Episode 170: Emergency: Women in Medicine during Covid
/Show transcript:
Welcome to The Broad Experience, the show about women, the workplace, and success. I’m Ashley Mine-Tyte.
This time, bringing change for women in emergency medicine.
This pandemic year has taken a huge physical and mental toll on them and their colleagues. My guest says the medical profession could do a lot to improve things.
“They can remove the stigma around needing mental health support so that physicians and other healthcare workers can feel safe, not to think that by seeking care and saving their own lives, they will also lose their careers.”
Coming up on The Broad Experience.
Before we begin…we’re going to touch on a number of different topics in this show from gender equity in medicine to questions about the Covid vaccine, but one of the things we’re going to talk about is suicide – just to give you a heads up.
I met Dr. Dara Kass on email about five years ago. She got in touch to ask me to speak at a small event she was organizing for women in medicine, and even though that didn’t work out and we never actually met, I kept following her work. During Covid I noticed she’d amassed a huge following on Twitter. Her tweets about Covid and other things reminded me I really did want to talk to her for the show.
[Doorbell sound]
Dara is an emergency medicine doctor at Columbia Presbyterian Hospital in upper Manhattan.
“Hello, hello!
Nice to meet you…
Come, come…”
She has had both shots of the Pfizer vaccine and she was happy to have me to her house in Brooklyn to talk. I kept my mask on, but then she said, why don’t I just give you a quick Covid test right here? Out came a little packet…
“Close your mouth, put your head forward, look forward…”
Up went that skinny swab into my nose…
“Aaah! Oof…”
“OK…it’s totally fine…”
And within a few minutes we found it was fine. I was negative.
Dara lives in this house with her husband and kids, 13, 11 and 8. She grew up with an ER nurse for a mother. She says she was always attracted to emergency medicine.
“It actually suited my personality really well. I am probably an undiagnosed, but severe ADD person who really just likes running around and focusing on interesting things.”
Today, in her forties, she does less running around, but a mix of work still keeps her engaged. Pre-Covid, she spent quite a bit of time on advocacy work – traveling the country lecturing on how to improve equity in the medical field. She co-heads a group called FemInEM that supports the advancement of women in emergency medicine.
She still does shifts in the ER itself, and she does a lot of telemedicine as well, seeing patients via video in their own homes.
AM-T: “Did you go in as a young resident, were you already thinking about gender in medicine, or not at all?”
“So not at all. I mentioned that my mom was the reason I became a doctor because she was a nurse, but she certainly wasn't ever limited by her gender that I'd ever seen, and my parents had a pretty equitable relationship and my dad was a teacher and he was the primary care provider for us when she was at work. So I never really thought of gender as being a defining characteristic of my career. It certainly defined, you know, who I was as a person. And so when I became a physician, I never thought that there was a reason that women couldn't be doctors. And I didn't think it would limit my professional growth other than, you know, knowing that a woman had never been president. So I knew society had certainly some barriers for women, but not for me.
You know, it's an immense level of privilege when you're raised in a family that feels very egalitarian. And then I got married and I became a mom, and I realized that the ideas that I had had about how many things I could balance at once were limited by what I was being supported to do at my workplace.”
It started with her first pregnancy. As the baby grew it got cumbersome to work in the ER, to move quickly, do everything she needed to for patients. At one point she started to go into pre-term labor. And she found out plenty of other women physicians before her had as well.
She couldn’t believe she was dealing with this. This was the two-thousands…yet she was expected to do what so many other women had done before her: fit in to the workplace as it was, or simply get a different job. And Dara wasn’t prepared to do either.
“And that was really the birth of the work around gender equity was when it became an insurmountable mountain for me to deal with, that I had to then create sustainable change so that other people didn't have to solve it for themselves.”
Much of her advocacy has been around leave. There wasn’t any parental leave where she worked during her first pregnancy. And the non-birth parent, usually the dad, she noticed never took leave when a child was born since any leave was unpaid. So she’s proposed a gender neutral leave strategy everywhere she’s worked. And she says every time she’s had a child – and she’s had three – the leave policy has been a bit better than the time before.
