Hey there, folks, welcome to this episode of Amy and TJ. Robes sitting next to me here, and we're gonna start with this. I got a bone to pick with you.
Great.
You do this all the time when we start. We used to do this when we were hosting the show on television together. TEJ, you start right, I give you the opportunity. Hey, you can start. I let you do it if you wanted to, and you said no, So I'll take it.
I said, I know what I'm good at, and I know what you're good at, and you were significantly better than me at starting.
You know how to just.
Rev it up, all right, So I'm reving it up by taking I have a beef to pick with you, okay.
I have a.
Really big problem with how sometimes you talk about your health, okay. And what I say to that is, as we sit here, you are, how far as a breast cancer survivor past the date of when you were recommended by your doctor to have blood work done? You came in hot, you said, I'm better at starting. How's that starting?
Well?
I also said, you know how to rev it up or stir it up, and you certainly are doing that. So the last time I had blood work done was August of twenty twenty two, and it's been weighing on me because I know, up until that point I was getting blood work every six months, as was recommended by my oncologist. I got off to moxifen then after eight years, and so that's the drug where I do have to
be monitored very carefully and closely. And so then I just kind of took it upon myself to extend how long I was going to go back for the next blood work, and then all hell broke down.
You shaid, so good upon yourself. I have that right.
I made that choice. I made a choice.
Okay, So August twenty twenty two. The next one you should have had would.
Have been when February twenty twenty two.
And you didn't have it. I was twenty three, right.
Sorry, sorry, Yes, February twenty twenty three. We were going through our hell, and yes, it was the last thing on my mind.
So your doctor, upon hearing that you have gone a year and a half past getting blood work done as a breast cancer survivor of ten years now, which is I know what, you get a little farther past the date, and I think they say it's not as often that they are.
Statistically speaking, it's less likely to come back metastatic.
Yes, okay, what would your doctor say too.
That she would tell me to make an appointment for my blood work?
How soon?
Probably should call when I'm done with this podcast?
Okay? So why is it as we sit here still you have a grin on your face And that's okay. I'm not saying you're taking this lightly, but I'm saying, why still won't you or haven't you done it? And you say you'll do it right after the podcast, I'm guessing you won't. But tell me why you're putting it.
Off, because I think anyone who has survived this knows that when you go in for the blood work, it's very emotional because you're literally getting they're looking for tumor markers, is what they're looking for. So if the cancer were to come back in the places you don't want it to, with breast cancer, bones, liver, lung's brain, you would think that you'd get a blood test that would show a tumor marker, which means that you would be facing then
a terminal yet treatable, but ultimately a terminal cancer. And so I think the fear of that you get into this mindset I don't want to know. I'd rather not know. It's not going to make a difference anyway. You start to get in that headspace and maybe it's an excuse just not to have to go to the doctor again, or go back to the NYU Cancer Center again, or just to avoid something that's uncomfortable and scary.
You're saying, you're saying you as a general thing, like the general population. I'm saying you are you telling me because I'm telling it from me. Okay, we were talking about this early and I was surprised to hear this. If you go back in that the blood work you get and if you get a bad result, then that is essentially you being told this is a terminal now illness you're dealing with. Is that correct?
Yes?
I mean if I had tumor markers that showed that it had spread, yes, that my cancer had become what we call metastatic stage four. Yes, But I do know that there are amazing treatments out there now. They can extend your life, they can make your life, you know, a lot better than they could have even five years ago or ten years ago.
So there's a lot of.
Promise, but yes, it would ultimately be right now, it would be considered terminal.
See, I don't know how to get my I've covered obviously covered breast cancer. I've known people with breast cancer. I'm now in love with somebody who has as a breast cancer survivor. But it always bothered me and it scares me. Right, And you and I have talked about this, and that we have gone through a past almost a decade together in a lot of ways, and been through
a lot as friends. You've seen a lot of hell and help save my life in a lot of ways, I would argue, and all we went through together to this point. And I have to pause sometimes and catch myself when we're having the conversation because you do talk about it in the way you talk about it, and all I'm hearing is that this woman I've gone through all this with isn't doing all she can to make sure we have as much time together as we can. Does that make sense?
Yes?
Okay? And that this is your body, this is your struggle, this is your what you went through. But for some reason I feel bad, or I feel selfish, or I feel wrong for having that thought about our relationship.
Well, I think it's very sweet, and I'm sorry to because it is true. I think my mom would feel the same way, my dad would feel the same way everything you're saying. And so I know, I know they do. Yeah, yeah, and I know, and I appreciate that. I know that means that you truly love and care for me, and I understand where that's coming from. And so yes, it's actually I think selfish of me to not go get the test, but it just I don't know.
That's what I was getting at. There, all are produces are in here. They were all in it right, tears in their eyes, and now they're like, come on.
Do you know what's interesting is I preach this or I have preached this to so many women who this is what I'm saying right now is the same mentality a lot of women have about not getting mammograms because they don't want to know. They don't want to find the mask. They don't want to know if they have cancer because that's scary and that means it's going to be.
