to share that with people, and for them to be able to dip into my thoughts like that. There's something scary about writing and sharing that writing. 

 48:50

But, there's also something incredibly liberating about being able to have people read pieces and come back to you and say, part of that poem was exactly what I was feeling when my mother passed. Just to be able to have that connection, I think, was just so unbelievable. It exceeded my expectations. 

Dr Maria Christodoulou Host

48:58

Lovely. Well, it's a beautiful anthology and, for people wanting to reach out, it's available on Kindle. 

Dr Nabeela Kajee Guest

48:58

Available on Kindle and Amazon. All the good places.

Dr Maria Christodoulou Host

49:25

So often when I'm doing these conversations, by this time in the conversation I've kind of got in the flow, and it feels like we're telling the story. I feel like we're there but we're not, like there's elements of the story that are not being told. And maybe a good starting point is, what is the story that you would want our listeners to take away from this conversation? 

Dr Nabeela Kajee Guest

49:25

Mmm. Part of this conversation is really to start the conversation, because there's so much about humanising medicine that begins with the way that people see themselves, and the way that people are able to reflect on their journeys. I think a big part of the work I'm doing and also, not just externally but even within myself, is to think about self-awareness. And, is there a way we can bring a self-awareness to what we're doing and an intentionality behind the way we're interacting with each other? If you are a medical professional, the way you're interacting with the people that you work with, with yourself, with the challenges and the joys, and not only seeking the joys, but also seeking the challenges and being willing to sit with what is difficult. I think in our society we often think that difficult means bad and I often think the things that have been difficult - grappling through the challenges of working within healthcare systems - those have been actually some of the richest experiences that I've had and I would never trade them. And I think that, for those who are thinking of medicine but deeply afraid, to realize that that is actually very much something that you can build upon and you can grow within, and it doesn't have to define you or confine you. 

 Medicine is a beautiful field and it has so much to offer people. I think that's something I really want to underscore. It requires the individual who goes down that road to be willing to grapple with those challenges. To be a clinician but not to be who you are too, is to lose something. And I think another part of the message is, beyond just grappling with self and understanding that you as an authentic person can exist within medicine, is to also understand that sometimes what we think is out of reach is actually quite possible. 

 51:14

 That is a hopeful message, and I want it to be a hopeful message, but it does not mean that the path will be easy. There'll be times you will doubt yourself. There will be times that others will doubt you openly. There will be times that you will be criticized. There will be times that you will even be intentionally put down for who you are, what you stand for, what you might think you are, and in those moments, especially, you will want to stop. You'll want to go home. 

 51:39

 Part of that is not undermining the extent to which that is difficult and sometimes even soul crushing, but it doesn't have to be your motivation. Other people's reflections and mirrorings are their reflections and mirrorings, and knowing that you have a place in this world, no matter who you are, where you come from, what your background is, who your family is, who they think you are. That doesn't give you a golden ticket in life. 

 What gives you a golden ticket in life is knowing that you are here and you are a part of something greater than yourself, and also understanding going forward with what you do, that so much of the journey is being able to believe even in the dark, because it's not often that the light will shine. My mother often tells me this whenever I'm thinking oh, here's another dilemma. You have to be willing to tolerate the dark to see stars. You have to.

Dr Maria Christodoulou Host

52:34

Have there been times in your journey where it’s been hard to believe that the things you want exist? Have there been times when that darkness has overwhelmed? 

Dr Nabeela Kajee Guest

52:46

Oh, many times, Many, many, many, many times. As someone who leaned very heavily on bursaries to complete my medical school, there wasn't a certainty that I would be able to afford medical school, let alone university. I think a big part of, also, what, in my mind was why I didn’t concretize medicine was because I didn't really have the privilege of knowing that I could afford it or that it would be something available to me, and so I think I kept it very flexible in my mind. Almost self-protectively as well. That if I don't get this, it's okay, like it's fine. Like, you know, there are lots of options. Sometimes, when you're in situations where you don't see the whole road, options feel like power, it feels like a way of feeling protected. The more options I have, theoretically, the more chance I have of being able to do something. There were moments where going to the fees office at Stellenbosch University and looking at the due accounts and thinking, okay, I need to try and find a way to pay this or to manage that through bursaries and kindness along the way. 

