Dr. Mark Schuster is the William Berenberg Professor of
Pediatrics at Harvard Medical School and Chief of General Pediatrics at
Children’s Hospital Boston. This essay is based on remarks he made as
the featured speaker at the Children’s Hospital Boston GLBT &
Friends Celebration in June, 2010, and has just been published in the journal “Academic Pediatrics.” We post it here with his permission.
ලෝක ප්රකට හාවර්ඩ් ෛවද්ය විද්යාලයේ ළමා රෝග පිළිබඳ මහාචාර්ය හා අංශ ප්රධානී ෛවද්ය මාර්ක් තම සමරිසි භාවය පිළිබඳව කළ ඉතා වැදගත් දේශනයක් තමයි මේ.
මේ දේශනය සමරිසියන් යනු හුදු ලිංගික අැබ්බැහි කරුවන් රෝගීන් පමණක් යැයි කියනා සමහරුන්ට අතුල් පහරක්.ඒ වගේම කිසිදු බාධකයක් හමුවේ නොසැලී තම සමරිසි බව ගැන දුක් වෙමින් නොසිට ජීවිතය ජය ගන්නා අයුරු ගැන අපි කාටත් හොඳ පාඩමක්.
Dr. Mark Schuster, Harvard Medical School professor and Chief of General Pediatrics at Children’s Hospital Boston
The first time I stood before a large audience to speak was when I
was 13 years old. It was at my Bar Mitzvah. I walked up to the podium,
looked out over the sea of faces, and thought to myself, I am a
homosexual standing in front of all of these people. And I wondered what
would happen if I told them.
That was in 1972, and even mentioning the word homosexual, unless
paired with an expletive or derogatory adjective, would have been
unacceptable at my synagogue. It would have been unacceptable in my
home, my school, or any place I knew. I could not have conceived of
telling my doctor. I assumed that I would never say out loud that I am a
homosexual. The idea that I would someday be able to stand in an
auditorium, stand anywhere, just a few miles from where I live with my
husband, our two sons, and our dog, with everything but the white picket
fence, was not something I could imagine.
Today I stand on a different stage. The Children’s Hospital Boston
GLBT and Friends group asked me to share my story as part of its
celebration day. How I got here, what I learned along the way,
especially at Children’s, and how the world changed — these are what I
will talk about.
A decade after I considered turning my Bar Mitzvah into a public
confessional, I entered medical school at Harvard. Some students had
started a gay group the year before. They had scoped out the territory,
searched for role models, and come up nearly empty. In a creaky old
closet, tucked way in the back, they found a world-renowned senior
physician at Children’s. He advised against starting the group, offering
that it was much better to be secretive about being gay so that no one
would bother you. I’ve heard that same advice many times from men and
women from earlier generations who had fewer options in their day.
Around the same time, a Harvard physician I later met was just coming
out. He was spotted at a social event with someone his hospital’s
Chairman of the Board suspected was gay. The Chairman reported to the
hospital that he thought the physician was gay too and said that people
like that should not be allowed to work there.
Fortunately, the CEO ignored the Chairman.
There was a junior faculty member at Beth Israel Hospital who was out
and actually willing to talk with gay students. When I made my
pilgrimage to meet her, even she advised me to remain closeted until
after I got my first semester grades. She explained that the school
would want to kick me out if they learned I was gay, and they could use
poor grades as an excuse.
That’s not to say that there was silence about gay people. We did
learn about them in an elective course on “special” populations. One
week we learned about prostitution; another, about drug addicts. In
between, we learned about homosexuals. A real live one showed up to tell
us what it was like. He was articulate and our own age and seemed just
like all of us. Indeed, I knew him. We had gone to college together and
he was a student at Harvard Law School. I sat in awe of his bravery and
prayed no one had seen him say hi to me.
I came out to classmates I felt close to. They were mostly
supportive. One time I was talking with a classmate about a guy who had
asked me out on a date. She confessed that she had thought that being
gay meant simply that men had sex with men; it had never occurred to her
that they might actually go to a movie or fall in love. Her honesty
gave me a window into what many peers believed, as I would learn
repeatedly over the years when people let down their guard.
During medical school, I was on the admissions committee. Two people
interviewed each applicant and then presented to the rest of the
committee. There was an applicant who was outstanding in every category;
I gave him a 10 out of 10. The other committee member who in- terviewed
him, a doctor at Children’s, gave him the worst score we’d seen. His
record at one of the top schools in the country meant that he would have
had to have confessed to murder, or worse, preferring Yale to Harvard,
to get such a low score. We waited to hear the explanation. He said that
he just didn’t feel “comfortable” with the applicant.