But then there’s being back at work after you’ve had a baby…working and lactating can be tricky enough when you work in an office. But when you work in an emergency room…
“So I remember that I, as a new attending in the ER, because we didn't have breaks and we didn't have double coverage, if I was the only doctor in charge of a room of, you know, 15 patients in the ER, I would have to pump behind a curtain, but still accept patient presentations while that was happening. Now that's absurd, right? It's bad television, right? It's a bad television show. You think that's going to happen like on The Office or something, where like somebody is going to be at the door, they're going, ‘knock, knock, knock.’ And you hear the ‘shoom, shoom, shoom’ of the pump, and you realize how uncomfortable it is for the person on the other end, too. Right? Like nobody wants to be part of that process.”
She says at least they’ve made the pumps quieter over the years. But she worked to persuade her managers, you know, women really need a place to pump…and they heard her.
Still, she says…
“It's a struggle in many emergency departments to find the time and space to pump, and then the cultural support around doing it. So even if you've created a room with a chair and a refrigerator, and a time that says, ‘okay, from 12.30 to 1, you can do it,’ if everyone around you thinks that you're taking a break and they equate it to smoking, which was happening a lot, right? You know, ‘you don't cover me when I smoke, why should I cover you when you pump?’ Which is crazy, right. It's just, this is an absurd mindset to have, but these are the things that we had to address once at a time in the house of medicine.”
AM-T: “Well, tell me, so what happened though? So you propose this…. did they say, ‘Oh yeah, great, thanks. We'll implement this.’ How did it go?”
“So I'm a pretty persistent person, I guess, is the word., I don't really take no for an answer, especially when it comes to logical solutions for people that I think need help. So I didn't take no. I did presentations and I went to…I made sure that I had the right partners, and the truth is that, you know, it's not that people want to be, they don't want to be against change. They don't want to be punitive. They just don't want to necessarily have to solve the problem themselves. And they don't want to be burdened with the inconvenience of that problem.
So if you can find a best middle ground that doesn't really cost them money, that doesn't really make things uncomfortable for them and just gets everybody what they need, you can usually find people to come to the table. It hasn't been easy. And you know, I've been doing this, my daughter's 13 years old, so it's not been overnight. But there has been a cultural shift in emergency medicine and what I do around the support for all parents.”
The inequalities don’t just occur around birth and childcare. She says female doctors earn less than male doctors – whether or not they’re parents. But in a profession where shifts and long hours are the norm, family does play a huge role in women’s ability to get ahead when they’re the primary caretaker in a household. Which plenty still are.
“When you need reliable childcare and flexible scheduling and the ability to be available to your family when it's necessary, that often comes at a salary cut, because you pay for that…because our society has been constructed to the fact that the neutral worker is not distracted, has no other commitments, is always available and never sleeps, you know? And so when you look for any consideration that allows you to have a life, then you pay for that, whether it's promotion or respect or money, something comes out always, until we reframe that expectation.”
Dara says there’s no better time to re-frame that expectation than now, as doctors continue to reel from the impact of Covid 19.
At the very beginning of last year she says she wasn’t that worried about Covid. It didn’t seem to be in the US. But then, in February, with all the news from Italy and their cases spreading like crazy, she became more concerned. She remembers it was late February when she first wore a mask in the ER with a patient she thought might have Covid. Still, shortly after she flew off to give a talk in another part of the country.
“By the first week in March, the game had already changed. It was my last plane trip to go give a lecture somewhere else. We started hearing about a lot of patients in New York that were home with these upper respiratory symptoms. And really our telemedicine practice exploded, with so many patients who were sick that I knew that we were all going to get sick.”
Dara’s youngest child, a boy, had to have a liver transplant when he was two years old. So his health was a big consideration for her as Covid began its march through New York City…
“I remember that my husband and I went to Soul Cycle, which we loved, and it was our last Saturday class and we're walking home and we're trying to figure out what do we do if somebody in our family gets sick, how do we live in our house? How do we move people around, how do we quarantine? And, you know, I found Soul Cycle very cathartic. I still do. And I started thinking about the idea of being sick with my son and being the reason he gets this virus. And I couldn’t handle that.”
She thought, I can’t live with myself if he gets it because of me. At that point she’d been doing telemedicine for a few days, she hadn’t been in the ER, and she didn’t think she’d been exposed to Covid. So she and her husband moved her three kids to her parents’ house in New Jersey. Dara didn’t see them again for well over a month.
