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We welcome Christine J. Ko, a dermatopathologist, to discuss the evolving landscape of women in medicine. Inspired by America Ferrera’s powerful monologue in Barbie and Jennifer Lycette’s insightful essay on the challenges faced by women in the field, Christine shares her personal experiences and the choices she made while navigating the tension between medicine and her children.

Christine J. Ko is a dermatopathologist.

She discusses the KevinMD article, “It is literally possible to be a woman in medicine! We are doing it every day.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Christine Ko. She’s a dermatopathologist, and today’s KevinMD article is “It is literally possible to be a woman in medicine! We are doing it every day.” Christine, welcome back to the show.

Christine Ko: Thanks. Thanks, Kevin.

Kevin Pho: So Christine’s been on multiple times. Go to KevinMD.com/podcast to search for her name, hear her story and prior episodes. But today let’s jump right into your most recent article, “It is literally possible to be a woman in medicine! We are doing it every day.” What’s this one about?

Christine Ko: Well, I read Dr. Jennifer Lycette’s article about how it’s impossible, and it’s sort of a take on the Barbie speech, America Ferrera’s speech, how it’s impossible to be a woman in the world. And I love that speech, America Ferrera, it resonated with me. Dr. Lycette’s article resonates with me. So I’m not trying to negate even my own experience or other people’s experience about how hard it is to be a woman in medicine.

Kevin Pho: Just for some context, for people who didn’t see the movie, tell us about America Ferrera’s speech.

Christine Ko: Yeah, she’s sort of like, oh, you can’t be too ambitious but you have to be ambitious, you can’t be a mother but you have to be a mother, you can’t have a career but you have to have a career, otherwise what are you doing with your life? Just all of these sort of, you’re between a rock and a hard place, that you can’t really do anything right.

And so I guess for me, the way that that speech resonates is, since I have two kids and I work full-time, I’ve never felt mommy wars. I really don’t feel that I look down in any way, or think that I’m better than a mother who doesn’t work outside of the home. I do get paid to do work outside of the home, I think that’s just different versus any parent, mother or father or parent, who doesn’t get paid to do work outside of the home.

But I think that, I never realized, I suppose, when my goal was to be a doctor, that there would be, I guess it’s naive and kind of silly, but I never realized that there would be so many times where you feel like you cannot do both. I’m trying to be a mother and a doctor, and I’m being pulled in different directions completely, and I cannot do both, not literally at the same time, as I think during COVID people tried to do with telehealth, and I’m seeing a patient on the computer and trying to supervise my child’s English class on Zoom.

And so yeah, I guess I feel kind of silly about it, but I never realized how difficult it would be.

Kevin Pho: Well, tell us how you navigated that tension. You mentioned during the pandemic multiple telehealth appointments, and kids, just like my kids, they had these remote lessons and you had to supervise that. So how did you navigate that?

Christine Ko: I know, in some ways I don’t have any answers. I think the article that I wrote, what I was just trying to say is that our presence, women are almost 50 percent or even more. In dermatology, my specialty, women are more than 50 percent of the workforce.

And I think by saying it’s impossible to be a doctor in medicine discounts that. We’re saying that somehow we’re not doctors then. When I’m showing up at work every day, am I not? I think if I truly believe that, I’m already saying that I’m not doing a good enough job and I’m not really a doctor, if you really go by the true meaning of the words. And I don’t think anyone really means that, if we come right down and think about it.

I think women contribute a huge amount to families, I mean giving birth, to start with, to society, whether you work inside or outside of the home or both.

And so to come back to the movie Barbie, I think what bothered me, but really I love the movie, and then what kind of left me sort of a little hanging, and I haven’t even resolved it fully in my head right now, is the ending, where she goes to the gynecologist. Sorry for anyone who hasn’t seen the movie, it’s a spoiler alert, I guess.

So Barbie, I think, becomes a quote unquote real woman, she’s not a Barbie doll anymore, and you see her in a really nice SUV, she pulls up to this really nice building, she walks into this really nice lobby, and there’s a very professional looking receptionist at the lobby. And she’s like, hello. And you’re sort of wondering, I don’t know, does she have some big job, is she working now for Mattel, is she going to create, I don’t know, I was thinking she’s going to create a whole new line of Barbies that are different, or who knows.

And they’re like, hello, and she checks in, she’s like, I’m Barbie, or Barbara, I can’t remember, she’s like, I’m here to see my gynecologist. And that’s how the movie ends. And the theater I was in, everyone just started laughing. And so I think that’s why, I think a lot of people think it’s funny, they think it’s a joke. I know that Greta Gerwig, the writer, thought it was hilarious, and she really loved the idea of ending the movie that way.