 53:46

 Definitely, I would say, there were dark moments where I thought, will I graduate? Will there be an invoice in my graduation cone? A month before I graduated, which is ironic because, you know, I was the top student. By a miracle, honestly. I was working my butt off because I was really worried about whether or not I could keep my scholarships and whether I could keep my merit bursary. For those students who are grappling and wondering to themselves, oh, will I be able to do this? Can I afford this? How will I afford this?

 54:23

 Perhaps there's no one who can sign on your student loan as surety. Maybe you don't even have money to do the things that you think you need to do. Maybe the textbooks are too expensive. The resolve that I got from people around me, and the encouragement that said, you know what, we'll find a way, a plan will be made. I think also in medical school... This is hard to really define, but I'm sure you relate to this Maria. There are moments where you, almost existentially, are not sure about whether or not you can become what you think you need to be, and I have a very strong recollection of one tutorial we had in endocrinology and we had to go all the way to the 10th floor.

 55:04

 One of the consultants that had passed us by that day had said, we shall not take the elevator, we must take the stairs. And so we went all the way up to the 10th floor, found the DEXA scanner, had our tutorial. It was incredibly overwhelming. World Health Organisation this and this, and just buzzing around my head. And then I remember going all the way down the 10 floors again and coming home, and thinking to myself, wow, this is one of the first experiences I had in a big hospital. I'm going to have to go up and down the stairs every day like this. I'm going to have to know all these criteria out of my head. This is a part of the job. 

55:43

 I think there was a lot of that that felt almost out of grasp and felt extremely scary and overwhelming. And you know, watching other clinicians who are much older just spin out of their heads criteria, and spin out of their heads various parts of clinical knowledge. Clinical cutoffs and numbers, just like this, off the top of their head. As a second- and third-year medical student, I remember feeling really, really overwhelmed by what was ahead of me and wondering will I make it, will I be able to do this, will I be able to learn these things? Looking at the textbooks, looking at Netters Atlas of Anatomy, and paging through that and thinking, will there come a day where I will know the insertion of each muscle? That existentialism in medicine is something that I've seen translated across other disciplines. It's not just medicine. I've seen it in other people too. It’s this idea of becoming within a profession which is, I think, something that I still wonder about and I still actually sometimes hit a wall, thinking, I'm not sure. I've never done this before. Will I be able to learn this? 

 56:42

 Navigating medicine as a young woman is very hard in the beginning. I remember being called ‘nurse’ pretty much on a 50% basis, and even when I became a young doctor. And also working within structures that were sometimes extremely sexist. I remember colleagues saying things like, oh, let's not be caught with our skirts up, and things like that. All kinds of other very much patriarchal and somewhat even misogynist content that actually was very disturbing.

 57:10

 There were times where I was afraid as a young woman, as a doctor. Not just with certain patients but actually even with certain healthcare professionals.  Because I think sometimes, the clinical environment caters – not sometimes, I think quite often - caters to the norms of society that have existed before. I used to question it and sometimes I used to feel really quite conflicted, because I would be, for example, standing on a ward round and say, it would be obstetrics and gynaecology and we'd be in the obs ward, labour ward, a woman would be delivering, and the way in which women deliver, for example, is in itself quite patriarchal. If you speak to any woman and you say, well, if you're going to be delivering a child, would you like to lie flat on your back, potentially in stirrups, and deliver a child like that? I think most women would say no. They would prefer to use gravity to deliver their child, perhaps in a more squatting position or something like this.

 58:05

 And there are ways to make that sterile, there are ways to make that condition good for delivery. And I remember discussing this with a male obstetrician and a female obstetrician and seeing the differing opinions. Or talking about gynaecological exams and saying, well, does it really have to be like this? Are there ways that we can change this? Or change the narrative around care, or thinking about the ways in which we even interact with patients? 

 58:28

 There are lots of parts of medicine that were intimidating to me, and when I came into medicine I didn't feel like the prototypical doctor. I really didn't. There were parts of me that felt… were not fully recognized. The creative parts in me, the parts in me also that questioned status quo, or that wanted to change things.

