USA Today bestseller! Dr. Elizabeth Comen, ALL IN HER HEAD: The Truth and Lies Early Medicine Taught Us about Women's Bodies and Why It Matters Today
[0:02]Hi, I'm Zippy Owens, and I am the host of this podcast, Moms Don't Have Time to Read Books.
[0:08]I am also a newly minted USA Today best-selling author of the novel, Blake.
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[0:31]Dr. Elizabeth Coman is the author of All in Her Head, The Truth and Lies Early Medicine
[0:35]Taught Us About Women's Bodies and Why It Matters Today. This is included in my summer
[0:40]reads list, which you can check out on ZippyMedia.com. Elizabeth Coman, MD, has dedicated her
[0:46]medical career to saving the lives of women, an award-winning internationally sought after
[0:51]clinician and physician scientist. Dr. Coman works as a medical oncologist with a special
[0:56]routine breast cancer at Memorial Sloan Kettering Cancer Center, and is an assistant professor
[1:00]of medicine at Wild Cornell Medical College. She earned her BA in the History of Science from
[1:05]Harvard College and her MD from Harvard Medical School, then completed her residency in
[1:09]internal medicine at Mount Sinai Hospital and her fellowship in oncology at Memorial Sloan
[1:14]Kettering Cancer Center. She lives in New York City with her family.
[1:17]Welcome, Dr. Coman. Thank you so much for coming on Moms Don't Have Time to Read
[1:21]Books to discuss All in Her Head, The Truth and Lies Early Medicine Taught Us About Women's
[1:25]Bodies and Why It Matters Today. Congratulations. Thank you for having me. My pleasure.
[1:31]And as we were just discussing, I know your background as a doctor is just so amazing and you've
[1:36]helped so many girlfriends of mine and people are saving lives, saved their lives. So thank you
[1:41]for that from the bottom of my heart, honestly. Thank you. Okay, the book. Let's go there. Let's do it.
[1:47]Let's do it. Okay. You are at open book. I feel like I will never be able to ride a bicycle
[1:54]again after reading this story. I'm like hearing what women do to their bodies. Oh my gosh.
[2:00]Okay, tell listeners what your book is about and when you decided to write it and all the
[2:06]backstory, everything. The next story. So I am a breast oncologist, which means I take care
[2:11]of breast cancer patients. I've taken care of thousands of patients over the course of my career,
[2:15]also majored in the history of medicine. And I have always been passionate about understanding
[2:21]the experience of illness and then in my professional world, really the experience of illness
[2:26]for women. So the book is a walkthrough women's bodies in history and by organ system,
[2:31]really tackling, I think, one of the biggest myths, which is that women's health,
[2:35]women's health care is just up rest in our, our uterus. When in fact, we are head to toe different
[2:40]from men, we are not small men. So it is a walkthrough your body by organ system,
[2:46]told through stories, really gripping egregious stories from the past, but all the way through
[2:51]to the present interviews with expert physicians and every specialty and also my experience with
[2:57]my own patients. And when did you become so interested? Were you a little girl who loved medicine?
[3:03]Like where did this come from? You know, my dad is a litigator and my mom is a therapist. And so I
[3:08]think I've always had an interest in questions and narratives and the stories that we tell ourselves
[3:13]and what's the facts? What are the, what's the evidence and science and history of science really
[3:20]tells us that nothing we do and think is about finding the truth is really just that. It's all
[3:26]the perspectives and science and medicine is inextricably linked to everything, culture,
[3:32]history, religion. And for me, I think as a little girl, I wanted to have some sense of authority
[3:38]in a home where lots of other people had authority, but no one knew about science. When I was a
[3:43]little girl, I loved Halloween. I still love Halloween. And I remember my mom, I grew up in Boston,
[3:49]and she always would make me wear like these huge coats over my fabulous costumes. And one day,
[3:55]I was about six years old and I read this book that germs caused the cold, not the cold. And I
[4:00]I said, you know what, mom, I don't need a coat today. I will not get sick. I'm going to go out
[4:04]and this bunny costume. And I don't need a bigger coat because it's the germs, not the cold. And I,
[4:09]and I remember that moment as being like, wow, science is really powerful. I could do something
[4:15]with this. But no, and in all serious, I've always I've always been fascinated by the body,
[4:19]but equally by the humanities and and drawn to this extreme sense of how do we engage in the human
[4:26]experience and how could I be part of that? I had one experience where I convinced my parents
[4:31]through data, but it wasn't through science, but I was trying to get my, this is totally irrelevant.
