Letter to a Young Female Physician: Notes from a Medical Life by Suzanne Koven, MD is both instructive and empowering for a professional audience. The “young female physician” is Koven herself 30 years ago, and the memoir’s title comes from a New England Journal of Medicine op-ed she wrote that brought to light Imposter Syndrome (a perceived and misplaced self-doubt that high-achievers are unworthy of the confidence others place in them and that soon enough they will be found-out as imposters). A primary care physician, Koven creates a narrative that addresses issues facing women in medicine such as pay iniquity, harassment and sexism. While all of the above is plenty to keep readers in the clinical world engaged, the book’s success resides in something else—the way Koven approaches universal truths by examining and honoring the specific experience of her life as a woman and as a doctor. Going beyond the halls of the hospital and the titular “young female physician,” she creates a narrative sure to resonate with many.
Suzanne Koven, MD
Photo by Patrick B. Duffy
I read it for our residency's book club in conjunction with the women-in-medicine group. Koven, the writer-in-residence for the Massachusetts General Hospital, where my residency is based, translates a life and career full of fears and blessings at once uniquely hers and yet understandable to those examining their own life narrative and searching for who they are and how they got there. Empathy goes both ways in this engaging and truthful memoir, and like many great memoirs, Koven’s book invites us into her life and we discover ourselves in the margins.
I am a student of the Good Doctor, Samuel Johnson, who wrote that "not only every man has, in the mighty mass of the world, great numbers in the same condition with himself, to whom his mistakes and miscarriages, escapes and experience, would be of immediate and apparent use; but there is such a uniformity in the state of man, considered apart from adventitious and separable decorations and disguises, that there is scarce any possibility of good or ill but is common to human kind." Koven's story is just such a judicious and faithful narrative useful for anyone who seeks crisp prose and careful reflection to find the themes in someone else's life present in one's own. As poignant as it is instructive for any young female physician, the book has as much to share with any young person, any gender and any physician.
Take, for example, the way we all search for clues in our past to explain the present. In trying to pin-down where and how the call to doctoring came to her, Koven writes:
“Oddly, even though I spent hours after school tagging along while my father practiced orthopedics, I didn’t associate my desire to visit his medical office with a desire to be a doctor. What I wanted, I think, during those afternoons when I dipped x-rays into vats of sharp-smelling chemicals…was to be close to my father. … I went to his office, in part, to discover clues as to why he had chosen a profession for which he did not seem to have obvious enthusiasm.”
In addressing the subject of identify formation, Koven begins one chapter, “I’ll tell you a secret: the day I graduated from medical school was the happiest day of my life...the joy was mine alone…for one glorious day I didn’t doubt myself. I knew exactly who I was. I had never felt and would never again feel less embarrassed.” It was as if she read my journal word for word. In a chapter unpacking a struggle we think of as a weight issue but know deep-down is a struggle with self-image, Koven feels a pang in her soul and a slump in her career. She considers leaving medicine to become a rabbi, coming to her senses when another rabbinic classmate questions, “What do you need to be a rabbi for? You’re a doctor! You’re already doing God’s work.” It’s really the same hunger that made her (and me) seek the bottom of an ice-cream tub and made her (and me) flirt with another profession. And she figures it out—and the audience gets to figure it out with her: “What did I want then?...Simply to be myself.” I know and understand the appetites she has tried to satiate. Many of us do, and reading the familiar secret unfamiliarly confessed is a mark of a great memoirist.
Another theme Koven explores is mothers and fathers and our dynamic relationships with them from our cradle to their grave. In reading her narrative, I remembered being picked up after primary school by my mother and then returning to the county courthouse where she worked. To keep me from running wild, she would pay me pocket change to retrieve books from what seemed like a catacomb of tomes. I was endlessly curious about judges in their robes, country lawyers in their bowties, and how happy my mother was—even laughing—with her fellow female attorneys. Like Koven’s father, my mother and her friends didn’t seem to particularly relish their jobs, but there was an inseparable pride in an equally inseparable life’s work that sustained them. They would talk about their children; they would talk about their cases. She and her friends always stayed late because the work was theirs, something outside of a seemingly predestined domestic sphere. Later, my mother largely gave up her practice and professional life to take care of her family. In contrast, Koven writes of her own mother, the brilliant housewife who went to law school in her 40s out of boredom. In approaching the text in the context of my own story, the complex dynamics of professional families put a new focus for me on my mother’s struggles and decisions.
The dust jacket’s watercolor white-coat drawing holds meaning as well: This book is a careful illustration of a life figuring out if the fit of one’s story is a tribe’s tartan or an imposter’s costume. It’s neither. A life is bespoke, and Koven’s story is one that will resonate and be meaningful to future generations of clinicians. —Michael P.H. Stanley
Michael P.H. Stanley, MD is a senior resident of the Mass General Brigham Neurology Program. He currently serves as the director of outreach and engagement for the Boston Society of Neurology, Neurosurgery, and Psychiatry as well as the director of the Young Oslerian Group within the American Osler Society. In addition to his clinical duties, he is a frequent contributor of essays and articles on the intersection of medicine and society, writing for the Wall Street Journal, National Review and Portland Press Herald, among others. Follow him @Mphstanley on Twitter.