 58:52

 I think oftentimes I was met with a lot of resistance when I presented ideas around changing shift times or changing ward rounds in some organizations, and so I think I learned that you can't always change a system without taking very major steps to understand yourself first, and to understand the ways in which that system operates and what is feasible at a particular point in time and with the people you're around. Each of those moments at some point has presented a turning point. There's some things that you may not be able to fully change, but you can adjust and you can say something about in a way that does bring about some meaningful change. Even if that the only change is that you find another colleague who can literally stand opposite you and say, I thought I was the only person who thought that. 

Dr Maria Christodoulou Host

59:46

Right, and I love that you say that, because, as you've been sharing all these different experiences that were moments of darkness, that’s what .stood out for me. On the one hand there’s this prototype of being a doctor, which we could talk about. If we just look at the credentials, you know, here you are, you're a doctor, you’re a Rhodes Scholar, you're at Oxford doing your PhD. You had opportunities to go and do summer schools in Utrecht and to do electives in Oxford and New York. One could, from the outside looking in, say, you are the prototype. You've published in medical journals, you've published your anthology. And so, to have people with your experience and your credentials talk about the self-doubt and the moments of darkness, and the struggle, and the fact that you still question whether you can do this, whether you have the ability or the skills, that's the piece that, for me, feels like it's missing. 

 01:00:32

 There weren't, certainly when I was a medical student, enough mirrors that I could look into and go, I recognise myself in that. There’s hope. I could do this. I could become a doctor. Somebody said to me the other day… They described themselves as an edge walker and then I thought, well, that's exactly the dilemma. How do you find mirrors when you walk on the edges of disciplines and paradigms? I know that you share my passion for integrating the humanities and medical education, and the practice of clinical medicine. What are the mirrors? Who are the mirrors?

Dr Nabeela Kajee Guest

01:01:09

I think, I have wondered sometimes, how do people see themselves in the world when the world sometimes seems so tilted? Where people often are projected as either heroes or as demons, and there's this like black and white thinking that we have. That people are either successful or unsuccessful, talented or untalented. I think these are not realities. If you walk the path in a way that isolates and make yourself really lonely, and you do it in a way that’s extremely ambitious and very driven, you're not going to find mirrors. It's going to be very hard. I remember once, this businesswoman said this to me. I'd asked her, how do you stay vulnerable when you're supposed to be the CEO and you are seen as this extremely stoic character? How do you actually show vulnerability? And she said Nabeela, it's lonely at the top. If you do forge on on your own up a mountain and you zoom up there, you can get there. It's possible, but it's also depriving of a lot of parts - as you've said so well, mirrors - that will protect you, remind you of who you are. I think, also, validate you and who you are as a person within this world. When you are able to surround yourself by people who are able to really truly see you.

 01:02:35

Sometimes it's hard to find those people, but I think when you find them, you should hold onto them tightly. It could be the Toastmasters Club. It could be a neighbour. It could be your grandmother. I would say that would be my advice, in terms of, if you have things that you want to do in this world, and they don’t all have to be things that are measurable. You know, a lot of the things you've said are measurable. Oh that I've gone here and I've studied this and I've done this and those things are very valuable and they're good things. But actually, when I think, one day when I lie on my deathbed, I wonder which of those things will be the things that pass through my mind. There'll be some, I'm sure, but I don't think necessarily that my PhD is going to be the first thing I think about. No, I really think it's valuable and I hope to do something good. There's so many immeasurable things that I hope will pass through my mind. Like the smile on my grandmother's face when I've asked for a recipe that she'd made us when we were little, and I've written that down, and what that moment was. Or a moment that I've had with a friend where, in this moment where you actually realize the two of you are so weird in the same way, and there's that click, and I think, even professionally, the moments I remember are actually the really quiet moments. The really simple moments. When I did my first caesarean section, I was so afraid, but the amniotic sac just bulged open like an orb and I was the lead surgeon in this. As an intern we get to do these procedures to learn. My co-surgeon looked at me and said are you ready? And I took the forceps and I just pinched it. 

 01:04:07

 Medicine has been such a valuable part of my journey, but it's not all of who I am, and similarly, with the work that I've done, I hope that the things I've done will have made some difference, but I also hope that the things I've done will not define me. I really hope that, because I think it would be sad if the person I was became the things I did. There are a lot of parts of me, also, that are really very much work in progress. I'm not a very good driver. There are lots of other things about me that are rather questionable, and every person has those parts, and so I really hope that people will be able to also see that they are a mirror for themselves. That's what I've actually loved about writing is… I think writing has revealed to me that there's a mind within a mind, or what we as scientists call metacognition, and sometimes, when I'm journaling… 

 01:05:02

 I will read something I've written, maybe like a few weeks ago, and I can’t believe that I wrote that down. I actually… I needed to read that. Or a friend will say, I’m going to tell you something that you told me two years ago that you need to hear, and I'll think, oh, that's exactly what I need to hear. 