Kevin Pho: You talked about how difficult it was for you during the pandemic, doing things remotely, supervising your kids. So that was a few years ago. How’s your situation now, in terms of managing your kids, your family, and what you have to do professionally?

Christine Ko: It’s easier now, I think, the older that my kids get, it’s a little easier. Well, I should say it’s easier in some ways, harder in others. We don’t have a lot of family, well, we don’t really have any family around us, and I don’t have a nanny still or anything like that. So since they have more activities as they get older, it is a little bit harder to get them around.

What really helps is, my daughter, once she turned 16, she did start driving, and that helps a lot. And then my kids actually don’t do tons and tons of activities, so that’s helpful too. And right now my son is in a sort of recreational basketball league outside of school, and I realize it helps immensely, and I don’t think we’d be able to do it if he weren’t doing it with three of his friends who live right in our neighborhood. So the other parents have been really helping a lot to shuttle him back.

Kevin Pho: Do you still feel pulled in many different directions, like you said during the pandemic?

Christine Ko: That also, I think, is a little bit less, because as my kids are older they have their own lives more and more, and things that they don’t want to share with me even. And so I think it’s good to have them individuate away, and they have their own thing to do, so I don’t have to do as much for them.

I think they still have problems, I think all kids do, and they’re bigger problems in some ways, I think, than just like, I’m hungry, I want something to eat. Bigger problems like with friends, or socially, or maybe not a problem per se but just a life event, that my daughter’s a junior and she needs to start thinking about college and things like that, and just to have conversations with her about it.

So I think they need me in a different way. So I still want to be fully present for them when they need me, when I can be. It might not be right in the moment, but like, oh, let’s talk about this at X time.

Kevin Pho: And so do you feel you’re able to do that, as a physician, as a dermatopathologist, be fully present for your family when they need you?

Christine Ko: Yes, but it’s a choice. It’s an active choice to have said no, either a week before or a month before or a year before, to different things, and to work a certain way, and try not to be obligated to be doing work at home.

I will work at home, but I try to do things that I enjoy doing. I enjoy writing papers, I’ll write a paper at home. But I try to do things ahead of time. This is just my personality, not everyone, some people are fueled by procrastination, and the stress, that just really kills me. So I do things ahead of time as much as possible.

So yeah, I think everyone has to figure out their tricks for themselves, but for me, I realize mentally it is a choice, that my kids are my priority and I need to arrange my life such that I’m there for them.

But the nice thing is, as they need me less, it is kind of nice. Like, post-COVID I’ve been starting to travel a little more for work, and it’s nice to be on my own and just worry about one physical body and where I have to go. And I’ve realized I’ve lost skill in that, sort of navigating by myself. Sometimes I’m like, where am I, I really need to go to the gate and make sure I’m there for boarding and things like that. So I think I’ve lost some ability, in some strange ways, to sort of think for myself and navigate the world by myself, which is kind of crazy sounding. I can do it, it’s just, it’s interesting.

But yeah, I think it takes time and it takes failure. We’ve talked about failure before, I think. But I do things wrong, and I yell at my kids and I make mistakes, and I realize, oh, I wasn’t there for you two days ago, you were asking me something that was important to you and I wasn’t there.

So I think, along the way, just a lot of acceptance of failure, which I think is what that movie Barbie was about, for the most part. It’s like, America Ferrera’s speech, look at all the ways in which the world says we fail, but look, I’m doing this.

And then in the movie, right, the Kens and the patriarchy take over, but then Barbie and her friends take it back in Barbieland, but it seemed like they were sort of recreating the patriarchy just with them in charge.

So I think for myself, what the big lesson, maybe the only, and it’s not really an answer but a pseudo answer that I have, is I just really need to figure it out for myself. Like, what is it for me? And I think that’s what even my daughter has to do, my son has to do, anyone else, the residents, fellows, if anyone’s listening. It’s like, there isn’t really an answer that’s going to be generalizable to everyone, I think.

And that was my big takeaway from Barbie, that it can be crazy and fun and imaginative, and maybe you’re going to have dyed hair like Ryan Gosling and be in a pink car and wear crazy outfits. And they were having so much fun.

Kevin Pho: So one of the things that struck me is that you made a choice to be present with your kids, implying that sometimes you have to be less present for what you had to do professionally. Tell us the thought process behind that choice, or how difficult was it for you to make that choice?

