Denise Asafu-Adjei, Resident Physician - Urology

Hi, Denise! What do you do, and given how specialized it is, how would you describe it to someone unfamiliar with that space?

I am a resident physician, which means that I have finished medical school. My sub-specialization is in the area of urology which has a focus in the surgical management of the urinary system, including the kidney, bladder, prostate, and the penis. 

Can you describe your educational path? 

I was born and raised in the Bronx, and attended probably one of the country’s most famous magnet schools, the Bronx High School of Science. I then attended Carnegie Mellon University, majoring in biological sciences. At that point, I knew I was going down the medical path. I’ve always been interested in the science field, so in college medicine felt like the best match. I went to the University of Michigan for medical school, and took a year off to do a master’s of public health at Harvard’s Chan School of Public Health with a focus on healthcare management. Currently, I’m a chief resident in my last year of residency in urology at Columbia University Medical Center. So, I took a fairly straightforward path for a physician. The one difference is my MPH, which at the time wasn’t as common, but the trend is on an upswing now. 

What attracted you to urology, specifically?

This is always an interesting question. When I went to medical school, I didn’t want to do surgery. As I started doing clinical rotations, I became drawn to surgery but thought I would do primary care or pediatrics. When I decided on surgery, I was getting ready to start my MPH at Harvard. Part of my spirit was not sold on general surgery. I knew that I liked working with my hands and liked the immediate gratification after completing a procedure for a patient. What really shifted my attitude on surgery was the passing of my uncle who had metastatic kidney cancer. When he was getting evaluated in Ghana, I was trying to read more about the field because I had no idea what type of physician took care of people with kidney cancer. To help my family determine who my uncle needed to speak with, I read so much information on the urology field, and I came away feeling like that specialization would satisfy my own surgical interests. I also knew that there was some versatility to change my focus if that’s what I wanted, which also drew me to the specialization. It’s also an area where you can still have a solid work/life balance. 

Why is it a better work/life balance for this particular area?

Urology is a subspecialty within surgery, and within surgery there are so many choices for what you can do based on how frequently you want to be in the operating room. If you want to operate all day, there are subspecialties where you can do that. As I have gotten older and developed more ownership over my future, I know what I want, and I know what I don’t want. Being happy, having the opportunity to have a family — these things are what really matter to me. Urology offered the ability to have that kind of balance. Soon, I’ll be starting at UCLA for a fellowship in sex medicine and male infertility, which is a fairly heavy clinical-based practice with some OR time, but not overwhelmingly so. 

Who has been a major influence for you? 

Not to sound cliche, but my parents. They’re both very persevering. We may have had no heat on growing up but they always made sure our school fees were paid for. My family really appreciates education, and I think my parents could have both done a lot more outside of what they did when they came here forty years ago as immigrants. But they always put us at the forefront. They inspire me every day with the deep love they show me and my siblings.

In the little time off that you have, what do you like to do?

I enjoy going to the theatre and to the movies. I love live performances. Spending time with my family is always a huge plus. I also really like physical activities to keep myself in shape. Me and my partner picked up golf a couple of months ago. I appreciate trying things I never thought I’d do. I also really like politics and policy, and understanding how systems work. And traveling — love, love, love traveling. 

Have you had any especially challenging experiences?

During medical school, you have to take the United States Medical Licensing Examination, or what is more commonly called “the STEPs.” It includes all of the things you have to do to apply for board certification when you apply for residency. We don’t have formal grades. It goes by how you’re doing in the class. It’s a required exam, and in the first part of the series, I had studied probably the most intensely I have ever studied in my life. I would start at 6 a.m. and go until late. I was studying so much but I didn’t do as well on the exam as I had hoped. When you’re coming from a place when you’ve always been on top and nothing has been hard, it’s challenging. From the standpoint of “lessons learned” it was actually really good to see that I need to take care of myself. I had been practicing this physical martyrdom that just wasn’t sustainable. I needed to be happier with myself, and that attitude transferred into decisions I would make for myself later on. 

Can you share a bit on your UCLA program you’ll be beginning soon? 