Difficult.
And so that you know, ignorance is bliss mentality, as stupid as that is and as illogical as that is somehow becomes this human trait that I'm now experiencing because I've put it off. I've and once you keep putting it off, you're like, Oh, this feels so good to not have to make a phone call. This feels so good to not have to do good a blood test. I feel normal. I feel like I never had cancer. And that's what I want to feel. And so then
somehow I want to wish it into existence. But it's illogical and dumb.
Okay, doctor Coleman, I just want you to react to what you just heard the back and forth. We're going to officially do the right introduction to doctor Elizabeth Cohen and on cologist who's in the room with us here now, But give us what do you think about that dynamic and that back and forth and what the concern for a loved one me sitting in this seat with the loved one who has gone through what she's gone through. Just I would like to hear what you think of what you just heard of us from us.
Well, I have an emotional response, and then I also have an academic doctory response. Emotionally, I just want to give you both a big hug. There is so much love there. There's so much connection, and there's just so much deep passion for each other that you both feel. And this is just incredibly, incredibly hard stuff. So I would first just want to give you both a hug and a ton of grace, because clearly you'll nowavigate it with a lot of love and a lot of grace.
From an academic, purely intellectual doctor voice standpoint, tumor markers are complicated, and you may be getting them for a very specific reason for yourself. It's not historically something that we do for all women who are survivors of breast cancer. They can sometimes be misleading, They can cause a lot of anxiety. It doesn't always mean if you have elevated tumor markers that it's necessarily cancer. Lots of things, other
things can elevate them. So they are very wrought with a lot of anxiety when women go, depending on the context for those tests. But I also think it's really understandable people have a lot of trauma from our healthcare system. Women in particular. The idea of going even having to show up at a place where you were treated for cancer, even if it is for some form of monitoring, can
be really terrifying. And sometimes you know, if this is something that your doctorate suggest did, maybe you make a pack to go together.
Yeah, it's funny just you even saying about going back into the place where you were diagnosed. It's crazy the PTSD you have from walking and thinking you were perfectly healthy to realizing that you actually weren't, to think I could go in again and this could happen again, and it prevents you from doing things maybe that you should because you're so traumatized by that moment when it happened, when you thought it was impossible. What do you say to doctor Elizabeth Coleman, by.
The way, maybe we should introduce her.
I mean, she is one of the leading breast oncologists here with memorial Sloan Kettering MSK like the gold standard of treating people who are battling breast cancer and just has been an unbelievable voice and an advocate for breast cancer patients. And I love your your advocacy for breast cancer research. I know that your passion is my passion, and we met. I believe it'd BCRF Breast Cancer Research Foundation, but also have ties to five hundred and forty as well.
Where these are organizations that one of them is to helping women get through tough times emotionally and physically, but the other is to prevent or to stop this from killing women. So I know you've done so much work looking for that blood test that actually would let a woman know at an early stage that she had breast cancer instead of a mammogram. So you are an amazing
physician that you've saved countless lives. But now you've written a book which goes beyond breast cancer, goes beyond cancer, and it talks about women's health altogether, and it's all in her head. We've all heard that, right, And this is something to me that spoke to I think any woman who's ever gone into a doctor's office or had
an issue and second guest herself. There's a reason why we doubt our bodies, in doubt what we're feeling and think maybe it's nothing, or maybe it's just anxiety, or maybe I am emotion and that's what it is.
Hysterical.
Right. That's so tell me about why you're a woman, you're a physician, Why would you write a book like this?
Well, a lot of it came from, as you said, I've spent my whole career taking care of women, countless women, thousands of women, And the book is not about cancer, but really what it is like to be a woman
seeking medical care throughout history. The book is broken down by organ system the same way that specialties and are created today cardiology, gastroentrology, neurology, and mirrors the fragmentation of the body as we learn about it in medical school, and walks through history with each of those organ systems.
But I wrote the book really having been inspired and at times heartbroken and other times enraged and horrified by the stories that patients were telling me when I met them, not about their cancers per se, in some instances dismissed for having alan been being told or you're too young to have cancer, but in all other aspects of their medical care, feeling invalidated or shamed or apologizing for their
normal bodily functions. And as I became a mother myself and a daughter and caring for women in my family, I just felt this overwhelming need to work to try to change that narrative and be part of a mission to improve the health care for women which goes far beyond cancer, but in every aspect of our bodies.
You said, change narrative. It seems on a wider scale, when we talk about women's health, it's uh, breast cancer and abortion rights, right, and that's the end of the On a larger scale, we know there's more, but why are we not talking about more when it comes to when's he.
