Introduction
A friend once had to tell Dr Anastacia Awad's colleagues, in plain terms, that she needed to go to the emergency room right now. She was a rising scientist in New York City, exhausted, swollen, running on denial, and convinced she was simply not working out enough. Her body had been sending warning signals for months. She had built her entire identity on pushing through, and pushing through nearly killed her. This is a conversation about what happens when the story you tell about who you are stops matching what your life is actually costing you.
The Bathroom Stall Moment That Shaped a Scientist
Anastacia Awad traces her drive to know everything, to never be caught unprepared, back to a moment at five years old. At a summer camp in Louisiana, faced with two unmarked toilet stalls, she guessed wrong. The wall was shorter than she realised, other children gathered and laughed, and she walked out humiliated. In a conservative environment where little girls were expected not to embarrass themselves, the moment became formative.
She decided, as a five year old, that she never wanted to be caught not knowing again. That decision hardened into a philosophy that carried her through school, through a rejection letter she still keeps, and eventually into a hospital bed. The instinct to always have the answer, to always be prepared, is a strength until it becomes the reason someone ignores what their own body is telling them.
Excellence Without Confidence: Growing Up Surrounded by Brilliance
Awad grew up in a family that prized education. Her parents met at university, her mother taught school, her father had what she calls a stem brain and an artist's temperament. She was placed in magnet programmes and academically selective schools throughout her childhood, environments built to produce excellence.
What she found, though, was that being surrounded by equally brilliant peers did not build her confidence. It undermined it. There was always someone a little better, a little faster, a little more assured. She graduated with a full scholarship and every academic marker of success, and still did not believe she was smart. Confidence, she learned, is not built by proximity to excellence alone. It is built by being seen as fully yourself within it.
Finding the Majority: What an HBCU Taught Her About Belonging
Everything shifted when Awad enrolled at Florida Agricultural and Mechanical University, a historically black college. For the first time in her life, she was in the majority every single day, surrounded by people who looked like her and thought like her, focused on the same future.
She describes it as intoxicating. Her stress levels dropped. She could walk into any social situation and understand the norms without translating herself first. It was there, not in the high-pressure magnet schools, that her confidence actually grew. It was also where she made her first independent decision about her own life, switching her major from premed to straight biology because she preferred research to clinical practice. Small on paper. For her, it was the first time she chose a direction based on what she wanted rather than what her parents had mapped out for her.
The Rejection Letter She Still Keeps
When Awad applied to a graduate programme at the University of North Carolina at Chapel Hill, she was turned down. The letter told her, in careful language, that she hoped to find a programme better suited to her. She has never thrown it away.
Instead of retreating, she mapped out a plan. She went to a different graduate programme in Michigan for a year, worked at a punishing pace, ran four lab rotations, published, and built a reputation as the student everyone wanted to write a reference for. Then she reapplied, not to one programme at Chapel Hill but to three. She was accepted into all three, including the one that had rejected her the first time, and chose it. The letter stayed in a drawer as proof of what was possible on the second attempt, not evidence of what she wasn't.
New York City and the Question of Who You Really Are
Moving to New York for postdoctoral research at Memorial Sloan Kettering Cancer Center forced a different kind of reckoning. She describes her first year there as the year the city forces you to ask yourself who you are. The social rules were unrecognisable against the ones she'd grown up with in the South: no small talk with strangers, constant competition, a transactional edge to relationships she wasn't prepared for.
She had a choice, she says: bend into the version of herself the city seemed to reward, or hold onto her values and let the city reveal a version of herself she'd suppressed to fit in growing up. She chose herself, but it was a different self to the one she'd been in the South, one that was more eclectic, more curious, more willing to talk to anyone about anything. New York didn't change who she was. It gave her permission to stop hiding parts of who she'd always been.
Ignoring the Body: How Denial Nearly Killed Her
This is where the identity she'd built, the one that pushes through anything, turned dangerous. Awad was exhausted constantly. Her legs and ankles swelled on every flight. She had night sweats that soaked her bed. Her menstrual cycles had become abnormally long and severely painful, bad enough that she would lie down in the lab and wait out the pain before walking home. She developed intense, specific cravings for chickpeas, which she now knows was her body signalling a severe iron deficiency from anaemia.
She explained all of it away. Not enough exercise. Just what happens when you fly. Just New York. It took a friend physically walking her to a doctor's appointment, and then a specialist seeing her blood work and telling her, without ceremony, that she was looking at roughly thirty days if she did nothing, for the seriousness to land. Even then, she tried to finish a lab experiment before going to the emergency room. Her blood levels were so low the specialist said he didn't understand how she was still functioning. "I think it was absolute denial," she says now. "I had that whole thing of, I'm going to be strong, I'm going to be smart, I can do anything, and I'm not going to let anything get in my way." The identity that had carried her through every academic setback nearly cost her, her life.
Two Months of Stillness: Rebuilding a Life Around Truth
Awad needed a blood transfusion, four units, before she was strong enough for major surgery. The surgery itself had life-threatening complications. She spent five days in hospital afterwards, then two months recovering at her mother's home in a small town in Louisiana, watching crawfish in the yard and doing nothing that resembled her old pace.
That stillness did what New York's relentless motion never could. It gave her the space to ask who she actually wanted to be, not the version her parents had mapped out, not the version the lab demanded, but the whole of her: someone who loved science and also loved people, connection, and curiosity that had nothing to do with a bench. She decided to leave hands-on research for what she called scientific administration, work that supported science rather than performed it directly. Telling her PhD mentor felt, she says, like a confession. She had internalised a belief that leaving academia for pharma meant she had failed as a scientist. Her mentor laughed, called her a silly goose, and told her to live her life for herself. It was, Awad says, a release she couldn't yet give herself.
From Bench Science to Systemic Change: Building Inclusion Into Everyday Decisions
That decision led her into a career building diversity, equity and inclusion work inside a major pharmaceutical organisation, work she now leads globally across a division of roughly seventeen thousand people. She started by running scholarship and training pipelines for students who, like her, faced barriers of geography, income, or being first in their family to attend university. Many of those early participants are now leading in their own fields, and she still hears from them.
Her more recent work goes further than standalone programmes. She has pushed to embed inclusion into the ordinary decisions scientists make every day, not as a separate initiative but folded into how experiments are designed, which patient populations are considered, which data gets asked for. She calls it her cauliflower mashed potatoes approach: sneaking the thing people need into the thing they already want. Her stated vision for the field is a future where a doctor's recommendation is built on a patient's molecular and genetic profile rather than assumptions drawn from how they look. It is, in effect, the same principle that saved her own life turned outward: pay attention to what the evidence is actually telling you, not what the story says should be true.
