Pulling Back the Curtain: Ifeyinwa (Ify) Osunkwo, MD, MPH

Ify Osunkwo, MD, MPH
Clinical associate professor of medicine at the University of North Carolina at Chapel Hill and the director of the Sickle Cell Disease Enterprise at Atrium Health’s Levine Cancer Institute in Charlotte, North Carolina.

In this edition, Ify Osunkwo, MD, MPH, talks about her childhood in the Bronx and Nigeria, growing up with four sisters, and the friendship that persuaded her to specialize in sickle cell disease.

What was your first job?

When I was 13 years old, I worked as a kitchen aide at a private hospital in a small town in Nigeria, where my mother ran her own licensed practical nursing school. She provided nurses for the hospital when they needed staffing. So, when I was looking for a job, she went to the hospital CEO and said, “My daughter wants to go to medical school – can she come and work at your hospital to get experience?”

He agreed, but the only available position was in the kitchen. So, I worked there for a summer, then transferred to the pharmacy the next summer, and then worked as a nursing aide the summer after that. I completed my licensed practical nursing training and worked on the nursing staff at the hospital before I ever went to medical school. Living with my mom, you really had no choice! Eventually all four of us kids became doctors.

Did you always know you wanted to go into medicine?

I remember the specific moment when I fell in love with medicine: When I was about four years old, I had a severe asthma attack and my parents took me to the pediatrician, who was a sweet, older gentleman. I took the medicine he gave me and – boom – I felt better! To a four-year-old, it was like magic!

So, from that point on I knew I wanted to be a physician. But, medicine was all around us growing up; my parents were both involved in health care (my mom was a nurse and my dad was a medical lab tech), and I had two older sisters who also wanted to become physicians. Initially, I thought about becoming a pulmonologist so that I could treat asthma, but that idea lasted about a month after my oldest sister died of a severe asthma attack during my second preclinical year of medical school. After than I fell in love with hematology.

What was it that made you fall in love with hematology, and eventually with treating patients with sickle cell disease?

My earliest memory of becoming aware of hematology was spending time with my mom. I tagged along when she conducted community health education events, which included raising awareness about sickle cell disease and making sure families had penicillin and folic acid and that children received their vaccines. You see, Nigeria has the highest prevalence of sickle cell disease worldwide. I would also go with her to offshore oil-drilling platforms to vaccinate the workers, and watch her teach about preventing anemia from malaria using mosquito nets and taking antimalarial prophylaxis. That was when I started thinking, “Hematology is all kinds of cool.”

Then, when I went to medical school, it so happened that, every time I started a new rotation, I was assigned to a hematologist. So, if I was on a pediatric rotation, I was with a pediatric hematologist. It was like fate.

To cap it all off, I had a good friend whom I met during my first year of medical school who was living with sickle cell disease. He died the year I graduated. He had six younger brothers, all with sickle cell disease and all of whom died while I was in school. When he died, I was devastated, and I looked at this family and I thought, “This shouldn’t be happening. When you hear ‘sickle cell’ in Nigeria, it’s like a death sentence. That’s just unacceptable to me. We should be able to do better than this.”

Dr. Osunkwo (second from right) with her husband and their three children.

What brought you from Nigeria to the U.S.?

I had the best of both worlds growing up. My parents are originally from Nigeria and they migrated to the U.S. in the 1960s on separate scholarships. They got married in New York City and we were all born in the Bronx. When I was seven years old, my dad decided he was tired of the cold weather, so he went back to Nigeria. We stayed in the U.S. for one more year, then went and joined him in Nigeria. I feel lucky to have experienced life and medicine in two very different continents

After graduating from medical school and completing a yearlong internship in Nigeria, I came back to the U.S. – earning my master’s in public health from Johns Hopkins University, doing my residency at the University of Medicine and Dentistry of New Jersey (UMDNJ), and completing my fellowship at Columbia University.

What was your childhood like, growing up with four sisters?

It was fun – except that my mother used to dress us alike … When we were in New York, the area we lived in was mostly Caucasian, and we were the only black family. Sometimes we felt a bit weird, and there were racial tensions, but, as kids, we didn’t feel it. When we left to join my father in Nigeria, we were not happy with such a drastic change, but when we got there, it was great! We were treated like princesses – the interesting “new kids” who spoke with funny Yankee accents.