It's a great question because I think that's exactly part of the problem. When I was in medical school, I thought, you know, women's health was gynecology. And as I've had this much longer career taking care of women, the reality is we are not small men from head to toe. The way we present with diseases is entire It can
be entirely different. There are female specific and female predominant diseases, but yet our healthcare system and the public we've largely been reduced to, as you said, our breast and our reproductive function. And that's a real problem. I mean, we don't recognize as a whole as a society that, for example, eighty percent of autoimmune diseases are in women. Much of
those we don't even have the right names for. We don't even know how to have the right blood tests, or that Alzheimer's disease is two times more likely in women than men, and women are often the ones who are the caregivers of our society, So who's caring for those women? Or that heart disease is the number one killer of women, And yet we are often taught that the way women present with symptoms is atypical as compared to a man, that we're greater than fifty percent of
the population, We're not atypical. So all these ways that we have myself included thought that women's house with this was this very reductionist view of what our bodies are, and I want that to change. It has to change.
Oh, I mean, I think this is so relatable to any woman who's gone in with with some issue and are so afraid they're not going to be believed even.
To start off with.
Have you ever experienced that bias you as a woman, you as a patient. Have you ever felt like you weren't believed or you were dismissed.
Absolutely, it's almost embarrassing to say, and I didn't want to include it in the book, But when I told my editor what had happened to me at the end of writing the book, right before I wrote the conclusion, she was like, well, how can you not share this? And I said, well, here, I am advocating for women's health. I have all these resources in the world, and look what happened to me. If I couldn't do it. How can the average woman do it? Or how can the
woman with no resources do it? I had had at the conclusion of writing this book, I had a very small back surgery, and about six weeks later, I developed a horrible headache that was worse when I was sitting up but somewhat relieved when I was lying down, but
literally I could not raise my head a millimeter. And I had said to a friend, I think that I'm leaking spinal fluid from where I had my other surgery, and that can happen beca because your spinal fluid is encased in almost like a cellophane membrane, and that connects to the fluid that's in your brain as well. So if that leaks from the back of your spine, you have less fluid around your brain, and it can feel like your brain's being sucked down your spinal cord, literally
in a vacuum. It's something that women who have had
an epidural might experience after childbirth. It's called the spinal headache, and so immediately I thought I knew what I had, but very long story short, I had several other people tell me that it was not that, and instead of advocating for myself and believing, well, I know what's wrong with me, I spent days and days and days not getting the care that I need, not being heard, and ultimately being admitted to the hospital with swelling around my brain.
What I mean, did they do any testing or you just said it and they said, now I don't need to check for that or what.
Well.
I was so embarrassed that my idea seemed so crazy, which is what I was initially told. There's no way that could happen. You're crazy. It's just like a compressor nerve or you just have a head. So in that process I didn't even express a part to my friend what I thought was going on. So the last time the diagnosis was uttered was when I said to my friend, who's not a doctor, who's like, I don't know who do you?
You were asking someone who isn't a doctor, and you're a doctor. That's so fascinating, Yeah, yes, yes, and so relatable by the way, so relatable, and then I had several doctors also tell me that I was crazy and that's no way it could be that, but it was, but it was.
Are women doctors more prone to listen to women or no?
So when you look at the data per se, women in general listen longer to patients. Women who are operated on by women do better. Overall, if a man is operated by a woman or by a man, their outcomes are the same. Now wow yeah, oh wow, So that's the data. That's not to say uniform. That's the case. There are amazing male physicians to do a beautiful job of listening and are empathic, and then there are female physicians that are not. Right. We can't just split this along gendered in sex.
Lineskay, But generally if you're a woman, you're in better hands with a woman doctor if.
You will agitated. But I would like to say is that that doesn't have to be that way. We can value nurturing, we can value listening, we can value empathy from any doctor that shows up. And I think we have to bake that back into our system. That's kind of sidelined some of those qualities that are really essential to being a good doctor and have pressured our system.
Dramatically, doctor Clem, and I asked, if you had ever not been believed, have you ever dismissed a female patient, And come to realize, oh wow, she was actually saying something that I didn't hear.
You know, one of the stories in the book, if I can be somewhat provocative.
Was you can go as a safe space.
Okay, so we're just going to go there. You can start giving me hand signals if if it's a bit much.
Nothings as off limits, okay.
So I had a woman who isn't She must have been in her late seventies, and this amazing photographer and artist and just sort of fabulous with big glasses, and I love taking care of her. And she had been put on in aromatase inhibitor, which, as you know, depletes the amount of estrogen. Can cause joint aches, it can cause decrease libido, it can cause vaginal dryness, it can cause decreased bone density. It can have a lot of different side effects. And when I spoke with her, I
neglected to talk about her sexual health. And one day she came in and she said, you know, I'm really having some problems with my special friend, and I thought, well, this lady lives alone. What is she talking about? And I got all excited that I that there was some new person, her new special friend. And I said, well, you know who's your special friend? And she said, it's my vibrator. And you you never talk to me about what the hell would happen to me on this aromatase inhibitor.