 01:05:17

 So I do think there's external mirrors, trustworthy individuals who are part of your inner circle, chosen family, and then there's people who you need to remember are not your true mirrors. Outside of that, who are often naysayers, and for whatever reason want to derail you. And you need to be intentional about not allowing them to do that, and reclaiming your power.

 01:05:40

 And then the last part is knowing that you also serve as a mirror. And if you find yourself in a position, especially to the listeners who are out there, where you’re stuck or you’re confused, or you’re afraid. Just know that there are moments where no one else has the answer and there's only a portion of the mountain that you can go, and it's very scary when you're there, but if you trust yourself and you trust your life as it's unfolding, I do believe that the answer of what is the next thing that you should do, or how you should do it, will come. If you trust. I haven't lived enough life to validate that, but the little life that I have, so far, so good. That's worked. 

Dr Maria Christodoulou Host

01:06:23

I think it's David Whyte who spoke about how, you know you're on the right path when the path keeps disappearing in front of you. So if I was to ask you who you are, who is Nabeela, who is Dr Nabeela Kajee, what would you say? 

Dr Nabeela Kajee Guest

01:06:40

I would say I am human first. I would say that I’m in the service of humanity, I'm in the service of all that is human, and I would also say that I am a liver and a lover of life. A big part of my soul and my personality has been to find the pieces of life that resonate with what makes me feel alive, and the things that take away or make me feel less alive, I look at and I wonder about, because they're not the same for everyone. There are things that some people really gravitate towards that I can’t really abide or tolerate.

 01:07:30

 That, for me, has been a big part of who I am. Really taking life by the horns and saying, you know, there's this one life we have to live. Can I live it in a way that honours my talent, but also is willing to accept that I may not fully know what I'm capable of doing? Accepting the unknown, because so much of life is - and I experience this in every part of what I’ve done. What is your 5-year plan? What is your 10-year plan?

 01:07:55

 And none of that has ever materialized. None of those 5-year or 10-year plans have come to pass. There are moments where, I think any human being can relate to this, where you're tested to a point where you don't know whether you can walk again after whatever's happened. But I also think, like, to live afraid is not a way to live. And I think that is what has driven me to do the work I've done. Is just to say, you know what, I am afraid, but I will not let the fear be the voice inside my head driving me. That may be like the background sound, but it's not going to be the person and it's not going to be the choice. I showed up in Oxford and I looked around and I didn't see anyone like me. I wondered, do I feel like a snow leopard or what? There were moments also, even when I was at Oxford, where I read a book called Superior by Angela Saini. I highly recommend it to listeners. She talks about race as a construct. Where does this come from? Who invented this? I looked around Oxford at these beautiful buildings and I thought to myself, who built them? That thought had never crossed my mind. Who built them? And then I walked through the streets and I wondered about the streets and I said who cleaned them? And then I'd walk through to the college and I'd sit down and have a dinner and I'd think who paid for this dinner? On whose backs was the money that was used to fund these second desserts and very wonderful traditions, but also exorbitant traditions. Where do they come from? Who funded this? Was slavery discussed in this room? Were the foundations of slavery discussed in this room? 

 01:09:37

 Walking through places of privilege is something that we need to remember and we need to think about. We need to acknowledge our personal privileges, and privilege is not only financial. Privilege is also social. It is also, in terms of psychological privilege, what you've been made to believe you can have. Historical privilege, intergenerational suffering and intergenerational traumas. And I think a big part of my time to date has been walking paths that I have walked, but also starting to think about the paths that have existed before me. And change happens, but it happens really, really, painfully slowly. I think a big part of people starting to think about their roles and where they can make a difference in a real way, is starting to think about, like, the trajectory of their lives and the lives lived before them, and also to realize you're part of a bigger story.