My parents got divorced a few years later, so my mom ended up raising us on her own. Money – and space – was tight. To get through it, I poured myself into school. Middle school and high school were a blur because I was so focused on where I wanted to go, and that didn’t stop once I got to medical school; it was all about achieving and being the first in my class.

Were there any mentors or advisors who played a big role in shaping your career?

I’ve been blessed to work with amazing individuals throughout my career. My chief resident at UMDNJ, Patricia Morgan, MD, was a lifesaver. She taught me everything about actually being a doctor and basically walked me through how to be an intern, how to talk to and develop a rapport with patients,  and how to put in orders. Interestingly, when I applied to my job now at Atrium Health, the interviewer said, “Did you know that Pat’s here? I see you went to UMDNJ around the same time.” I said, “What do you mean, ‘Pat’s here?’” It turned out that she was working with kids and teens at Levine Children’s Hospital also at Atrium Health, so it was a happy reunion.

My fellowship director, Linda Granowetter, MD, also taught me so much about how to be a clinician. She was very smart and very skilled, but also a very down-to-earth, no-nonsense person. When I was a new mom and trying to juggle that with fellowship, she told me something that has stuck with me to this day. She said: “Ify, you have a great job, but please don’t make your job your life. Take care of your husband. Take care of your children. Figure out how to get some balance.” Those words are a constant refrain in my head whenever I feel my life getting off track.

James Garvin, Jr., MD, PhD, was my clinical fellowship mentor. He reminded me of my medical school mentor and watching him help me model what type of patient provider interactions I wanted to embody.

I credit my fellowship director Mitchell Cairo, MD, with teaching me how to write my first book chapter, first clinical protocol, and first manuscript. He was a kind of “task master” but I realized later that I needed that! He helped launch my clinical research career and I was delighted to moderate a press briefing at the 2018 ASH annual meeting with Dr. Cairo as one of the panelists. Talk about coming full circle!

During my time at Emory University, I met and developed a great friendship with James Eckman, MD, who ran the adult sickle cell program at Grady Memorial Hospital in Atlanta. We got along instantly (maybe because he reminded me of the pediatrician I saw when I was 4 years old…), and if I ever need anything, I’d just pay him a visit.  That’s still the case today; when I call him, day or night, he answers the phone and we can talk for hours. He was an extremely patient individual who was very thoughtful and spent time with me talking about my career and offering wisdom and guidance for my personal life. I loved that, even though I was younger in my career, he talked to me like I was a peer. He’d walk me through career-related questions, complicated patient scenarios, treatment decisions and offer me sage advice on everything, from how to talk to people, how to get what I want, and how to not have a temper tantrum when I don’t get what I want. I may not always have heeded that advice, but I’d usually call back and tell him, “Jim, I really should have listened.” He would just say, “Well, you’ve got to learn.”

In 2009, I participated in a research training institute led by Betty Pace, MD, as part of a National Institutes of Health–funded initiative to increase minorities involved in research. This was a career-changing experience that helped catapult my career as an established clinical, translational, and outcomes researcher, and led to success with grantsmanship and academic productivity. Dr. Pace remains a trusted friend and mentor.

I’m extremely fortunate to work for Derek Raghavan, MD, PhD, as well – and I’m not just saying that because he’s my boss at Atrium Health (though he has been the best boss I’ve ever had). He’s direct, fair, and can tell me hard things that I may not want to hear in a way that makes me hear them. We share the same passion for health equity for underserved populations, and he has given me amazing opportunities to create a system of care for individuals living with sickle cell disease.

As a minority woman, I truly value the mentorship of Belinda Avalos, MD, who helped recruit me to Levine Cancer Institute. She has been a wonderful role model on how to exhibit dignity and grace under pressure and is my biggest sponsor and career cheerleader. It helps to have someone like her in your corner as you grow in your career.

What lessons has your work life taught you? Are there any pieces of advice that you would share with younger hematologists?

The first thing I learned is to appreciate the different personalities of everyone who you work with, in and out of the hospital. Not everybody is like me, and that’s okay. Everything I do, I do with a lot of passion. I can be pretty intense, and I can overwhelm folks with my passion. Other people might not get as excited, but that doesn’t mean that they are less effective or not as interested in the work as I am.