And I'm miserable. And so I had dismissed that an older woman would want to be sexually vibrant and thriving. And she said, that's a real problem. You got to think about why you didn't talk to me about that. You talked to you about about other women. Why did you neglect to think about that with me? My special friend is very important to me. And so there have
been many patients along the way. I am human and I have drank the kool aid as well about a lot of the legacy that we inherit when we show up at the doctor's office, a lot of the bias whether we're doctor or as patient. So as much of writing this book was not only to help patients, but it's the kind of book I wish I had read in medical school. And I perfectly not perfectly, but I have to humbly own what has happened to me along the way and what I have learned.
I've never heard I heard it put that way to where it snaps, and I get it in a better way in that you're talking about a woman and yeah, a vibrator, right, But you had a bias against this woman based on her age. There are so many other women that walk in bias based on their education level that a doctor we're looking at, Ah, you're not a colle educator, so I don't have Or this is because
of race. Is that what we're talking about, the same thing, that example, But that is the way that someone could get less healthcare or not get the type of quality care they deserve because a doctor like you. And I'm not getting onto you, but to that point, just makes a simple conclusion based on age, race, or whatever it may be.
And I think it's not always intentional. I show up with the good intentions, but part of writing this book was to unpack again this legacy that we may not even be aware of that we inherited. The book walks through history and there are extraordinary examples, going back to the Greeks to the Middle ages to the nineteenth century
that will blow your mind. I guarantee you that medical history can be fascinating and engrossing, and those examples are obvious where it's like, oh my god, I can't believe they did that. What I think becomes more insidious and subtle, and even worse is to recognize the ways that we don't even realize that we are showing up that way. And if we look at our medical system when we think about the aging woman, what we learn about so much in medical school is women at the age of puberty,
women and their reproductive function and their reproductive fitness. But that woman who goes through menopause is less tended to in our medical system. That aging woman who may have cognitive decline is less tended to in our medical system. And much like medicine doesn't exist in a vacuum, but is so inextricably linked to society, we neglect the aging woman as a society. So that trickles through into how we study women as the age, how we care for women as the age, and how we tend to their
medical problems as the age. And that was very much something that clearly I was doing in my practice and didn't realize.
Wow.
I mean, you're a daughter, you have your own daughter, you're a woman, you're a self, and yet you know we're continuing to perpetuate this. I mean, it actually makes me sad. I remember I have a very good friend. She was in her sixties and she said to me, there's nothing as invisible in this world as a woman past menopause, Like people don't even see you. Your value
goes down significantly. So then what is your advice to women of any age to make sure that you're owning your own health care and that you're asking the right questions. And let me ask you this, as a doctor, is the onus on the patient, on the woman?
I think the onus is really on that doctor patient relationship and our society at large, our medical system at large. And then, you know, Amy, you talk so much about what it means to not just survive, but to thrive, And much of writing this book is the idea that everybody that we're in has a history, a history we've been told by our family, by society, by the healthcare system. And my hope is, after reading all of these stories,
can women tell a different story about themselves? And in that can we ask better questions about what it means to really have a good day, what it means to really find joy, what it really means to thrive. And so my hope is that patients will come back to the healthcare system, come back to their doctor and say, as that woman getting older, you know what I miss this or this is what I really value in feeling good. It's not just about making sure you get your paps,
mirror and your colonoscopy. But you know, I really enjoy playing piano. But my hands are bothering me. I have these joint aches and I don't know what that's about. I would like to access that again. Can you help me? So I think there's really this two way dynamic that we have to create space for. And that's what I'm really talking about changing this narrative about women's health moving forward.
Why is this so hard to cure cancer?
Oh? Wow, you're really going for it.
Well I have's let's do it.
I seem all I feel almost silly asking the questions, right because we talk so much about it. It seems to be so much money. She always was the thing.
You say, there's a cure for cancer, it's called cash. Yeah, yes, it's a question.
So I think part of it is the history of what we've called cancer. So you know, a leukemia, where you have a replication of a blood cell many times over, is extremely different from a solid tumor cancer, like where you have one cell that multiplies awry in the colon or the breast. So again, cancer is just one cell in your body, starting in one tissue that starts to multiply too much and then develops the ability to invade
and travel. So that is the basic definition. But when we talk about curing cancer, a blood cancer is so wildly different than a breast cancer, so wildly different than a lung cancer. But yet we've created this like how we're going to cure all of cancer. And I think it's the reason why it's so complicated is because we've used this one name for a very very It's like saying, how we're going to cure an infection, right, but a
skin infection is totally different from a pneumonia. And so we have these very, very complicated diseases that are not only very unique biologically just in a petri dish, But then again we have to think about the hosts that they live in. You can have the same biological cancer, the same diagnosis in two different women, but how they do and how that interacts with their whole body and
how they experience illness is entirely different. So it's a very very very complicated web that you know, you have so many people dedicated to working on.
Do you think that there will be a cure to metastatic cancer in your lifetime?