She moved them out on a Friday.
“And I went back into the ER and started seeing patients. And by the following Monday I was infected. So it was pretty close. I found myself coronavirus positive March 19th, which was pretty early. I was part of that first wave of people who were sick. And what was interesting was, finding out that you have the same virus that is overwhelming every patient you see is actually pretty scary.”
She had no idea how her body would handle it. But luckily for her, she didn’t get short of breath. She had a fever, terrible body aches, a cough…but most of the time she was sick things felt manageable: she took painkillers and kept working as a telemedicine doctor from her bedroom.
Her husband was staying in another part of the house – a setup they initiated before Dara came down with the virus.
“And we're very lucky that we have a house that has enough bedrooms that we could separate, and I'm Jewish and I've been Jewish my whole life. And so I have a family that's Orthodox, and there's a whole aspect of Orthodox Judaism by which you, you know, you don't come together until you're married, so you don't touch, you don't even hold hands. And so I told my husband that we were going to be a unmarried Orthodox Jewish couple. And the only reason why I use that analogy, because it made a lot of sense to us, was it really put a limit on us touching, right. I didn't know if I was going to get it. I didn't know if I was going to spread it. And so my husband and I did not hold hands. We didn't sit within six feet of each other for the entire week before I got sick, and he never got it. And so for me, it was the perfect lesson in how to prevent spread of this virus because I wore a mask at my own house. I ate in my room, and this was really early. I started being able to tell other people that they could stop the spread of this virus, even if they had to live with other people. So when I had patients who lived in multi-generational houses, I could give them guidance on how not to spread the virus.”
But even after she felt better, she didn’t think it was safe to have her kids back until she’d tested negative. She knows better today, but back then no one knew exactly when you were no longer infectious. So she moved out to a hotel while her kids moved back in with their dad after a house cleaning. She stayed at the hotel alone for three weeks until she got a negative test result.
“It was sad, but I also was busy. And so I worked a lot in the ER and I, um, I watched a lot of Netflix and I tried to enjoy... There's a lot of days before the pandemic where I just prayed for one day in bed with no kids and nobody bothering me. And I tried to remember that as I was unexpectedly in a hotel by myself with no kids and no one bothering me.”
Dara was working with Covid patients during New York’s terrible spring of 2020, when hospitals filled up, refrigerated trucks took in bodies, and 20,000 people died.
“Because of the way that I practice medicine right now, I don't do a lot of critical care, but I do try to help out where I can. And I do remember that we had one day in the city where we had just an overwhelming number of people pass away from the virus and I offered to help make the phone calls to parents, to the families. Because when you want to do something like that, if you don't have anything else to do, it's much better, right? You want to be able to sit and have conversations. And it was, you know, a lot is made of, especially as in the beginning of the pandemic in New York, we rejected every family member from coming into the hospital. We had to contain things. We made women give birth by themselves.
I remember when I found that I was positive for the virus and I was going to get antibodies, the first thing I tweeted was, ‘I'm taking myself and my antibodies and I'm going to be the best birth partner for every woman in the hospital.’ But a lot of these families were dropping off their loved one at the hospital, had no idea what was happening to them, and this was happening all over the country. But the day that I started making my first phone calls to parents and children who dropped off a loved one at the door of the hospital and within 12 hours, the person passed away. I mean, that is a skillset that I don't want to maintain. And listening to people cry on the other end in a way that has, it doesn't happen that often, right? We've been dealing with death in the emergency department forever. I mean, that's unfortunately part of our job. Like, that part wasn't new. The sheer pain and unexpected nature of the loneliness and the fear around how patients were dying was completely foreign to me because it's not how we do what we do. And I never want that to come back.”
That awfulness was at least part of her job. But in late April Dara went through another tough experience…this time it was personal.
The supervisor of the emergency department at Dara’s hospital, Columbia Presbyterian, was a doctor named Lorna Breen. She was a friend and colleague. She was accomplished, hard driving, ambitious, funny. And after dealing with Covid for many weeks - understaffing at the hospital, not enough protective equipment, and too many patient deaths, Dr. Breen became seriously depressed. She went back home to Virginia to be with her family and get treatment. But one day, she took her own life. She was 49.