I’ve also learned that it is okay to fail. I’m an extremely competitive person; with myself and with others – probably because I was the middle child of five kids and I had to fight to get a piece of pie before it was all gone. I even compete when there is no competition, like trying to best my fastest speed on the treadmill at the gym. Ultimately, I’ve learned that I don’t have to get an ‘A’ all the time. I don’t have to be the first in everything and “failing” is not always bad. What I might think of as failures are learning opportunities. For example, I failed my first pediatric hematology/oncology boards and I was devastated. I had never failed an exam in my life. I felt shame and a lot of fear … but my competitive nature kicked in and I was able to get through the retake successfully. I’ve also had so many grant rejection letters that I stopped counting them; each of those rejections, though, just made me better at writing the next grant.

You mentioned learning to find balance between your work and personal life – what makes that difficult, and do you have any advice for finding that balance?

It’s a struggle, and I tip into an imbalance pretty often, especially when I have an exciting project that I’m working on, but my husband is the most patient, amazing partner I could dream of. We have two daughters and one son, and my husband is an attorney with his own practice a mile from the house, so a lot of the responsibilities of dropping off and picking up the children fall on him. I think the fact that we have been married for more than 21 years is actually one of my biggest career accomplishments.

I made a real effort to set better boundaries for my personal life after I had a rough patch at work a few years ago. I looked around and I saw that the people who were there for me was my family. So, I said, “Okay, I need to start over and make time for the people who are always going to be there. Work people come and go, but nothing is so serious that it should come before my family.”

I love my job, of course, but I’ve learned to say no to certain commitments. For example, before I had that “a-ha” moment, I would finish my work in the clinic around 5 p.m., then I would see patients at the hospital until 9 p.m. I gave everyone my cell phone number and made sure that I was available 24/7. I would bring work home regularly. There was always something more to do and I always made myself available to do it.

I don’t do those things anymore – not because I don’t love my job, but because I need to give my kids and my husband some part of me. If one of my kids asks me to spend time with them, I know that I need to be there for them.

How do you spend that time that you’ve carved out for yourself?

I love dancing and I love to sing. If there’s a party, I’m there in my stilettos and there better be a good DJ. I’m sure most people think I’m a big extrovert, but I also need to spend time relaxing in quiet at home in my own space. In my quiet time, I love to read short romance novels to take my mind away from the present. I have a collection of more than 500 novels I’ve read since fellowship.

Who is your dream dinner party guest?

I would love to have dinner with Michelle Obama. I have so many questions for her: How do you get your buff arms? How do you balance your work and your family life? How do you stay so calm and collected in the face of all the drama? What do you want to be when you grow up?

She never looks stressed, or upset, or frazzled – and that’s something I aspire to, because, I must admit, my inherent personality is quite the opposite.

What is one thing that people would be surprised to learn about you?

I have dyslexia, so I invert letters and numbers when reading, dialing the phone, and writing. I also have attention deficit hyperactivity disorder (ADHD). It’s not something I shared with many people because I was embarrassed by it. Once, during medical school, I showed up to an exam on the wrong day because I read the calendar wrong, and the test administrator turned me away. It was devastating. So, I learned to hide the fact that I was dyslexic. I also have two children with ADHD. It is quite humbling to have children with a chronic illness and to battle one yourself as a physician. People expect you to be super human. But, in the past couple of years, I hit a brick wall and realized that I had to tell my boss because, of course, the higher I went in my career, the harder it was to cover up these challenges.

I’ve learned to be a better patient with managing my asthma. I also have severe food allergies to nuts, mushrooms, and shellfish. Now I must disclose this to anyone and everyone as I have experienced a few near-death anaphylactic events in my life!

When I started sharing with people about my dyslexia and ADHD, I noticed that they were more understanding about some of my quirks. Like, now they know why I need information presented in a certain way with visual cues, why I need frequent reminders (preferably via email/text), and why I strive for consistency with my clinic schedule. I’m great with the big picture, but I need collaborators who have an affinity for the smaller details. Before, people might have been aggravated by these things, or just assumed that I was extremely demanding, but now they understand that this is part of the structure that I’ve created for myself to be able to do things more efficiently.

Living with food allergies, asthma, dyslexia, and ADHD has also taught me that everybody struggles with something – sometimes we know what it is, and sometimes we don’t. I realize that this is what makes us all human, to our colleagues and to our patients. It also makes us more empathetic of others. I really think it has helped make me a better physician.