I hope so, I hope so. I mean, I say you believe that, I believe it. I mean I am desperate to be out of a job in that way. I think we both know the trauma that that really far too many women suffer from and have endured, and it's it is unacceptable. I think, much like people can live with a chronic disease like diabetes or heart disease. I think that is a very reasonable that we're already doing that. Can we make it all go away? I certainly hope so, But I'm not I'm not sure.
Do you know what you said, I'd be happy to be out of a job, you know. And this floored me when I started going through this. How many people out there do believe that there is a conspiracy within the healthcare community to make sure that cancer isn't cured because a lot of people, doctors, pharmaceutical companies would be put out of business.
What do you say to that, because I know you've heard that before too.
I have heard that before, and I have a hard time not crying when I when I answer that question. And I will try to answer it as logically as possible, because people may say, well, you're just too low on the total pole. You don't know what really goes on behind the scenes. But having cared for royalty, having cared for people who have seemingly more money than God, who could buy out any pharmaceutical company, and you know, hire any CIA agent to I, I don't know, uncover some
secret cure in a corner. It doesn't it doesn't fit right. People with all the power in the world world have died from cancer. People with all the love and power and money who would do anything possible and could have still lost love once to cancer. People at pharmaceutical companies have died of cancer with all of their power and insight into how everything works. It's understandable because it's a horrible, horrible disease. And also there's a lot of mistrust, understandably
in our healthcare system. How could this possibly be? How
have you not figured it out yet? But yet there have been incredible advances from academics, from pharmaceutical companies, from government institutions that have really allowed cancer to look incredibly different than what it used to when I first started out, whether it's immunotherapy, whether it's women living for years and years and years with metastatic disease, whether it's some women who are getting treatment from metastatic disease and I can't
see their cancer on their pet skin anymore. We have made tremendous advances and I hope will continue to do so. And I am sympathetic to this conspiracy theory because it is scary and how could this possibly be so hard? But it is?
Was it a king, a queen, the prince, you said, royalty that nobody else skipped over? That it's just going to slide.
I think any doctor that brags about who they care for is a problem. Right, We don't need to hitch our start to anybody.
They hit me with that, But but I think that I say it to say that, you know, whether it's high ranking political leaders, royalty, people with billions of dollars, I don't even know how much.
Cancer effects is an equal common denominator to suffering.
Dude, are we throwing everything at it? Even if right, even though it's not a conspiracy? Are we still doing all that can be done? Of course, more money is always a good thing. But is there a collective enough of a of an effort going on out there? Are we doing enough to try to cure cancers?
I think there's never There's never enough because we have such a huge problem. I wish that we could inspire younger generations to go into cancer, to go into oncology, to go into research. There are so many incredible minds out there that I sometimes wonder if you weren't developing a video game, could you come on board and help us out right? Could you think outside the box? What
are we missing? I'm humble, right, and I think it has to start with new and fresh ideas and humble ability to really pull together people from various different walks of life and different backgrounds. Because one of the problems with medical science is you never want to get too comfortable, and you never want to be too siloed in your ideas, and that means really bringing in people of different interests
and capacities. So for anybody with kids who are thinking about, you know, developing another toy, maybe there's something else we could do with that bright.
Minds, right, I love that, doctor Colemann.
How many women do you think, I mean, this is just give me an idea perspective, have lost their lives because they weren't believed.
I don't obviously, I don't have numbers on that. I think there's two different ways that I think about that. There's losing their life meaning being alive, but being miserable, and I think that is countless. I think countless of women have asked questions far too late in life about what they really want, how they really want to feel, how they can feel better in their bodies, So that
number is countless. In terms of medical error and people feeling invalidated, that's complicated, but I think that also happens far too commonly. But the bigger problem of women not feeling like they have the runway to access the medical that they really want is countless. It's unfortunate that every woman says to me, I love your title. I have a story for you. Everywhere I go, I have a story for you. Let me tell you what happened to me. Let me tell you what happened to my mom. Let
me tell you what happened to my daughter. I don't want this title to resonate so much, but yet it strikes a chord with every woman I talk.
To, and it's this whole notion of hysteria. Yeah, talk a little bit about if you're a woman and you're saying and you're in pain, and maybe there isn't a test to say, ah, this auto immune disease, that's what you're suffering from it. I know people and so many women talk about chronic fatigue, chronic pain, kind of not even being able to describe it, coming and going, and being too embarrassed to have someone look at you skeptically
or tell you it's all on your head. They just live with it, this whole notion that we're just hysterical or we don't have a high pain tolerance. How do you combat that?
It's interesting I just gave a talk to a group of young women, probably in their mid to late twenties, and I said, I wasn't sure what the answer was going to be. How many of you have ever been told that you were hysterical? Every single one of them
raise their hand. If you go back in history, the word hysteria derives from the Greek word for womb and Hippocrates, and you know where we say the Hippocratic oath had all these treaties and there were other doctors that aligned with him that basically said, the wandering womb is the source of all women's ills. And over course of time,
obviously we learned that actually it's tethered in place. It's not that we have to put certain smells next to our nose and other smells next to our vagina to reposition the uterus, but that was what they thought we should do.