[4:35]And I can cut this out later, but I was trying to get my curvy raised. And all my friends had
[4:39]later curfews, like literally they did. And I went through and like made a whole chart of all my
[4:43]friend's names and their mom's names and their phone numbers and their curfews. And I gave her like
[4:48]this whole presentation. And I was like, this is why I needed better curvy. And it worked. So anyway,
[4:54]yeah, that's brilliant. We all have these pivotal moments in our lives where we have to find some sort
[4:58]of power within and figure out how we're going to use it for hopefully good in the world.
[5:03]Exactly. Would you say night curfew? Oh, I don't know. I just like sat in somebody else's living
[5:09]room for longer and like hung out. I was pretty tame to be honest. Well, I don't know, whatever,
[5:16]I don't know, not much. I mean, honestly, the problem with curfews is that you go home alone,
[5:22]like I was having to go home alone versus with all my friends. Anyway, yes. Anyway,
[5:27]all to say harnessing data, very important, especially as a child who feels powerless. And now
[5:32]as also as women, we can feel equally powerless when we are not getting the health care that we
[5:36]need or the advocacy that we need. And you are outline all of this and show us like all the things
[5:43]that we should know that where this has come from and it's empowering. The book is super empowering.
[5:48]How did you get started? Like which organ system? Like where did you, how did you think to organize
[5:54]it this way? Tell me about the bookwriting process. So I'll tell you about the organization first
[6:00]and then I'll tell you what really sparked it. I was really struggling with how to organize it,
[6:07]how to structure it because it really is a whole takedown of the body and what we know.
[6:13]And then I really thought about, do you want me to repeat this? Do you hear the siren in the background?
[6:18]Yeah. Oh, all right. Let me start over again. Sorry. That's why I love my apartment.
[6:23]So I'll answer your first question or I'll answer the first part in why did I decide to
[6:29]structure it by organ system. And in all of my reading over really the past couple decades about
[6:35]history of science and women's experience, one of the things that really struck me was how much
[6:40]our bodies are fragmented. We all are seeking this holistic health care and this massive wellness
[6:46]industry because we want to feel whole and well and seen and validated. And a lot of this made me
[6:51]think about, well, we're at it all begin. And with the rise of medical science in the 19th century,
[6:55]that's really when you saw the rise of these medical specialties and experts in cardiology,
[7:00]gastroenterology, neurology, urology. And for me, I wanted to go back and unpack the legacy that
[7:07]exists in our health care system today of these extraordinary specialties, but they've also fragmented
[7:12]our bodies in the process in particular women's bodies. And many of our needs have been lost in
[7:18]the process. If you think about the field of urology, how many of us, me included, thought about
[7:22]women and the fact that we don't need to be jumping on a trampoline and peeing in our pants after we
[7:28]have a child, like that's not normal. And it doesn't have to be, but yet there's this whole
[7:32]field that many women don't even know exists because we've accepted a certain level of suffering,
[7:37]accepted a certain sense of, well, this is my new normal when it doesn't have to be. And I think that's
[7:42]part of the legacy that we've all inherited. In terms of really what got me started, I always
[7:47]knew I wanted to write this book, but I didn't have the courage to include the history,
[7:52]even though it was, it is my passion. I'm not a PhD in history of medicine. I'm not a professor at
[7:57]Harvard and history of science. And I had a lot of imposter syndrome. But I stumbled upon this book,
[8:03]Nymphomania. And one of the cases in the book is about this man, Horatio's store. Horatio's store
[8:08]was 26 years old. He also went to Harvard med school. He had a pension for sticking
[8:13]poachers of female cadavers vaginas because that's just what he thought was normal. And there
[8:20]was this one case of Mrs. B. Mrs. B was married to an older man. And he wrote about this in a
[8:25]famous journal in which he titled her diagnosis Nymphomania. Mrs. B was brought to Horatio's store
[8:33]who became the founder of the Boston Gynecologic Society. And what was the problem? The problem
[8:38]was she wanted to have more sex with her husband, who was older than he did. He claimed that
[8:42]there is an obstruction somehow in her vagina. When really, clearly, if you read this, you probably
[8:46]had erectile dysfunction. And in the course of this, Horatio's store examines her
[8:52]pretty, quite brutally and says, well, if your desire doesn't stop, you're going to have to put
[8:59]a chemical on your clitoris, replace your pillow with horse hair. I mean, with needles,
[9:03]you're going to have to stop eating certain foods, not read romance novels. And if
[9:08]that doesn't work, we're going to send you to an asylum. Your husband and I have agreed,
[9:12]we're going to send you to an asylum. This was a little over 100 years ago. It is not that long ago.
