10 year anniversary


It's been ten years since my book When the Personal was Political  was published.   It was a frantic summer, trying to put it together while the publisher, iUniverse, was merging with another online publisher.  To say that they were not focused on my book was an understatement.

Ten years on,  my central thesis, that the experience of a woman doctor is different from that of a man doctor, is hardly disputed.  People are familiar with the concept of implicit bias and women are fighting again for wage equality.  But at the time, there was a lot of push-back from men and women who felt that we women doctors should just be grateful to be in medicine at all.  It was unseemly to draw attention to our less-than-equal status.  I have always been susceptible to this argument, which in one sense is practical advice.  Assertive women are judged pushy and aggressive.   The "angry black woman" is an enduring stereotype.  On the other hand, nothing changes if we don't speak up.  There's a wonderful essay by C.L.R. James where he addresses the accusation that he is showing poor sportsmanship by pointing out the discrimination against black cricket players.  He says, "What do they know of cricket, who only cricket know?"

As I near retirement, I am proud of my years as a primary care doctor and my later years in the disability program of Social Security.  We were an altruistic generation and many of us shared the goal of treating every patient with dignity and fairness. We advocated for our patients because that felt comfortable in our doctor role.  It still does not feel comfortable to speak to our colleagues about fairness in the workplace.  

Reading discovery

Sometimes I come across a book that explains so much, answers so many questions that I never quite formulated much less asked, that I regret that I am reading it so late in life.   The book The Varieties of Religious Experience  by William James, lectures that the psychologist delivered "at Edinburgh  in 1901-1902" is such a book.  It's a synthetic work, which doesn't get bogged down in the details of individual beliefs but offers a grand overview of what we talk about when we talk about religion.  Here's a favorite quotation, from the chapter on mysticism:

 "Most of us can remember the strangely moving power of passages in certain poems read when we were young, irrational doorways as they were through which the mystery of fact, the wildness and the pang of life, stole into our hearts and thrilled them.  The words have now perhaps become mere polished surfaces for us; but lyric poetry and music are alive and significant only in proportion as they fetch these vague vistas of a life continuous with our own, beckoning and inviting, yet ever eluding our pursuit.  We are alive or dead to the eternal inner message of the arts according as we have kept or lost this mystical susceptibility."  

I think of my school hymn, "Lord, thy daughters pray thee, make us one and all, like the polished corners, of thy temple wall..."  and finally understand why I disliked it so much when I learned it in middle school.  I already recognized that those polished surfaces were not for me.


Everyone has feelings

Last weekend I attended the  Berkeley YWCA Women Authors Luncheon, which is a annual fundraiser.  As usual, there were four thought-provoking women authors, who spoke about their work.   One of them was Arlie Hochschild, a sociologist I greatly admired in the past, for books like The Second Shift and The Managed Heart.  Unfortunately, the best I can say about her current project, Strangers in their Own Land is that it is tone-deaf about race.  It's been hailed as "the book that explains the election" because she went to Louisiana to interview working class white people (the analogy would be going to South Africa and interviewing only the Afrikaners) and came away with the "Deep Story" that they feel that they have been waiting patiently in line for the American Dream and that "blacks, immigrants and ambitious women " have cut in line in front of them.  Never mind that educational attainment and income for blacks in Louisiana still lags far behind that of whites.  Ms Hochschild wants us to focus on feelings, not facts.   I asked her why she didn't ask her subjects about race directly, since they spent their formative years under segregation, a  lifelong Head Start for whites.   First she said that she knew that they were afraid that she would call them racist (now why would they be afraid of that? but good to know she realized that she was protecting them ) and then she referred me to the appendix of the new paperback edition.  I felt like I was back in my childhood, where no one ever talked about race and it was impolite to bring it up.  I wonder if Ms Hochschild ever anticipated how asking for empathy for white Southerners would feel to a black reader whose parents left the South to find opportunity? Especially when she does not ask them for empathy for us?

Here is a quotation from W.E.B. DuBois writing about reconstruction, that helps put the suffering of working class white people in the South  in perspective. "When a right and just cause loses, men suffer.  But men also suffer when a wrong cause loses.  Suffering thus in itself does not prove the justice or injustice of a cause.  It always, however, points a grave moral.  Certainly. after the war, no one could restrain his sorrow at the destruction and havoc brought upon the whites; least of all were the Negroes unsympathetic.  Perhaps never in the history of the world have victims given so much of help and sympathy to their former oppressors. Yet the most pitiable victims of the war were not the rich planters, but the poor workers; not the white race, but the black."   

Opioids in practice

For some time, I've wanted to write about the opioid epidemic from my point of view--the doc in practice, who doesn't understand what's happening at the time.   Here is that piece.   It is difficult to imagine how doctors trying to do the right thing can ever prevail against  the influence of  the drug companies, who put profits ahead of patients.  The coverage in the mainstream media, which has focused  on the doctors who were paid spokespeople for the pharmaceutical companies, has not emphasized enough how the companies influenced the rest of us through state medical boards, legislation and the FDA.  



What happened?

Those of us who pushed our way into "male" careers forty years ago learned to cope with a workplace that was not welcoming to women--it was the only way to do what we wanted to do. They told us that we had to be tough, and part of being tough for women was not letting men derail us.  As I wrote in The Personal was Political  we were astonished to learn during the Anita Hill hearings that there was a name, sexual harassment, for the abuse of power we took for granted. So I am not shocked by the current revelations, more surprised at the reaction this year when last year it was business as usual.  Years ago, I wrote a short story (fiction) based on one situation I encountered in training, a story which was published in the online magazine Persimmon Tree.  http://www.persimmontree.org/v2/winter-2013/sara-and-us/

Back from vacation

Just returned from a trip to Canada--Calgary, Lake Louise, Banff, Vancouver.   