Throughout history.
This specter of the ghost of the hysterical woman lingers on till today. Whether it was also our ovaries that made us crazy or even worse, your bathes and estrogen and that's just every cell of your body is completely screwed because we're so hormonal. This has infiltrated every aspect of our medical care and what we study and what we understand. It wasn't until the nineteen eighties that it was even removed as medical diagnosis.
Hysteria, Yeah, was a medical diagnosis.
Absolutely hysterical. Yeah, nineteen eighties, Well I just got chills?
What yeah?
What?
Yeah? That was an actual diagnosis that you could be diagnosed with, But yet it gets translated in different ways. And there's also the other component of that women somehow endure suffering and that we are meant to endure And perhaps that even goes back to original Sin and Adam and Eve. We can dissect that. But whether it's women in pain or women from fatigue or any sort of ailment, there is throughout history this thread of we are just
suffering too much. And in part it's because in recent years, in the last one hundred and fifty years, our medical system was created. And I'm not bashing men, but it was created not by women and not by listening to women. And so if you have female predominant diseases, how were those men supposed to understand them unless they really took
the time to listen to women. And a lot of what I'm trying to change now is we have to reconfigure this narrative of how we listen to women to better understand their symptoms, to not just say, oh, you're tired because you know you're a new mom, you're joint aches because you didn't sleep well, have a glass of wine and relax. It's just you know, or maybe it's that time of the month.
Well, but what do you do with that, because sometimes it's a badge of honor for women will say all the time, but what they can take, what they can endure and have their pain tolerance even higher. You've been very arrogant about that at times, with me having the same illness or.
Whatever we call it man flu right, Yes, I think.
But really that is that that is very pervasive in our society that sometimes even women take that as a badge of honor, and you're saying you should not.
No, I think that women also apologize. They apologize for their pain, They apologize for needing to take care of themselves. They apologize for having to call out sick when they're you know, got a fear or one hundred and four. I think we need to have pacts with each other to stop apologizing, to say you don't need to be in this much pain, let me help you. And that takes that takes village because sometimes it's hard for women to do that by themselves.
Yeah, you write about and this one really struck me about some of the patients who've apologized to you, and why they were apologizing to you.
Yeah, so the opening of the book is a woman who apologizes to me on her deathbed for sweating. Not the first nor the last woman to apologize. Every day in my clinic, women apologize to me for basic functions, whether it's I forgot to shave the hair under my armpit or I'm having a hot flash. I'm so sorry, you just gave me really scary news about my pet scan. I'm sorry now that you're examining me that I'm sweating.
Why is that? It's unacceptable and it really holds women back from actually having the space and the comfort to access what's really scaring them, as opposed to apologizing to the authority in front of them.
You know, I'm reacting to that because of you, Rotes that this wasn't on goodness. So many times if I end up at NYU with you over the past year and a half or a couple of times, the reason of the other but one of them was doctor Coleman was your case. He was your on collegist telling you to get in that saw something she didn't like on you know what I'm talking about.
Here right, Well, it was it was my obgyn because my tamoksovin uterus and she saw I did not take care of what was happening with my uterus, and I let it go a year and things had grown, and there was concern that now there could be potentially uterine ca cancer or some polyps that were developing that weren't healthier. Good.
Well, this was full doctor comba. This was full freak out mode, right. And again we hadn't gone in yet, but this was it had gone a week or two weeks and the doctor was onner about going in and another situation to where she just didn't want to know, right, didn't want to know. But we go to this appointment and you made me think of it. In the story you were just telling. Is that we're sitting I'm sitting there with her. She's got the gown on. The woman
is doing the ultrasound right right right. She was looking for the ores right right, all right, and she couldn't find the second right, she couldn't find one. Am I over it? This was the thing she during this exam. I'm watching her. She's not asking questions, She's not wondering or what's going on? Or is there an issue or where is it or what can I do?
Nothing?
To the point I felt like like this isn't my party, but hey, I got a question. To the point, I did more talking in her exam than she did. It's
called fear, and that was bizarre. But to your point, there even looking and we walked out of there not having a resolution or feeling better because she couldn't find something on the scan right, And so you making the example of telling the point about being believed or speaking up or apologizing almost for the tech not being able to find her over like, I'm sorry, am I Over is tucked in there. I don't know where it is.
I'm not sure where it is.
That was bizarre to me, but that sounds like it's normal to you. That's a normal thing.
Well, I also think when you're so anxious and you said fear, when you're so fearful, you're in fight or flight in mode and you just want to exist in
that moment any way you possibly can. But how lucky she was to have you there, because we all need an ally, we all need no matter I don't care how smart you are, how empowered you are, what an advocate you are, everybody needs someone with them when they're terrified, to help ask those questions, to help for reassurance, to make sure you have another set of eyes and ears with questions and answers, to say, you know what that wasn't answered, Can we try that again?