[9:17]And then I've read, well, Horatio's store sent his own wife to an asylum at age 39 in
[9:21]Worcester, Massachusetts, where she died. This same man went on to have found the physicians against
[9:27]abortion crusade. And I thought, and this man is still lionized by certain groups in society
[9:33]today. And I thought, you know, I didn't know about this man. I didn't know about this history
[9:37]of the Boston gynecologic society. And I've taken care of thousands of women. What else
[9:41]don't I know? And once I started on that path, I just did not stop with the rabbit holes.
[9:46]It became a complete obsession. What do we know about exercise? What do we know about cardiology?
[9:50]Why is heart disease the number one killer and women? And yet we've got all these women
[9:54]dying and not realizing their symptoms of a heart attack. And it just became absolutely compulsive.
[10:00]Well, so when are we doing all this?
[10:02]You're seeing patients.
[10:03]You have your whole life.
[10:03]When are you doing this?
[10:05]So another pretty courageous move was there had never really
[10:09]been anybody in my hospital who'd worked part time
[10:12]in the type of department that I was in.
[10:14]And so it took a lot of courage for me to ask
[10:17]to cut back a little bit on my clinic time,
[10:20]take a massive pay cut, and really commit to this project.
[10:24]So there were a lot of, I know you write about this to you.
[10:27]There were a lot of 4.30 in the morning wake-ups
[10:29]but a lot of people asked me, was it hard to write this book?
[10:32]I think cancer's hard, taking care of young women,
[10:35]really, really sick, is really, really, really, really hard.
[10:39]Writing this book was one of the greatest
[10:41]joys of my life, if not the biggest intellectual joy of my life.
[10:45]And how do you get through taking care of women, young women,
[10:49]and seeing all the sadness and things you can't maybe fix?
[10:53]Yeah.
[10:53]So when I went into the field of oncology,
[10:55]my mom especially was really worried about me.
[10:57]She said, you have to be willing to be part
[11:00]of the process of caring for someone no matter the outcome.
[11:03]And you and I both know that there's only so much
[11:05]that we control about cancer.
[11:07]We've all been affected by it personally
[11:09]or in some greater way in our community.
[11:12]And I don't think I fully comprehended that.
[11:15]What it would be like to become a mother myself,
[11:17]to become a daughter taking care of her parents.
[11:20]And I take care of women of all stages of disease.
[11:23]And it is a huge privilege to be part of their lives,
[11:25]to hear their stories, to hear what they wish for themselves.
[11:29]But I don't think I fully grappled with
[11:32]what that would be like for myself.
[11:34]I'm a huge empath.
[11:35]I don't have boundaries.
[11:37]I don't compartmentalize well.
[11:39]And I absorbed a lot of that over time.
[11:41]And I've had to really, and I'm still learning
[11:44]how to process all that.
[11:46]Writing this book was part of my own love affair
[11:49]with medicine again, with the whole person,
[11:52]with sometimes realizing that I've been in the valley
[11:55]of death a really, really long time.
[11:57]And you have to see the sun too.
[11:59]And that's what fills you with the courage
[12:01]to take care of the next patient,
[12:03]especially in the imperfect healthcare system
[12:05]where we exist today, where you might be compressed
[12:08]with time, you might not have the hours
[12:10]to find out that your patient's dog's name
[12:13]and everything that they love and everything
[12:15]that they want for themselves.