 Dr Maria Christodoulou Host

01:10:35

 I'm struck by the irony that you would have been a medical student around the time of #FeesMustFall and the whole controversy about the Rhodes statue at UCT... 

 Dr Nabeela Kajee Guest

Yes. The #MeToo movement. 

Dr Maria Christodoulou Host

#MeToo. All of that was happening. How did it feel to be given a Rhodes Scholarship and to end up at Oxford? 

Dr Nabeela Kajee Guest

01:10:58

Yo, yo, yo yo. This is a really powerful one. Back story. On my mother's side... I love stories, I ask my family about everything, but my great-grandmother, who I actually knew when I was little. This is my mother's grandmother. She grew up in Kimberley and, for those who don't know, Cecil John Rhodes lived in Kimberley, and this is the turn of the century, the late 1800s, early 1900s. My grandmother remembered Cecil John Rhodes. My great-grandmother. Kimberley had the first streetlights in South Africa. It was the great diamond rush. 

 01:11:30

 My grandmother grew up in a very different circumstance. She was married off at 16. No choice as to her husband. Her husband was, I think, twice or maybe even three times her age. It was a very normal thing at the time for women to be married off in their teenage years, not to necessarily have a choice about who the person was, just simply more of a financial decision, a social, normative decision. She had a very interesting life. She went on to be married to this man. It was very difficult for her. She recounts stories of running away from him at the bed with a knitting needle in her hand. He passed away after a few years. He was relatively older than her and I remember asking her when I was younger because she told me about this and I was very young, and I said how did you feel when you died? And she actually said, I felt relieved and I felt that there was so much of my life and I had felt sad, but it was a mixed feeling. She went on to move to Cape Town, and to meet who was then my great-grandfather, and get married and then have her children. 

 01:12:36

 But I reflect on the life she lived alongside Cecil John Rhodes. Like, here you have this British imperialist who is a diamond magnate, amassing all of this money and fortune, building up this huge empire. An empire that, if you look at what he actually owned in South Africa and in Rhodesia, which is now Zimbabwe, and other parts, you realize is incredibly huge. You look at what he endowed to the scholarship that started in 1902, also remarkably huge. And then I think about my great-grandmother, married off at 16, never finishing school, having her life really moulded by other people. And I think about those parallels. I think about the miners in Kimberley who mined those diamonds and were forced to work extremely long hours in some of the hottest, most humid conditions you can imagine. And far away from their families, with the struggles of migrant labour, which we know has been a driver for a lot of social ill and a lot of suffering health-wise. Years later, when I was encouraged to apply for the scholarship, those thoughts moved through my mind. 

 01:13:39

 I could picture my great-grandmother. I could picture this idea of Cecil John Rhodes and who he was and what he represented in the colonialism and the British Empire, and I also thought about the vision that he had. Making leaders of change, but really in a very particular way. They should be male and they should be from this particular group. And then thought, well, isn't this subversive, that I am now a woman of colour, a woman whose great-grandmother had seen Cecil John Rose in her little town in Kimberley. I thought, wow, I'm for this. I'm for taking something that was intentioned in a particular way, making the good of it, and also realizing there are painful parts of it that are there. Thinking about my great-grandmother and thinking about the environment she found herself in, and thinking about the people who lived in that town and worked for that money and never saw the benefit of that money. It aches really to feel that, but there's a little part of me that sleeps easier at night thinking that this situation was one which is so complex and has a lot of pain and a lot of loss. But I feel that, on some level, there is this justice in my mind, or social justice, that we can redefine what history has set forth and that can be changed, and so I think I feel really affirmed to be in the scholarship. 

 01:15:05

 I feel very grateful to have the opportunity as a woman from South Africa, where most of Cecil John Rhodes’ money was amassed, Southern Africa. To be able to have this opportunity to give back to South Africa in my research. That means a lot to me. I do think, though, there's so much more to reconcile. The movements that have happened around… What has happened previously with #FeesMustFall, what happened with #RhodesMustFall, the #MeToo movement. These are all uprisings against inequity that I think should and, really importantly, must, have a space in our society and must take the really important part of how we think about previous structures is, thinking about decolonization and transformation, and it's not always easy. It’s not always about what people see, but it's about what happens behind closed doors, and it's not about do we accept this number of students from certain backgrounds, but do we actually support those students? 