You know, when she puts it that way, I felt rude. I didn't want to speak up. But when you say it that way, you need to be there to support somebody who is who has fear, who is feeling fear. That's a good way to put it.
Yeah, And especially sometimes when someone's this strong woman who can articulate and is really powerful and informed, that doesn't mean that you don't need somebody there with you and your side. And I tell patients all the time, you know, our healthcare system is hard to add, it's hard to navigate, it's hard to advocate for yourself sometimes, so having somebody there with you who can bring a set of questions
is really important. It's also essential to know how you're going to get information right because we have my chart right now speaking of fear, where a lot of patients can get information before your doctors.
I can read labs and think I don't want this information. I don't know what to do with it, and it looks scary, and I don't like my brother. I'm lucky as a physician, and early on when I was getting some of this stuff, I would just send it to him and say, please tell me what this means. I don't know what any of this means. So there is this information without any explanation, and I certainly don't have an MD. So yeah, you can go into a tailspin.
Yeah, it's really important to speak to your care team about how you want to get information, because that type of information without context is not compassionate or thoughtful care. It's just terrifying rabbit hole Google like nightmare, right, And we wouldn't google how to fly a plane and then try to do it, but yet it's like we're given
some instructional manual and then it's terrifying. But that's the nature of much of our healthcare system right now, and you have to be careful about how you want that information and who's going to communicate with you.
To be clear, you would recommend people do not start googling if you have a medical issue.
No, but we all do. I do the same thing to you, right, so I think.
How you do it too? Of course I love that, okay, but.
We all need it.
We all need it.
I have like three in the morning, it's the worst time. Right, we're a I don't know everything everything. It's I'm just I'm human, I'm mayor myself right, But I think knowing how who should you call in your your doctor may not be available. Is there a nurse, Is there a nurse practitioner? Is there someone that can schedule an appointment with you? Really knowing how your doctor's office works, so that you can kind of have these landmarks when things start to spiral.
I also love something that you wrote about in this book because my brother gave me permission to do this. And I say permission because it is one of those
weird things. It doesn't matter what you do in your life, who you are as a woman, maybe how outspoken you'd be when you're talking about someone else, but somehow, some way, when it's you and it's your health care or it's your concern, I know that I tend to feel like I just have to look up to the doctor as God and I don't know anything and they know everything.
And my brother was always so quick to say amy second opinions, third opinions, and if you don't like how someone's talking to you or treating you, by all means, get another doctor. And you said the same thing, and that was like I needed him to be able to say that to me for me to feel like I could because when you don't know, and you know you don't know, you think, well, that other person's got to be telling me the truth.
And you want to see a doctor who's comfortable with you get a second opinion too, Right, I'm thrilled if patients are worried and want another set of eyes, go for it, you said earlier in the conversation. You know what you know, right, I know what I know and i know what I don't know, and I'm humble enough in that. And if someone feels that they need to speak with somebody else or want me to partner with somebody else, I'm delighted to do that.
Okay, that's probably be a warning sign if your doctor doesn't want you to get a second opinion or gets an attitude about you getting a second opinion.
But that happens all the time. Wow, Yeah, what was.
The doctor you were just saying? They they found they almost.
Got on to you, like what you didn't feel that, so I had the This was tough.
The day I was diagnosed with breast cancer, the radiologist who was reading my sonogram in that moment obviously saw one of the masses and she took my hand and took my two fingers and put it up on the side of my breast, right underneath my armpit where the mass was, and she said.
You didn't feel that. Let me just tell you.
If there was a way for me to feel worse in that moment, she found it. And I remember feeling shame. Here I am being diagnosed with cancer, and now I'm ashamed that I didn't do brest self examinations. And so that was one of those moments where it's just I'm sure there wasn't an intention to be mean, but it was like, to feel shameful about your cancer was a whole new level for me in that moment.
It's horrible. I'm so sorry that happened to you. And also, I think women feel shame about their bodies even for their normal bodily functions, let alone when they have a cancer diagnosis, and that pervasive shame absolutely gets in the way of every aspect of women's healthcare.
I'm sorry, well, thank you for that, And it was a lesson. It was just an experience to learn from and grow from you. In that same vein, I was saying this to TJ when we were looking at your book. The Latin name for or female genitalia is.
What opeduendum that area to be ashamed.
Yeah, it literally means that. Can you explain, because I was my jaw drop when I read this.
Well, there's all sorts of language, and language is become so important with respect to the subtle cues that we give women, and they're not so subtle cues, but in multiple different ways, we are taught to shame or ignore parts of our bodies. If you look at the clitterists throughout anatomical history, it is lost and found and men who claim to find it as if women didn't know
where it was. How is that possible? In the Renaissance, the debate between these anatomus was just simply mind boggling, like, honey, I don't think you found.
