This Side of Doctoring: Reflections from Women in Medicine

Foreward

I've never been so glad to be proven wrong. When the idea of this anthology was first proposed, I was skeptical and hoped that Eliza wouldn't be too disappointed when so few women responded to her call. That so many physicians put their emotional and creative and feminine sides on hold during training, and never recover them, also seemed likely to doom this project. But behold the assembled voices of more than 140 women physicians, each authentic and strong. While this compendium cannot span equally well the universe of women physicians and underrepresents some, most women will discover in this book connections to a welcome network of like experiences.

Male readers will find this compendium valuable in quite another way. A brief anecdote illustrates why. I'm among the thousands who are grateful for the mentoring of Dr. Carola Eisenberg. Carola was the first woman in a decanal position at MIT prior to becoming the first woman dean of student affairs at Harvard Medical School. During the 1970s, women residents as well as students discovered in Carola a much needed beacon of sanity and support as, despite dramatic increases in the numbers of women trainees, the "gender climate" remained decidedly chilly. She began opening her home on occasional evenings to the residents so they could share with each other their stresses and coping mechanisms. Her fine husband, Dr. Leon Eisenberg (then chair of Harvard's Department of Social Medicine) told me that he did not understand why these very bright and obviously highly competent women needed extra help. But one evening while making himself a cup of tea in the kitchen, he overheard the voices coming from the living room. He remained transfixed for the next hour or so while lightbulbs flashed on. He had flattered himself to be a champion of equal rights for women but had simply failed to see what went on right in front of his eyes in the mostly male faculty groups he was part of every day. Thus, the ancient power of stories to draw in, to educate.

In Writing a Woman's Life, Carolyn Heilbrun (1988) urges women to write their stories because "power consists to a large extent in deciding what stories will be told." Women professionals looking for their foremothers' stories find comparatively few published ones. And as Heilbrun notes, the women's stories that have been published "are painful, the price [has been] high, the anxiety is intense, because there is no script to follow . . . let alone any alternative stories." Actually, women seeking to combine family, love, and work still lack anything resembling a script; no journey myth works either (Odysseus?). Each woman is still devising her own path on a far from level playing field, dodging unexpected paradoxes-for example, treating other people's children in the hospital while hers are sick at home or professional isolation whereas the experience for men is highly social and socializing.

Most of this book's entries pose questions that converge around three main themes interweaving across the chapters: Who am I in relation to my family? Who am I in relation to my patients? What about my own plans and ambitions? With regard to the latter, as More (2000) noted in her study of women physicians, the effects of "choice" and "necessity" remain more tangled in women's than in men's careers. As McClelland (1967) observes, "A woman's success is less easily visible [than a man's who is following a single course] . . . because it consists of the sum of all these [part-time] activities." But as Williams (2000) shows in Unbending Gender, "women do not prefer marginalization. . . . What is needed is not a mommy track, but work restructured to reflect the legitimate claims of family life."

To focus first on who a woman physician is vis-à-vis her family, tensions around women's multiple roles begin even before medical school. During their medical school interviews, many contributors were asked questions such as, "Why don't you want to be wife and mother?" At the same time, Linda Clever ironically notes, "Being a physician is one of the few socially acceptable reasons to abandon a family." Catherine Chang speaks for many when she says, "I have so much to say, it is difficult to find the words. . . . the struggle to balance my career and family . . . constantly tears at me." Cynthia Kapphahn confesses, "The sheer determination that helped get me through medical school and residency has proven quite useless in my family life. . . . instead, intuition, patience and a form of 'non-effort' are required." Marcia McCrae advises women to give up idea of balance: "Don't be frozen in the middle. . . . learn to prance, slide, skip, skid, and skitter from one end of the see-saw to the other." Laughter is also recommended; Patricia Temple found herself "at the park when the children had runny noses and wet diapers and all I had in my purse was a stethoscope." Linda Clever offers strategies on keeping family glued together and enjoying each other: "negotiate, accommodate, and recreate." Finally finding statement is the emptiness that can occur when women wait too long "to fit the mystical process of reproduction into the unerringly practical cycle of our professional production" (Sayantani DasGupta).