The committee was baffled. I wasn’t, because I had met the applicant.
He was a man who was effeminate. I didn’t know if he was gay, but I did
know that he was someone who was likely to have been called names or to
have been roughed up because people thought he was. The doctor who had
interviewed him already had a reputation at Harvard College, where he
helped premeds put together their applications for medical school. Gay
students knew to avoid being assigned to him.
As it turned out, with no articulated explanation for the low score,
the committee was unconvinced and went with my score. The applicant was
admitted, got an MD/PhD, eventually came out as gay, and has gone on to
do important work in transgender studies. I wasn’t sorry that the doctor
who had interviewed him left Children’s before I began residency here.
A year later I was doing my rotations. On my adult neurology
rotation, a young woman came to the emergency ward with urinary
incontinence and other symptoms and signs of a herniated disc. The
myelogram confirmed the diagnosis. The neurosurgeon was eager to
operate. The neurology team was delighted that she was a great teaching
case. But she proved a richer teaching case than we anticipated. The
neurosurgeon abruptly canceled the operation. It turned out that the
radiologist had reversed his reading.
When pressed as to why he no longer saw what even a third-year
medical student could see (that would be me), he confessed that the
neurosurgeon had pressured him to change his read. When our team met
with the neurosurgeon, he was direct. He had seen what he assumed to be a
lesbian novel at the patient’s bedside, and he wasn’t going to operate.
His rationalization was that she might have inserted something into her
urethra that caused her incontinence. He had no research or case
studies to support his theory. He had no explanation for why a lesbian
would do this. He had no explanation for why it wasn’t showing up on
x-ray. He made it clear, though, that he wasn’t going to operate on a
lesbian.
Then I heard a voice shout, “So, she’s a lesbian, what does it
matter!” And then I realized that the voice was mine. There was a moment
of silence as everyone turned to look at me, jaws agape. The
neurosurgeon burst forth with questions. How do you know? Did she tell
you? What did she say? Indeed, she hadn’t said anything. It was just
that she and the woman by her side during all of this were the most
obviously devoted couple I’d met in any of my rotations yet. The
neurosurgeon held firm. To their credit, the neurology team got
orthopedics to perform the surgery.
On another rotation, I was on a consult service that helped diagnose a
man with AIDS. His case hit home. He had just moved across the country
with his boyfriend, who was a first-year Harvard medical student. The
pulmonary fellow on our team, a generally kind man, grumbled to me that
he hated having to go into this patient’s room. And so we didn’t go in
much. The patient’s intern also avoided him, even managing to find
herself too busy to perform a timed blood draw one night for a key lab
test. I was still there writing my consult note, so after several
attempts to gently remind her to take a break from having a light
evening and chatting with staff, I just did it myself. This patient was
not unlike any number of patients at hospitals around the country,
wondering why the clinicians who were supposed to provide care and
comfort appeared to be avoiding and even judging them.
He eventually died. His surviving boyfriend, the medical student,
joined some other medical students and me at the 1987 National March on
Washington for Lesbian and Gay Rights. While there, our visit to the
AIDS quilt, a collection of panels that each represented someone who had
been lost, was particu- larly poignant as we remembered my former
patient and so many other patients and friends.
Later, during residency, we had a child in the neonatal intensive
care unit with two moms. The primary nurse assigned to him was
incoherent on rounds. She couldn’t contain her distaste for the boy’s
parents. She didn’t want either mom around, including the one who had
given birth. The charge nurse pulled her off the case. This was the same
neonatal intensive care unit in which staff also found it hilarious
that a female utilization review administrator used to be a man; they
snickered and whispered within earshot when she was there. I encountered
the same infant again a few months later on the wards when he was
admitted with bronchiolitis. There the nurses and physicians treated the
moms with all the respect that every parent should receive.
After my third year, I entered a joint masters program at the Kennedy
School of Government. Having benefitted from the peer support of the
medical school gay group, I teamed up with some other students to start
one at the Kennedy School. We organized a public screening of a
documentary about the life of Harvey Milk, an early gay rights leader
who was assassinated. I agreed to do the introductory speech for the
evening. When I mentioned this to my boyfriend, a junior faculty member
at the law school who was concerned about getting tenure, he told me
that word would certainly get back to the medical school and I would not
get a residency. That gave me pause. He also told me he would have to
break up with me because he wouldn’t be able to be seen with me once I
came out publicly.