I start my program in July 2020 and, as I said, I will sub-specialize in male sex and infertility. My ultimate goal is to shift the paradigm of policies around reproductive health. There’s lots of red tape around IVF [in-vitro fertilization] and sponsors and donors. I’ve always felt that minorities often have not been able to tap into IVF because of the associated costs, so I’m hoping to create better access.

That’s incredible. And so, finally, what are you excited about for the future?

In so many ways, I have felt genuinely blessed. In the short term, I’m excited for more travel. Recently I traveled to Greece, and I went to Ghana for New Year's. I try to get away when I can, because I deeply feel that you have to recalibrate in order to continue on. 

On a larger level, I think I’m excited about the tide of women of color that have begun to emerge and to ascend in every realm of society. I’m excited about the true diversity of this country being reflected in everything we do, and I think that value—diversity—is being recognized and respected more. I’m obviously biased because I’m a woman and I’m black, but I think it’s exciting. 

I also get excited about my speciality. Being able to help people have children and an improved quality of life through healthy sex lives. Happy, healthy people create happy, healthy societies, and any way I can contribute to that is great.

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Alysson Perrin, Advanced Practice Registered Nurse & Oncology Nurse Practitioner and Clinical Nurse Specialist

Hi, Alysson! What do you do and how would you describe it to someone unfamiliar with your profession?

I’m an advanced practice registered nurse (APRN). There are four types of APRNs, and I’m licensed to practice in two of the roles, which is rare — a nurse practitioner (NP) and as a clinical nurse specialist (CNS). So when you think of a nurse, you probably think of a registered nurse (RN). RN’s typically work in an inpatient hospital setting caring for the needs of patients who have to stay based on their medical condition. RNs also work in an outpatient clinic or office setting. In both settings, RN’s implement the treatment plan as typically outlined by the physician.

As an APRN, I am an RN with advanced education, training and licensure to assess, diagnose, order tests, and prescribe medications to manage patient medical problems. Depending on the medical needs of the patient, APRN’s can work independently as a medical provider or we can work with a physician to assist in managing their patient population. 

So what kind of setting are you in right now? 

I work in an inpatient hospital setting with adult oncology patients. 

What attracted you to nursing? 

I was always taught that I needed to pick a major that would provide a career that would quickly allow me to pay my own bills. (laughs) But also, I truly enjoy helping people. In high school, I figured out that I wanted to be either a teacher or a nurse. I volunteered at a hospital when I was in high school on summer breaks, but I mostly only filed papers in the medical record room so it wasn’t a good experience. So I thought I would go with teaching. 

In undergrad, I signed up for all the School of Education prerequisites and landed a teaching internship the summer after my freshman year called Summer Bridge. During the internship, college students teach inner-city students for a summer in preparation for the upcoming school year. I taught 7th and 8th grade African and Asian history in Atlanta. While I love kids they can be a handful to say the least. (laughs) And their parents can be quite a handful, too. I realized pretty quickly that teaching was not for me.

I continued volunteering at a hospital in college, and that second time around, I actually had interaction with patients which was such a rewarding experience. In re-considering what other careers would involve helping people and securing a job after graduation, I landed back on nursing. 

What are the highs and lows of nursing for you? 

The highs are that I really get to know my patients. I spend time with them through the trajectory of their diagnosis, during treatment, and at the end whether that means remission or end-of-life care. You get to know their families and close friends as well who are a part of their support team. I appreciate that interaction. It’s very fulfilling for me. In other areas of nursing, you don’t really get the opportunity to know patients as well because they come and go, you may never see them again. But in oncology, it is not like that. It’s really an honor to be able to take care of my patients. I also have had several family members who have had cancer so I feel as if I am giving back. 

The lows are that it can be really sad. Sometimes there is nothing you can do as a medical provider when an outcome for the patient isn’t ideal, or there’s a loss of life. That’s part of working in healthcare. 

That sounds challenging. What would you say are some of the technical challenges you’ve experienced?

