Women in Medicine & Life

I once heard a quote attributed to Jean Paul Sartre, something to the effect, “I prefer the company of women because men talk about their work, while women talk about their lives.”  Despite a lot searching, I cannot verify that quote.  If anyone knows the actual quote, or the actual source, please share below.

But it occurs to me that this is what women often bring to medicine.  College, medical school and residency are great gush, and a rush, of information and learning.  It is geek city.  That was doubly true when I trained at Charity-New Orleans, which had a number of snarky pseudo-mottoes, one of which was, “At Charity you see everything.

“Twice.”

And it was true. I remember a couple of osteopathic students who were rotating through the Charity ER.  They had been taught they would never see goiter, an enlargement of the thyroid glands in the neck.  They saw two of them in the ER waiting room.

I also remember admitting a woman to the Tulane gynecology service with agenesis of the vagina (i.e., she was born without one), an incredibly rare condition.  In the bed next to her was an LSU patient…

…with agenesis of the vagina.^[2]The wards each contained 10 beds; it wasn’t until the 1950’s that Charity stopped sleeping two to a bed.  They were immediately great friends.

Charity, like much of medical training, was a constant slack-jaw experience.

Then doctors finish training, and start practicing.  For a while, that’s a kind of madness, learning a new routine, learning to manage an office and finances, seeing patients, and learning the social and political nuances of hospital and medical practice.

But at some point after that, no matter what the specialty is, it’s pretty much the same 20 diseases day in and day out. There are a number of other conditions in addition to those 20 that show up occasionally, that the practitioner feels comfortable treating.  But for most diseases beyond those, you generally refer the patient to a specialist who counts the disease among his/her 20 diseases.  It’s just too time consuming to study and keep up with a disease you’re not likely to see again.

So many of us become jaded doing the same thing over and over.  Which can make doctors a pretty sour bunch.

Except for those doctors who are interested in their patients’ lives.  Because the diseases, the tests, and the therapies may be the same thing over and over, but the people are infinitely variable.  Who they are, how they live their lives, and how their diseases affect them and their families, are endlessly complicated.  And so they can be endlessly fascinating.

Medicine is a rare insight into humanity and the human condition.  Writers such as Anton Chekhov, John Keats, Sommerset Maugham and Sir Arthur Conan Doyle were all doctors, as were many other writers.  Medicine is a great source of inspiration about what life really look likes.  As a physician, people sometime share things with me that they have never told anyone, sometimes on the first occasion that I meet them.  House calls have fallen out of fashion, which is a pity, because that is also a revelation for understanding people.

And it seems to me that – again, on average – women are more interested in people than men are.  I have known some very compassionate men, and I have occasionally been around women who were ruthless.  With that, bedside manner isn’t always paramount, primary practice isn’t always the primary consideration.  If you have a rare brain tumor, you don’t care if the neurosurgeon has Darth Vader’s personality as long as he’s good at what he does.

But for most of medicine, for the mundane, a mundane approach is desirable. Not just in medicine but everywhere; most of life is nothing exciting, it’s doing the same thing over and over.  The lucky people are those who find joy in the quotidian, who see the importance of it, and who have the commitment to do it conscientiously.  Which to my mind seems to describe more women than men. If you disagree, or even if you are offended, please respond below.  To quote Tom Lehrer, “If something I say offends you, not only will I retract it, I will deny having ever said it.”

But I make these observations because I am beginning to think they are important far beyond medicine.  In industry and government, I see the same problems, that to do a job well takes a lot of commitment, and patience, and attention to detail.  And a lot of concern for people.  So much of government and industry is testosterone ambition and puerile impatience, striving to move on to the next conquest, the next innovation, the next excitement.  Just look at Washington and Wall Street.

It seems to me that when women are in the mix, they are the ones to focus on the critical but less exciting aspects, they are often the people who lead to gradual, but solid progress. It’s like a reverse of the traditional stereotypes, it is the men who are emotional messes as they chase after excitement, while women are the calm, logical thinkers.

What is the solution? I am not sure. There is a long, ongoing tension over women staying at home with the children vs going into the professions with the men.  I am enthusiastic about women doing whatever they choose, and I want all options open for my daughter.  What bothers me about the debate is tucked inside of it is the implied message that motherhood is not a worthy activity for a person of intelligence and education.

I am always a bit awed and humbled by dedicated mothers, as I am by dedicated teachers.  When I take over with our kids, I am aware that I simply do not have the same patience that my wife does.  And I also watched her as an instructor at the University where she was extremely popular, and motivated quite a few students to study further in Spanish.  To dismiss what mothers and teachers do is, to my mind, to choose a masculine drive for power and juvenile excitement over a feminine interest in people and mature craftsmanship.

So I would like to see more women taking care of people – all of us – in medicine, government and industry.  But I would also like to see them taking care of the little people who tomorrow will become medicine, government, and industry.

And there just aren’t enough women to go around.

Picture courtesy of Flickr:  Gugeegue, Marshall Islands (July 9, 2013) – Susan Opas, a pediatrician volunteer with Project Hope, lets a child patient listen to her heartbeat with a stethoscope at a medical civic action project during Pacific Partnership 2013. Working at the invitation of each host nation, U.S. Navy forces are joined by non-governmental organizations (NGOs) and regional partners that include Australia, Canada, Colombia, France, Japan, Malaysia, Singapore, South Korea, and New Zealand to improve maritime security, conduct humanitarian assistance and strengthen disaster-response preparedness. (U.S. Navy photo by Mass Communication Specialist 2nd Class Carlos M. Vazquez II/Released)