That was eye-opening in so many ways, and basically guaranteed that I
would go ahead and introduce the evening. We had tried to meet with the
dean to invite him to make some remarks at the event, but he wouldn’t
even talk with us. Through his assistant, he declined to attend the
event, but he did send a letter for us to read. It talked about the joys
of running for public office. It mentioned nothing about being gay or
our new student group. His letter became an object lesson for the
school, with the audience laughing vigorously at the words so carefully
chosen to avoid giving any hint of support for our group.
A few months later it was time for me to pick medical school
rotations for the summer, so I met with my attending from my pediatrics
rotation at Children’s, who was also a member of the admissions
committee for the pediatrics residency. He had decided that he should be
my advisor. He told me that I was definitely going to get into
Children’s for residency so I should take the opportunity to do adult
rotations because I’d get plenty of pediatrics for the rest of my
career. He told me who should write my recommendations, with him being
at the top of his list. At the end of our conversation, I told him I had
one more thing I wanted to talk about. I told him I was gay.
I felt I had to. He was inquisitive about his advisees’ personal
lives, often asking us who each other was dating, and I didn’t want him
to hear from someone else and think I didn’t trust him. Plus, my most
important example of leadership, which was presumably something that
residencies looked at, involved the Kennedy School gay group. He looked
stunned. He said nothing for a long time. Then he asked if I had told
anyone else at the hospital. I said that I hadn’t, and he told me not to
tell anybody. I left, not sure of what to make of our meeting.
After the summer, I came back to meet with him to finalize my
residency applications. The only new grade that had come in at that
point was an A+ on my end-of-the-first-year masters project. I went back
over my list of recommenders because I thought I should add an
attending from the summer. That’s when he informed me that he would not
be writing me a recommendation. This time I was the one who was stunned.
I hadn’t seen it coming. It wasn’t lost on me that without a letter
from the attending of my only pediatric rotation, I wouldn’t be able to
become a pediatrician. That boyfriend who had told me that word would
get back to the medical school and keep me from getting a residency was
right. What he hadn’t anticipated was that I would be the messenger.
So now I was in a bit of a tight spot. I had been scheduled to take
my final masters courses that fall, but I canceled them and looked for
open pediatric rotations. Luckily, the two I found on short notice had
wonderful attendings, Ken McIntosh and Bill Berenberg. Without their
recommendations, I could not have applied in pediatrics anywhere. This
makes the fact that my endowed professor- ship is named for Dr.
Berenberg a particularly special privilege.
It may seem odd that I didn’t complain to anyone, but there was no
one at the medical school or the hospital to whom I or my gay classmates
thought it was safe to complain. There were no policies to protect us;
no griev- ance boards; no mechanisms in place. Times have changed, but I
still have undergrads ask me if they can come out in their medical
school applications and medical students ask if they can come out in
their residency applications. Yes, times have changed, but they have not
changed enough.
I wound up matching at Children’s and went through residency afraid
that if the faculty found out about me, I could be mistreated or
marginalized. I felt like I understood why the Children’s professor had
said several years before that it was better to be secretive so that no
one will bother you. But I didn’t agree with him. I told myself that I
would never again hide my orientation in an application or work in a
place where I feared being out.
Residency left little time for a social life, but I did get out every
now and then. One night I was in a line for an AIDS fundraiser.
Suddenly there were shouts and we found ourselves being chased down the
street by a group of guys with baseball bats yelling, “Faggots, go
home!” After they’d made their point, they cleared out, leaving a man
lying unconscious in the street. I ran back to help him. A nurse from
Children’s also appeared. The man was cut and bloody. He was responsive
to pain but not arousable. We tended to him until the ambulance came.
From what I later read in the local gay newspaper, he remained cogni-
tively impaired.
After residency, I moved to L.A. for fellowship and stayed for 16
years. I was open in my daily life. It was nice. I overheard fewer fag
jokes, no one was trying to fix me up with their sister, and I became a
resource for people of all ages who were coming out and scared. I
brought my boyfriend Jeff, now my husband, to work events. I apparently
was the first person to bring a same- gender partner to such things. A
senior faculty member came into my office one day, closed the door, and
com- mented on my bringing Jeff to events. He then awkwardly told me
that he was gay and had a partner. I never did see him bring his partner
to a work function, but I think it pleased him to know that things were
different for the next generation.
Years passed and I found myself looking at job opportunities on the
east coast. An institution I was excited about invited me to interview.
Before I’d even visited, the chair offered a recruitment package that
blew me away. Everything sounded great. I asked on the phone whether
there were domestic partner benefits. It was a perfunctory question,
because given the city, I assumed the answer would be yes. By that
point, most Fortune 100 companies had them. Turns out they didn’t, but
they said they’d cover Jeff’s benefits to accommodate me. I explained
that I appreciated the gesture, but I wasn’t interested in working in a
place that didn’t have partner benefits for everyone.