In one of my APRN roles as a CNS, I am a part of the inpatient nursing leadership team for the oncology service line, so my focus is supporting nursing staff at the leadership level to provide high quality care. One challenge is getting nurses at the bedside to document patient care in a way that is needed for compliance. Another challenge is coming up with new ways to meet our quality metric goals. An example would be preventing central line bloodstream infections from occurring. 

What do you do for yourself, and for self care? How do you pour back into yourself given how much you’re doing for others?

I love going out to eat and trying new restaurants. It brings me joy. (laughs) I love traveling and  exploring different cities. My last big trip was to Lagos, Nigeria and I had a great time. I also enjoy having quiet time to myself to just reflect and journal. If I’m stressed, I write it down. That’s almost all of the entries because I only really journal when I am stressed. So those are the things that are helpful to me. 

I know you’re in Atlanta which is a city with a large black population, but I’d imagine there are still unique aspects to your experience given the profession you’re in. What is it like as a black woman in a leadership role at a hospital? 

It’s funny because, yes, I work in Atlanta and I used to work in Houston. Both cities have large black professional populations. In my experience, healthcare leadership is not as diverse, with an exception being leadership teams at hospitals that serve a majority black population. 

I have also noticed it’s not just a lack of diversity, but often a considerable generation gap. Many healthcare leaders are closer to the retirement end of things and have been working for a long time. If the leadership role is not nursing related, it is also often male-dominated. For example, executive healthcare leadership teams may only have one woman at the table who is often the chief nursing officer. My concern is that until this generation of leaders retire there won’t be opportunities for a more diverse demographic of health care leaders. In the meantime, I’m frequently find myself trying to fit in professionally with people who don’t look like, who are of the opposite sex, and who aren’t my age. 

Honestly, it can be draining sometimes. It takes energy to fit in spaces that were not originally created for me. But it’s important for me to be there to help these spaces diversify. I’m grateful to have a seat at the table and continue to hopefully move up in healthcare leadership. Hopefully I will have an opportunity to bring individuals from diverse backgrounds into these roles. Because we’re out here! (laughs) 

Do you think that there are industry reasons for why there are not more black APRNs? 

One possible reason is lack of accessibility. If you are working full time it is hard to go back to school to obtain your MSN to become an APRN. Also in nursing school you have to complete clinical rotations which is a part of your training where you learn in a patient care setting outside of your classroom time which also competes with other life priorities. I do think the trend may be reversing, because a lot of nursing programs have more flexibility. So you can go back to school and complete some classes partially online, as well as in person. Some hospitals are doing reimbursements for going back to school as well as repaying loans. Becoming an APRN is more accessible and more minorities, I hope, will take advantage. There are more MSN programs that are accommodating to different lifestyles. 

Can you think back to a big learning moment that really made you feel like you’d really found your footing? 

Yes, my first job as a nurse practitioner. I started and immediately was like, “What did they just teach us in school?” (laughs) It was such a big change from clinical rotations to actually caring for patients independently and making medical decisions for them. I learned that I did actually have all the tools I needed to succeed but that first six months is tough. It’s a role change, and you’re used to working as an RN and—to an extent—having someone telling you what you need to do. Now you’re the one helping to develop a treatment plan for the patient or an RN to follow.

What advice would you give to young women seeking to get into this space? 

I suggest doing your homework. There are lots of different APRN roles. A lot of people just want to get off the floor or out of the clinic so they think, “Oh, I’ll go be an NP.” There’s not much thought to all the types of programs available, or the variety of settings you could work in as an RN. So people are choosing programs where there are so many people going into that specialty you may have trouble getting a job post graduation. I would recommend considering what your priorities are and the work environment you want, and do your research. Take your time to figure out what is best for you.

When you think about your future, what makes you excited? 

I think what makes me excited about my future is the impact I can have at different levels. I think I’ve realized no matter what role I have or what level of nursing I am at, I can make an impact and bring a different perspective and a different set of experiences to the table. Most people don’t do multiple APRN roles. They usually only have the credentials to do one of the four. I think what makes me excited is  knowing I have an advantage because I understand both the behind the scenes leadership side of healthcare, and also the direct patient care side of healthcare. That sets me apart and creates a lot of unique opportunities for me to explore.

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