Dr Maria Christodoulou Host

01:16:00

Feels like we could spend many hours talking about the complexity of those things. Is there anything I haven't asked you about that you want to share? 

Dr Nabeela Kajee Guest

01:16:10

What I really love about your podcast series, Maria, is that you give people the opportunity to shine their light and really allow people to, in a very honest and unfiltered way, share, and that really means a lot to me and, I think, for the listeners. Something that I also think is really helpful to think about, maybe, is, what is it that I can do today that can help myself, my family, my community, those around me, to be more connected? One of the things that has increasingly been on my mind is thinking about how societies function today and how we sometimes don't even know our neighbours. We just walk through streets, we don't talk to people. 

 01:16:59

 When I was in the UK I saw that too. I’d be on the underground or the tube and people don't make eye contact. You can see someone slip and fall and people don't necessarily offer to help. Sometimes people do, sometimes they don't. I guess I wonder sometimes if we can remember how to stay true to community, and find community, and build community. And I think, even in the wake of COVID, how do we really protect community and protect the way we relate to each other? And this podcast space is an example of community. People being able to tune in and hear things and be able to relate to them and share, and so I think the one thing I would love to leave listeners with also, is this idea of how do I protect the communities that matter to me, and is there something I could do today? 

Dr Maria Christodoulou Host

01:17:43

I love that. Thank you, that's beautiful. Maybe, as an almost closure question, what are you hoping is next for you? I know you're still busy with your PhD. We won't talk about five- or 10-year plans, but what's the longing, what's in your heart for the next phase of your journey? 

Dr Nabeela Kajee Guest

01:18:02

To write more. So I'm actually writing another collection of poetry which I can't wait to share. So that's been really something I am very excited about. I'm very excited to be in a point, also in my research work, where I'm starting to see outputs, and we're starting to see what this research is meaning and what we're finding as results. I'm very excited, over the next year, to compile those findings and have my dissertation together and be able to put that forward and feed that back to the various groups that I've researched. It's always very gratifying to be able to share your research and share what's been found and so that something translationally can come from that. 

 01:18:44

 I think for me, a big part of what I want to do is protect my passion and the things that I really value in what I do. So, service is a big part of me and who I am and I am very curious, and so I think there'll always be a part of me that will want to be involved in things like research and policy and the nuances of how we implement medicine. But there's a big part of me that's also a clinician and that misses that direct impact on people's lives and serving in a very direct way. I think merging those parts of me will be the exciting next steps. Bringing my junior doctor clinical work into my research and trying to marry those two will be very, I think, exciting, but also a new step for me. 

Dr Maria Christodoulou Host

01:19:31

Lovely. I'm excited to see where the journey will take you and what will unfold. 

Dr Nabeela Kajee Guest

01:19:36

Thanks, Maria, thanks so much. 

Dr Maria Christodoulou Host

01:19:39

Is there anything you would like to ask Amy? 

Amy Kaye

01:19:42

I've been sitting here quite quietly and it didn't seem like there was really a pocket, like I was listening so intently. I didn't want to interrupt with my own narrative, but I really just want to say, as a narrative coach and as a writer and as a poet, I really, really appreciated this conversation, and I love the way that you are in the world with your poetic heart. The way you describe things and see things is just… the metaphors and the imagery and the way you use language. As a writing teacher, I appreciate it so much. And then when you started talking about going to Oxford and walking on the streets and looking at everything and I thought, I don't know if you've read this book before, but what I love to do is always tell people like an album that really influenced me, or a book that really influenced me, and the book is Open City by Teju Cole. 

 Dr Nabeela Kajee Guest

01:20:31

 I haven’t read it.

 Amy Kaye

 So let me tell you about this amazing book. It's about a Nigerian man living in New York City who is doing his final year of his psychiatry residency. It's about being an African man in New York City and studying psychiatry and what that's about. And it's about him walking the streets of New York City, and the people he meets and looking at these buildings and going, who built these things? How did they feel about it? And it's just that thing, an African being overseas going… And just so many of those parallels. And another thing that came up for me, you said so many things. So, throughout this conversation we've had a few things with animals. I don't know what it is, Maria, but in these conversations, animals, I don't know why, but it's so…. 

Dr Nabeela Kajee Guest

01:21:14

Snow leopard! 