Christine Ko: Well, for me, I think that you’re shaped by the things that happened to you. Of course we are. And I don’t know what kind of person and parent I would have become if my son wasn’t diagnosed as being deaf and got the cochlear implant surgery. I think we’ve talked about this kind of stuff before too.

But basically he had no verbal speech at all, really, at age 2, when he got the cochlear implant. He was diagnosed with the disorder that he has, called auditory neuropathy, late, so it wasn’t picked up with his newborn hearing screen.

So long story short, since he got the cochlear implants, we took part in this particular type of therapy called auditory verbal therapy. And that is all about teaching in the home. Like, the therapist and the parent or caregiver is part of the therapy session, every single therapy session, because the therapy session is not just for the child or the individual who can’t hear, it’s for the caregiver or parent or friend or family member to take the skills learned in that session and take it home and do it every day.

So we had six formal sessions with an auditory verbal therapist a month, and then auditory verbal therapy at home was supposed to be as much as possible. And there’s a lot of failure in that, not just mine, because we would also get into fights at that time when my son was very young, because he wouldn’t want to do it. Sometimes he wouldn’t want to do the little exercises, and sometimes he wouldn’t do it right, because some of the initial exercises were very simple, like, ah, and try to get him to repeat, ah, ooh. There were like five sounds, they’re called Ling sounds, it’s like, ah. And he might go, h, and just repeat, ah.

And so, long story short, I learned through this process of auditory verbal therapy, which we were in for four years, so I’m a slow learner in a lot of ways, I realized, fail over and over and over again, but you make progress, and that’s what counts. You put in the effort, and that’s what counts.

And so, because also for us, we didn’t know the outcome. The medical professionals we saw weren’t sure what level of oral speech and language he would be able to attain, if the cochlear implants would really work for him. Does he just hear like a jet engine going off, or a fire engine going by, or can he hear these very small differences in sounds? The difference between m, n, o, if you think, they’re actually very similar. Can you hear the difference between that or not?

Ultimately, if you talk to him now you cannot tell that he’s deaf, which means that he’s achieved the kind of speech and language that is sort of quote unquote optimal. But we didn’t know that would be the outcome. He got there over a four-year period of time, and it was pretty slow at times.

So I think that whole experience of putting in that amount of work when you don’t know what the outcome is, and being OK with whatever outcome you have, was a huge life lesson that taught me a lot of things that I hadn’t really learned in such a way, over such a period of time, with such daily exercises that changed week by week as he progressed, or if he didn’t, it wouldn’t change.

And so just to see that, it was really something that I hadn’t quite learned. And I’m not sure why I hadn’t learned that, because it’s deliberate practice, I think, is really the psychological term for it. And people talk about chess masters, anyone who plays a musical instrument to a certain level, past like two or three months, right? You learn, you have to practice things over and over. You learn a new skill, you practice it, then you incorporate it into your way. A new chess move, and then you incorporate it. You play violin, you reach higher with your fingers, you learn vibrato, whatever, and you practice it and then you incorporate it.

So I did kind of learn that, but I think it was situationally specific. And I think the other big thing is, I was never OK with failure. So I was OK with the practice part, I was never OK with failure. So I think learning through auditory verbal therapy taught me how to be OK with failure, and be OK with sort of setting a goal for, OK, this needs to be done now.

So I really had to carve out certain things that I thought were obligations for me, things that I really needed to do as a parent. And auditory verbal therapy was part of what taught me to do that. So I do believe it’s a choice, because for example, it was a choice to choose auditory verbal therapy to begin with. It was recommended to us, but we did it. And then it’s a choice to keep going, because at one point I remember I was like, we’re changing therapists, I’m not sure, and things like that. And so, but yeah, it took me four years.

Kevin Pho: We’re talking to Christine Ko. She’s a dermatopathologist. Her KevinMD article is “It is literally possible to be a woman in medicine! We are doing it every day.” Christine, we’re coming toward the end of our show. Tell us some take-home messages that you want to share with the KevinMD audience.

Christine Ko: I think we just need to keep dreaming. That’s all. It sounds impractical, but I think that that’s the important thing. And I think that’s why Barbie’s lovely, it sort of just shows this dreamy kind of world. That’s why fiction is important.

And the world just does have still so many problems, medicine does as well. I fail in my patient care setting too, and I just keep telling myself that it’s OK. I just need to keep dreaming, really, that I can do better.

Kevin Pho: Christine, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Christine Ko: Yeah, thank you.