In Barbara Sommer's words, medicine still demonstrates a "pervasive lack of seriousness toward women who want an academic career while providing a loving environment for their family." Thus, most women physicians are still patching together individual solutions and shoehorning their professional and second-shift responsibilities into structures created by men with full-time support at home. The continuing tyranny of dualistic thinking-for example, either you're fully available during your 20s to 40s to work or you'll never reap academic rewards, either you're tenured or nontenured-remains beyond the scope of this book (McElvaine, 2001). But such systems issues beg to be addressed, given that (a) youth is associated with neither scientific achievement nor clinical acumen, (b) women physicians (at least in primary care) tend to be most productive between age 50 and 60, and (c) we cannot afford to waste medical careers, involving substantial public investment (Etzkowitz, Kemelgor, & Uzzi, 2000).

As McMurray and Jordan (2000) have written, "Medicine is particularly appealing to women because it offers the opportunity to have significant intellectual stimulation embedded in a relational context." For physicians, family and professional roles can enrich each other in unexpected ways. Daphne Miller remarks, "The moments of talking with patients about my conflicts and challenges [regarding family responsibilities] have helped me become a wiser doctor and mother, and they have bolstered the confidence of my patients in their ability to care for themselves and others." But witness the contrasts between the days when physicians had opportunity to talk with patients along such personal lines and today. As Lucy Candib declares, "I have chosen to remain in one setting for the past 15 years. . . . A doctor used to be a person who came and stayed . . . in the community." Not only is this community orientation much less common now, but the increasing corporatization of medicine can put physicians at war with patients, as Julia McMurray here notes, "New patients are enraged at the more than three months' wait for a physical. They feel betrayed by the slick advertisements . . . there just doesn't seem to be enough time for them to begin to trust me . . . I am simply heartsick."

Negative influences on the patient-physician relationship are indeed disturbing. But one of the strengths of the book is that contributors wear their hearts on their sleeves. The poetry here comes from the heart too: "Babies . . . slippery as chance" (Alison Moll); "Your love cut through the layers of my . . . shield" (Kathleen Franco); "the hospice within, buried in fertile soil, germinates and flowers tubular fruit" (Stephanie Nagy-Agren); and "Rare/restive respite, only briefly restful/the press of things undone still live and warm" (Mary Clark). Nassim Assefi discusses how writing complements her medical work: "We trace anatomical landscapes with our hands and battle pathology with the latest technology . . . the professional culture . . . fosters disagreement with the emotional realm . . . [But] with fiction, I get under the skin and am able to express processes at work in human life that cannot be explained in a medical textbook." Even women who don't consider themselves writers are advised, "Keep a journal of your stories. They are the vitamins that will help you grow as a person and in a profession . . . a roadmap of where you have been and where you are going" (Beth Alexander).

This collection is a vibrant and accurate roadmap of the past and present of women physicians. I also read it as Acts 1 and 2 of a drama with tragic, comic, and poetic elements. Act 3 is about to begin.

References

Etzkowitz, H., Kemelgor, C., & Uzzi, B. (2000). Athena unbound: The advancement of women in science and technology. Cambridge, UK: Cambridge University Press.

Heilbrun, C. (1988). Writing a woman's life. New York: Norton.

McClelland, D.C. (1967). Wanted: A new self-image for women. In R. J. Lifton (Ed.), The woman in America (pp. 187-188). Boston: Beacon.

McElvaine, R. (2001). Eve's seed: Biology, the sexes and the course of history. New York: McGraw-Hill.

McMurray, J. E., & Jordan, J. (2000). Work in progress: Relational dilemmas of women physicians. Wellesley College, MA: Stone Center.

More, S. E. (2000). Restoring the balance: Women physicians and the profession of medicine, 1850-1995. Cambridge, MA: Harvard University Press.

Williams, J. (2000). Unbending gender: Why family and work conflict and what to do about it. New York: Oxford University Press.