Amy Kaye

01:21:16

Throughout this conversation, I'm looking out the window here and there've been so many birds today. So many birds and so many different kinds of birds flying past the window, and I read… I think it was earlier in this week about how bird song… It’s a very comforting sound and people love bird song and they feel very relaxed when they hear bird song. But actually there's a biological reason why, because birds only sing when they feel safe. If there’s danger coming, a bird will never sing. It will be completely silent if there is danger. I’ve got full-body shivers right now. And the fact that there's been so much bird song today, I just thought it was the perfect... They're even singing right now, and I just thought what a safe, beautiful vessel in the background, and it's just been the soundtrack of this entire conversation. 

 01:22:03

 So I just wanted you to know that all the birds have been singing and flying past. It’s been absolutely wonderful. And I just want to say thank you. It's lovely and it's so heartening knowing that you're doing the work that you're doing. Again, that there's somebody like you doing the work that you're doing. 

Dr Nabeela Kajee Guest

01:22:21

Thank you Amy. I mean, the same to both of you. I mean, I think, thank you for saying that. I think sometimes it's just so nice to hear what people are experiencing in that conversation. It's an interesting thing. We as human beings, we speak and then we don't really hear ourselves. You know what I mean? We like project it and then someone else receives it. But it's an interesting thing that you said. I can't wait to read this book, Open City. I've like highlighted it. I'm like a book club girl. I'm like whenever I get a recommendation, I'm like already on Takealot. That's not an advert. I think it's so interesting what you're saying, because actually I just want to pick up on that word safety, because I actually think that's something that time and time again, I've realized is a privilege in this world. To be in the company of people and spaces where you feel safe, and safety isn't just someone is coming at you with like a panga. 

01:23:21

It’s safe because I feel seen, I feel valued. This idea of metaphorically sitting in the circle. I certainly have felt that in our conversation today, this idea of communing, sitting in the circle. And I love that you also write poetry and that you love narrative because this, I think, is for me something so valuable and has changed me in some way. In a way that I can't really pinpoint how, but whenever I see people able to tell the story, it feels different. There is something really powerful, I think, in the human mind, when we can allow ourselves to process through written word. 

Dr Maria Christodoulou Host

01:24:54

Absolutely. And on that note, I'm wondering if you would give me the opportunity to share two of your poems from your book as a way of closing this conversation, because they both felt really relevant to how I know you, but also feel very relevant in this moment to the conversation. The one is called Dear and it goes, “I once met a girl who would cry with people she never knew, who would awake in the slumberless night to seek out the difficulties and joys of those she never beheld. And I would think that the human spirit may be a blanket that we threw over our knees to warm each other's hearts”. That's how I felt when I met you. 

 01:25:48

And the second one is called Oh Soul, and I'm hoping it may inspire our listeners to remember. It goes, “You asked me what I wanted and, although I waited to tell you, at the quiet of evening upon the balcony bench, it is a candle I want. One to light the hearts of those who have forgotten what light means and how beautiful they are Oh soul.” Thank you for being a candle. 

Dr Nabeela Kajee Guest

01:26:15

Oh soul. Thanks, Maria. 

Dr Maria Christodoulou Host

01:26:19

Thank you so much, Nabeela. It's been a privilege and it’s been really lovely to have some time to hear more about who you are and what your life has been about and to, just as Amy said, you know, the way that you see the world and the way you share about the world, and your ability to… It almost feels like you see between the layers and you can give voice to that which is in the spaces between, and I really do feel the same way I felt in 2015 that with such passionate, dynamic and charismatic young women like yourself in the world, and in the profession, my heart can rest. There is hope for transformation.

Dr Nabeela Kajee Guest

01:26:53

Indeed, Maria. Indeed. And to have spent such a wonderful conversation with two absolutely wonderful people, as Shakespeare would put it, a marriage of true minds. Really appreciate the opportunity to share and to dig a little bit deeper underneath who I am, and to be able to have just a lovely sharing of stories. I really hope that our listeners have enjoyed the journey and, Maria, thank you, as always, for the odyssey. Our journey and adventures only continue. May they get crazier. 

 Dr Maria Christodoulou Host

01:27:25

Yes, absolutely. Thank you, Nabeela. I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook and Spotify, and go to Apple Podcasts to subscribe, rate and give us a good review. Thank you so much for listening.