A Look Back: Personal Growth, Empathy & Strength with Peomia Chela Brown, MD

I remember the particular quiet that settles over an ICU right before rounds—monitors still talking, ventilators still breathing, but the human part of the room holding its breath for a few seconds.

That’s where empathy either becomes real, or it becomes theater.

In Episode 3 of The Last Zebra, I sat down with Dr. Peomia Chela Brown, a pulmonary critical care and sleep physician whose career has taken her from South Carolina to Louisiana, through pandemic-era medicine, and into the kind of work where you can’t hide from people on their worst day.

Early in our conversation, she named something that many high-achievers think they’re alone in feeling: “my mentality and my emotion is set at imposter. I’m not supposed to be here.”

That sentence still lands.

Not because imposter syndrome is new, but because it’s often treated like a small private insecurity—something you fix with affirmations and accomplishment.

Dr. Brown talks about it as something heavier: a constant internal negotiation while you’re also expected to perform flawlessly.

“I don’t think there was a space… to even be vulnerable at work,” she said, “because you have to perform.”

If you’ve never worked in an ICU, it’s hard to explain how quickly a room can demand the most technical version of you and the most human version of you at the same time.

You’re reading arterial blood gases and watching a family read a face.

You’re calculating doses and calculating hope.

The idea that “empathy matters” is easy to endorse.

The harder idea—still the one worth keeping—is that empathy is not a personality trait. It’s a practice. And like any practice, it costs something.

In critical care, empathy costs time you don’t have.

It costs emotional energy after you’ve already spent your cognitive energy.

Sometimes it costs your own sense of safety, because you have to be honest with people who are desperate for certainty.

What I appreciated in this episode is that Dr. Brown doesn’t romanticize that cost.

She describes the weight of being a Black woman in a field that can be bluntly hierarchical, often male-dominated, and not always generous with the assumption of competence.

And then she speaks about grief.

With “full transparency,” she shared that she had a stillbirth—“delivered her, got pregnant again, had a baby, and moved.”

I’m not repeating that detail for effect.

I’m repeating it because medicine has a habit of turning personal loss into a footnote, even when it reshapes how a clinician meets the world.

A stillbirth is not “a bad outcome.”

It is a death.

And when you return to work after something like that, you don’t return as the same person who left.

What still holds up from this conversation is the way it connects three things we often keep in separate folders: professional identity, personal grief, and the daily work of showing up for other people.

Patients don’t ask whether you’ve suffered.

They ask—implicitly, constantly—whether you can stay present with them while they suffer.

The irony is that the systems that produce excellent clinicians are often the same systems that discourage the very vulnerability that makes presence possible.

So what should a reader or a patient take away from this episode, two-plus years later?

First: if you’re in a helping profession and you feel like you “have to perform” even when you’re empty, you’re not weak—you’re describing the default setting of modern work.

Second: if you love someone who is constantly “fine,” consider that their competence might be a form of self-protection.

Ask different questions.

Not “How was your day?” but “What did you carry today that you didn’t get to set down?”

Third: if you’re the patient, it’s okay to name what you need beyond the plan.

You can ask, “Can you tell me what you’re most worried about?”

You can ask, “What would you do if this were your family?”

Those questions don’t replace science.

They make room for humanity inside it.

And finally, for the clinicians reading: the work is technical, yes. But it is also relational.

Your knowledge matters. Your judgment matters.

And the smallest thing that still matters—maybe the thing that matters most when nothing else can be fixed—is the steadiness you bring into the room.

If this episode resonates with you, reply and tell me what empathy has looked like in your life lately—given, received, or withheld.

Dum spiro, spero. — Ugo