AM-T: “I want to talk about mental health for a minute, because you did lose one of your colleagues to suicide this year. And it was quite well-publicized here in the U S, certainly on the East coast. Do you mind talking about Lorna Breen for a minute?”
“So what I will talk about I think is what I think her family wants us to talk about. So, you know, the events surrounding Lorna's death I think were a direct reflection of the moment we were in. It was, it was terrible. I'll just leave it there. But one of the things that happened so quickly was because we were coming out of this horrific moment in New York, and because her family was thrust into the spotlight because of what it represented for the physician workforce, the healthcare workforce for New York City, the idea that an incredibly successful, beautiful, smart, amazing human could take her own life, reflected something that was so broken in our system, which was the idea that this pandemic was going to have consequences beyond if somebody had a cough or a fever, and that it reflected the brokenness of the health care system in support of its workforce, around mental health…and that there were aspects of Lorna's care that she was afraid to seek, because she was afraid of the stigma and the career ending consequences of needing to be admitted for depression and suicideality. And that once she had the strength, which we see all the time in patients that are depressed, to actually complete a suicide, she did. And we know that as a warning, amongst patients who are in treatment for depression, that their most dangerous time for a patient who's depressed is not when they're at the bottom of their depression, but when they're coming out of it, because then they finally have the energy to complete suicide.
And for Lorna and her family, one of the lessons I think that came out of this, and the thing that they've been carrying forward is that this healthcare workforce, our entire country's healthcare workforce has to be supported to come out of this pandemic. Because if you think that we have been in the bottom of the throes of this, it is the time when everyone sits back with the stuff that they've dealt with, that could be the most dangerous. And what her family has chosen to do is really invest in legislation and in support and in education around making sure that this doesn't happen to anybody else, and that they can educate physicians and nurses and other healthcare workers, and that they can remove the stigma around needing mental health support and even medications and treatments and hospitalizations, so that physicians and other healthcare workers can feel safe…not to think that by seeking care and saving their own lives, they will also lose their careers. So with that, I'm entirely inspired by her family who has taken a devastating loss and really channeled it into something so purposeful. And I know she'd be proud.”
I told Dara this conversation reminded me of a show I did a few years ago about physician burnout. One of my guests told the story of how when her husband got cancer and she needed to step back a bit from work to care for him, she didn’t feel particularly supported by her colleagues. She felt like a burden. She said there wasn’t a lot of empathy in an environment where everyone was working hard…and now they had to cover for her, too.
“That actually, it kind of reflects back to one of the things I was talking about in the beginning, which was the maternity leave and physical limitations of being pregnant, is that we reward neutral, right? We reward people that don't burden us with their needs, that don't get pregnant, don't lactate, don't break your leg, don't have a heart attack, whatever it is, but I don't want to know anything from you except that you can show up and do your job and be done. And the idea that people may be depressed and be on medication and need hospitalization or treatments, is a departure from our sense of ‘leave me out of your business. I don't want to know.’ So I think that the reintegration of that as a normal and completely typical way to live, I think is going to be critically important, especially as what we've gone through over the past year is not normal. It is extraordinary to think that you can take an entire workforce of humans and traumatize them internally and externally for an entire year, exposing them to a life-threatening virus, watching overwhelming death, I think be gas- lit by your administration…that this had to go on longer than even necessary, and then expect them to just be fine. You know, that's just not reasonable. And I think we're going to deal with the consequences of that for a long time coming.”
Given that I was sitting with a doctor in her living room I wanted to make sure I asked her about a couple of Covid-related things that had been nagging at me. One, I’d been surprised when I first read that many healthcare workers were reluctant to get the Covid vaccine.
Dara says there’s been too much attention paid to this – when in reality, why shouldn’t healthcare workers be nervous?
“The idea that healthcare workers… like healthcare workers smoke, they [drink] bad food. They don't always exercise. So the idea that healthcare workers would be the first, a hundred percent in line to take the vaccine when there is normal vaccine hesitancy around a new pandemic and a new vaccine, I think was unreasonable in its expectations. There is a correlation between the education level of people who are vaccinating themselves and those who are choosing to not get vaccinated. And so the higher, the more advanced degrees somebody has, the more likely they are to get vaccinated it seems. So we're seeing that the proportion of healthcare workers that are not getting vaccinated tend to be people that are not physicians or even nurses, but, you know, the home health aides and people that are working in the hospital system, but maybe not necessarily in direct patient care.