That was on a Friday. On Monday they called back with news. They had
committed to starting domestic partner benefits with the new year. This
was remarkable. This was an insti- tution at which the residents, who
were unionized, had recently included such benefits on their list of
demands, only to have the administration refuse to come to the bar-
gaining table unless that demand was removed. In the end, after
visiting, I decided not to accept their offer, but they nevertheless
followed through and implemented partner benefits. A simple nudge from
outside an institution can sometimes have more impact than repeated
requests from within.
Not long after, Gary Fleisher, our physician-in-chief, approached me
about a search that was opening up for the position I’m now in. As I
explored, I was surprised at how different the place seemed from when I
was a resident and how comfortable I felt. My family wasn’t just
something that was acknowledged but rather it was embraced. I was
treated like any other recruit for a division chief position, with our
hospital president Sandi Fenwick, Gary Fleisher, and others offering to
help my spouse find a job and advising on how to find a preschool for
our kids. There was something very natural about it. It was good to have
my family structure treated as unremarkable.
It especially felt good after I got here and received a call from the
head of our residency admissions committee, Sam Lux. He wanted to talk
about an applicant I had interviewed. Sam feared that the applicant
wouldn’t rank us #1 if his partner didn’t have an adult fellowship lined
up in Boston. I was charged with making this happen. I asked for the
partner’s name so that I could call the fellowships. It was an
unmistakably male name. I felt like there had just been an earthquake
and that no one had felt it but me.
As it turned out, his partner was so strong he didn’t need my help,
but Sam wasn’t taking any chances. He was going on about how I had to
call people at the Brigham and MGH and convince them to get their
fellowship committees to meet early. Sam was so wonderfully oblivious to
the pronouns. His nonchalance told me so much and drove home most
clearly how different things were. I could not believe that in a mere
two decades we had gone from “I’ve decided not to write you a
recommendation” to “Your job is to get this guy’s partner a fellowship.”
I felt that way again a few months ago. I serve on the medical school
promotions committee, which provides the final review before portfolios
are passed on to the dean. On our docket was a faculty member from
Children’s who has emerged as one of the leading researchers on the
health of lesbian and gay youth. Committee deliberations are
confidential, but I think I am within bounds to say that the enthusiasm
for her accomplishments again gave me a sense of belonging, and another
moment of realizing that what had once seemed impossible had actually
come to pass.
Things really have changed. They have changed in so many places. And
for that I am grateful. I have seen the Supreme Court rule that sex
between people of the same gender is legal. I have seen gay marriage
become a reality in Massachusetts. I have seen more and more states pass
laws against discrimination in the workplace on the basis of
orientation. I have seen gay youth come out in high school. I have seen
gay college students baffled by the obsession of my generation with
whether and when to come out and even the need to define ourselves by
our orientation. I have seen it and thought back to myself as a young
man who wondered why he was applying to medical school when he kept
hearing that he would have to choose between being a doctor and being
openly gay —- and I have felt both vindicated and happy.
It’s easy for me to think that my experiences two decades ago are
ancient history. For me, they are. I’ve been lucky enough to construct a
life that does not involve a daily fear of being outed, of being
beaten, of being fired, or of having my children taken away from me. But
many people still live with such fears. My experiences wouldn’t sound
so quaint to them.
I am currently serving on the new Institute of Medicine Committee on
Lesbian, Gay, Bisexual and Transgender Health Issues. The public
testimony has been moving. The enthusiasm that people have for the very
existence of the committee and the expectations they have for our report
have been humbling. Their comments have been a reminder of just how
marginalized people still feel, and how alienated they feel from the
clinicians whom they depend on in their time of greatest need.
I was saddened by the recent case of Lisa Pond, who lay dying at a
Miami hospital from a brain aneurysm while her partner of 18 years was
blocked from seeing her. I was also saddened when I learned of the child
of a lesbian couple who was hospitalized with a high fever in
Bakersfield, California. The biological mother was allowed at the
bedside while the other mom, who had legally adopted the child, was kept
out, even though two parents were allowed for other children.
I was greatly dismayed when Lawrence King, an 8th grader in Oxnard,
California, was shot and killed in his classroom for his presumed
orienta- tion. And even closer to home, I was more than saddened when
Carl Walker Hoover, a 6th grader from Springfield, Mass, committed
suicide after enduring months of anti- gay bullying. There are many more
stories like these.
Today is a great day to celebrate ourselves, our patients, and our
institution, and appreciate how far we have come, but there’s still much
more work to be done.
Thank you.
Original Link
http://commonhealth.wbur.org/2012/03/being-gay-in-medicine