 Moraine Lake in the Canadian Rockies

Moraine Lake in the Canadian Rockies

While I was away, an essay I wrote as part of a symposium on "neighborhood" was published in The Threepenny Review and a short story Fools Gold in a literary magazine Radvocate  Fall is here, with Japanese anemones in bloom and tiny flowers on the lemon verbena that I have never seen before.   With both writing and gardening, there is a long gap between beginning a project and seeing the finished product.   It's always a bit of a surprise to see how it turns out.

Women in fiction

I have been reading Alice Mattison's wonderful book about writing:The Kite and the String.  One passage that has particular resonance for me concerns literary writing about modern women with careers.   "For many centuries a novel about a woman doctor (for example) was so unlikely that when it became possible to write one, it still seemed unlikely.  When we have written such books, because the carrying-out of work by women is still a recent phenomenon, often they are books arguing that it's right for women for work, instead of assuming it and moving on from there."  Or, I would add, books where the career woman fails or sabotages herself.  For example, the midwife character in Michael Chabon's book Telegraph Avenue, is a black woman who fights with the obstetricians.  As any U.S. midwife can tell you, learning to work alongside  obstetricians is an essential skill, one they master in training or pick another career.   And black women have gone along to get along for centuries.  It was painful to read about this character committing what in real life she would have known was professional suicide in an almost casual manner. On the other hand,   Lab Girl  by Hope Jahren, a memoir by a scientist in her forties,  is spectacular because the author never questions her right to be a botanist and doesn't dwell on the inequities, without pretending they don't exist.

Tessa Hadley writes rich prose about present day  women (Clever Girl, The Past, The London Train) whose lives are still regularly derailed by pregnancy and childrearing.   Maybe literary fiction can not embrace women who take control of their reproductive lives with birth control and abortion because pregnancy is such a useful literary device.  I appreciate that Hadley wants us to remember that there are many women who  throw out their youthful ambition, like the character in Married Life who almost chucks her violin.  The descriptions of children are profound and the novels are seductively comfortable.   But I, like Mattison, would also like to see ambitious women on the page. 

Year's end

I open my new (secondhand) yoga book by Judith Lasater and read "Living well is not about being calm; it is about being present."   This has not been a calm year but I have been present for  the   graduations of two children, my husband's third knee replacement on the same side in six years, trips to London and Costa Rica and of course, the election.   I guess there is a reason that I have felt distracted and unsettled.   There have been months when all I have been able to write is my short garden column for The Berkeley Times.  Transitions take energy, even if they turn out well, even more if they are as unpredictable as our new president.  Oddly, I felt some relief, as soon as the storm broke in November.  Now we know, we can move forward, since that's the only direction available.   Happy New Year.

A summer respite

At the beginning of the year, I learned that I had been waitlisted to return to Hedgebrook, the idyllic women's writing residency on Whidbey Island, in Puget Sound.  I forgot all about it until I received the call near the end of July.   

I spent a very happy week in August in my own little cottage, Fir this time instead of Owl, writing, writing.  The other half dozen or so writers and I met at dinner each day, to talk about everything under the sun, always returning to writing and books.   One day we visited the county fair and shared a funnel cake, then explored Langley, WA, lingering at a wine bar.    Another we made a bonfire with genuine s'mores.  Everyday, I picked blackberries and raspberries for my morning yogurt.  I met this little frog when I was reading on the lawn.   

Back to work

    For some months now, I felt that I had nothing to say here.  The political turmoil has left me speechless.   So much hatred on display.  We just returned from a trip to London between two graduations on the east coast. The  Brits are debating whether to leave the EU, with plenty of vitriol leading up to the referendum in June.   Everyone asked us about Trump.  I think it made them feel better about their own problems.

        In February,  I received a letter that it was time for my "annual mammogram". The letter distorted the  American Cancer Society guidelines in order  to drum up business.  I felt ashamed for the hospital where I used to practice.  When I protested to the radiologist in charge, she admitted that the letter was inaccurate ( even the ACS now recommends mammograms every other year for my age group) but said that it didn't matter, because radiologists still recommend yearly tests.  She doesn't want any part of  empowering us to make our own choice if that choice could jeopardize her income.  

      At my daughter's  graduation from medical school, one of the speakers pointed out that we would never have been able to eliminate polio if that vaccine had been priced equal to the cost of caring for someone with polio, the way the pharmaceutical companies claim that hepatitis C drugs are priced.  Of course, internal memoranda suggest that there was no such calculation, just a decision to charge as much as the market could  bear.  Meanwhile, other pharmaceutical companies raise the prices on drugs decades past their patents to outrageous levels, so that even people with insurance can't afford them.   For the first time, the percentage of patients without insurance has dropped to single digits but doctors still have to "explain" to patients why they can't access the treatment they need. 

       When my son received his masters in education a few weeks later, one of the student speakers spoke of how he hoped to bring the benefits of modern medicine to his  home village in China.   Not "precision medicine", the  expensive individualized genetic treatment that has seduced the medical profession with its potential profits (at the expense of public health) just basic health care.  At both graduations, speakers focused on the inequities of the current system, which are strikingly similar, in education and health care.  It was good for me to hear their academic perspective, because it made me realize that whoever is elected, my job remains the same.