But we're also seeing that that hesitancy is going away with time. So it was a new vaccine and the healthcare workers were first. And so the fact that a third of healthcare workers didn't get vaccinated first pass is still a better average than the average citizen was that first week. And what I say to healthcare workers who are still reluctant is identify, what's making you hesitant? Because there's a difference between vaccine hesitancy based on all kinds of expected reasons. So it's a new vaccine, it's a new virus. I want to see more data. I want to see more time versus true anti-vaxxers people that are against science and against vaccination. And I worry that we are lumping both together, right? The idea that people who haven't gotten vaccinated won't get vaccinated. And so I try to get people to identify whatever marker it is that will make them feel comfortable, just because you're a nurse doesn't mean you don't want to see 15 million people get vaccinated before you.”
Just to make sure it’s safe.
But there are also conspiracy theories flying around about the vaccine…one big one is aimed at women. And the vast majority of healthcare workers are women.
“Conspiracy theories around vaccines are very deliberate. And if you think about a lot of the conspiracy theories around vaccinations for children and creating autism, which is a fear parents have, you think also about the fact that a lot of the people who are going to be vaccinated here are going to be both women and the women who are decision-makers for their families. And so is it shocking that the number one conspiracy theory I have heard, which is completely not rooted in science, is that somehow this vaccine affects your fertility, that somehow, and it's a pretty creative explanation, I mean you've got to give respect where respect is due. And so these people that make up these anti-vaccine conspiracy theories look to something relatively absurd, and then they walk it back with scientifically soft and questionable language. And so the idea that was put out was that the spike protein of the Coronavirus resembles the spike protein of the placenta, and that if you target the spike protein of the Coronavirus, you would then also prevent placental growth.
Now what's amazing about that, it means that every single person who's been naturally infected with coronavirus who has their own internal antibodies would also not be able to get pregnant. We know that's not true. We know that people in the studies with the vaccine have gotten pregnant. We know plenty of women have survived their pregnancies and the Coronavirus. We know plenty of people that have gotten pregnant after having had the coronavirus. So no, there's no evidence to say that it affects fertility. It is completely bonkers, but conspiracy theories aren't meant to be believable. They're meant to create doubt. And so that's one of the things that we need to remember is the misinformation and disinformation campaigns are good at what they do. And so we need to continue to address the science, which is to say that this is a safe, it's an effective vaccine. And it's really kind of exciting that it came out so quickly.”
AM-T: “You've alluded to some of this in the interview, but how do you feel now about the immediate future for women in your area, women in emergency medicine, and coming out of this pandemic in particular, equity...”
“So I think that…I'm on pause when it comes to making decisions about equity and access and careers for anybody right now. I think we're all on pause. This pandemic has been hard for the careers of everybody I know, and that includes women and women in medicine. I think everyone has stopped paying attention to their own promotion and growth, and we just need to make sure that we're getting paid and taking care of our families. I'm hopeful that the rebirth after this, cause it's going to be a rebirth, it’s going to be a regrowth, is more equitable at its foundations. And that includes things like paid leave support for families, work-life balance…I hate the term, but I use it deliberately now to say that we now know how much can be done from home. And even in medicine, a lot of our educational programs can be done from home.
And that means that I can see my kids more. You know, when I do an interview or I teach a class on Zoom, there are aspects that should be together, but if I can do half of them at home, then that's twice as much time with my kids, and that matters. And I want that to matter. And I think that should matter for women and for men and for all parents. But I think for women's careers, the less we have to fit everything into a square box, the better off we're going to be. And I'm optimistic that our whole selves are going to be welcomed into the future in a way that they kind of weren't before.”
Dr. Dara Kass. I will link you to more information about Dara and Lorna Breen, and the foundation her family has started in her honor, under this episode at TheBroadExperience.com.
That’s The Broad Experience for this time. You know where to find me if you have questions or feedback – I’m at ashley@thebroadexperience.com and on Twitter and the show’s Facebook page.
I’m Ashley Milne-Tyte. Thanks as ever for listening.