It, but that's great if you have to ask, yeah, yeah.
And then men claiming to have the name for it. But then in Gray's Anatomy in the nineteen forties, it wasn't even included in there. So it took till two thousand and five for a female urologist to even map the actual anatomy of the clitorists. So that's a problem Ian and five to use MRI imaging to actually map the full nerve anatomy. And we wonder why there's an orgasm gap, and it's never talked about or discussed. But here we are, yes, well, we all.
Have daughters, and you know it is something that needs to be talked about. It's an important part of being a woman, and so many women miss out on it because it's shameful or not to be discussed right.
Well, one of the themes throughout the book is how much woven into medical history and medical discovery and medical care for women, the fear of women's sexual desire, desire, and or the need to control it infiltrated every aspect of medicine. Whether you could ride a bike or not, whether your scoliosis was caused from somehow masturbation, whether your asthma was to blame for some sort of sexual habit.
Throughout history this is pervasive. And then when we think about the legacy today, why are we two times more likely? Why did I have that bias towards my older patient. Why are we two times more likely to ask men about sexual side effects from a chemotherapy, asian or cancer targeted therapy than we are men. There are so many ways that we have lagged behind in addressing women's sexual health and medicine, and we are still playing ketchup generally.
Look, you're going to continue your work no matter who's in Congress and who's in the White House, but in your community, and I'm not asking you to play politics or pick candidates or anything like that, But do you will have a concern during a political cycle that what happens in DC and what happens and who is in the White House will have an impact on women's health
as a whole. Again, we only end up talking about abortion rights so often, but IVF is obviously being talked about a lot in South But do you all in your community have that concern in an election year of the future of women's health over the next couple of years or election cycle based on who's there.
Politics dictate the type of care women can rest, both by legislature but also by funding right and we see how this is dramatically affected women's access to quality care in recent years. I think many of us are very, very very scared. Throughout history, so much of women's bodies have been seen as vessels and that is the priority, and I am very much politically aligned against that.
Where So you said it does matter, what are your concerns going into this election cycle.
Then, I'm concerned about so many different things about funding for women's health. I'm concerned about women's access to reproductive health. I'm concerned about women's ability, as we know the ruling in Alabama, their ability to have a family. So many of my patients were able to have families despite a cancer diagnosis because they had access to quality IVF, because we could move quickly in a matter of days to
preserve their fertility. And to think that that would be harmed or taken away from them as the exact opposite of helping and thrive.
We often have these debates about it appears to be old white women telling old white men, excuse me, and Washington telling women what they can do with their bodies. But there are a lot of women who voted for these old white men. There are a lot of women who are still engaged in this and could be impacted by the conversation we're having and about women's health. How
do we are you all? I guess it's up to all of us, But how where do you see the conversation happening with women and mobilizing women more so as almost I mean, not a one issue group obviously, but to vote more for their own health.
I think it's so important. I think you know, yes, I've wrote this book and I have this more public platform to speak about women's health. But where all of this started are the private stories that patients have told me. Democrat or Republican, it doesn't matter. Women have suffered from not feeling like their needs were heard, whether it's a
political or religious or medical standpoint. And I think more women need to share their stories because some of these women that may have voted one way may be voting because their husbands have voted a certain way. They don't feel like they have as much agency, They feel like they have to align with people in their community. But then in very private settings say I'm terrified I voted this way, but I'm terrified. I'm terrified for myself and
I'm terrified for my daughter. And the more we can have, at least alliances about what we're really feeling and what we're really afraid of. Then perhaps when we go into that private voting booth, we can have our own mindset.
That was so well said, because until something happens to you or to someone you love, you can think you think one way. But then when you don't share your stories and you don't share your experiences. I'm a huge advocate in the power of one voice. I love that final bit of advice for women to share their stories, to speak up, to have an advocate, you know, even those of us who want to feel like we're strong, And I love.
To having you. TJ makes fun of me. He says, I'm like Amy always.
Okay, I don't want know who wants to be weak, who wants to be physically or emotionally weak in any way. But it's when we let our guards down and we actually are open and vulnerable, be willing to have someone there by your side with you to speak for you when you can't because it's gonna happen and it's okay, and just admitting all of that and having real, honest conversations.
I love this book. It was long overdue, and yes, it's sad that that title resonates so much, but it does so many women have felt that way, and until we start being honest about that, that's how we start to change things. But thank you as always for everything you do, for the patients you serve, for the people you inspire, and for the work that you continue to do.
And I know our paths will continue to cross as we both advocate for better research, better funding, and finally finding a way to have cancer.
Thank you for sharing in the mission. I appreciate you both.
And again, folks, the book is called All in Her Head, The Truth in lies early medicine taught us about women's bodies and why it matters today, by doctor Elizabeth Coleman. The book is available everywhere that books are soul. We appreciate you listening as always. You can find Rogues and I of course on individual Instagram accounts, but you can also find the show at Amy and TJ the podcast