[12:16]But what can you do with the time that you have?
[12:18]So I've had to learn a lot of new skills.
[12:21]And I'm still learning.
[12:22]But that's part of why this book really saved me.
[12:25]Right before I wrote this book,
[12:26]one of my colleagues died at age 39 suddenly
[12:30]in my arms, really, in the middle of clinic.
[12:32]He died of sudden death.
[12:34]And it was right before I really committed
[12:37]to writing this book.
[12:38]And sometimes you have these pivotal moments in your life
[12:41]where you also realize you're helping everybody else live,
[12:44]but what are you doing for your own life
[12:46]and what will it take for you to thrive in it?
[12:49]And so as much as this book is about
[12:52]helping changing the legacy of women's healthcare personally,
[12:57]this was also a book that saved me.
[12:59]I'm so sorry that happened.
[13:00]Oh my gosh.
[13:01]What does that mean, died by sudden death?
[13:03]He, in the interest of privacy, he was 39.
[13:07]He had an underlying condition that he did not know about.
[13:10]But he was walking towards me in distress and collapsed.
[13:15]And everything was done to save his life.
[13:17]He had cardiac issues that were undiagnosed.
[13:21]And that he would never have known.
[13:23]But it was horrible to do CPR in your friend to, oh my gosh.
[13:28]The awful, but I will tell you that right before he passed away
[13:31]the last conversation, I confessed to him
[13:33]that I wanted to write this book.
[13:35]And he said, Elizabeth, you gotta write the damn book.
[13:38]You have to write this book.
[13:40]And it was one of the last things he said to me next to saying
[13:42]that he liked my sneakers, which were leopard print.
[13:45]And you think about, well, how do you honor someone's legacy?
[13:49]How do you do things that you feel like you were meant to do
[13:51]in this world and that this is one of them?
[13:55]Oh my gosh.
[13:55]Yeah, it's the ultimate if not now when, you know,
[13:59]kick in the pants type of thing in the most tragic of ways.
[14:03]Yeah, exactly.
[14:04]I gosh.
[14:05]I feel like I would be replaying that in my head all the time.
[14:08]That scene, do you do that?
[14:09]You know, do I replay that scene over?
[14:12]I did for a long time.
[14:13]And the thing is, is that my clinic,
[14:16]so where I practiced my whole career is the same place where he died.
[14:21]And that never changed.
[14:22]So every day, it's walking by that same place.
[14:25]But you try to do the best with, you know,
[14:28]the experiences that life throws you.
[14:30]I guess.
[14:32]What a huge champion of women, a huge champion of women
[14:36]and of joy and of thriving and in patients loving him
[14:40]and helping them.
[14:41]And my hope is that this book helps change the stories
[14:45]for so many women and be part of a larger mission
[14:49]to improve the health care in this country,
[14:51]which I think is woefully lacking with regard to women's health.
[14:54]Do you feel that there is something we can do about it?
[14:57]I've been feeling very down lately of all the things
[15:00]that are not able to be changed,
[15:02]but have been identified as lacking.
[15:04]Yeah.
[15:05]And I think that I didn't want to write a book that was just
[15:07]a Debbie Downer, but I really did want to say, you know,
[15:11]we can fight for all these things today,
[15:12]but unless we know where it's come from,
[15:15]I really don't think we're going to change the story
[15:17]all that much.
[15:18]I think there's a couple different things.
[15:19]First is an individual woman.
[15:22]And I needed to do this myself.
[15:23]It requires a lot of thinking about what are the stories
[15:26]you've been told about your body yourself?
[15:29]Know that when we think about the experience of illness,
[15:31]two people can have the same diagnosis,
[15:33]but what they go through, what their lives mean to them
[15:36]is so uniquely specific to who they are
[15:38]and all the things that go into the ineffable qualities
[15:41]of what it means to be an individual.
[15:43]And I think in that, my hope for women reading this book
[15:46]is that they think about the stories they've been told
[15:49]themselves, their experiences with the doctor,
[15:51]and does this empower you just a little bit more
[15:53]to ask the questions you've always wanted to ask,
[15:56]to not feel shame about whatever it is you feel shame about,
[15:58]to get that second opinion, to have somebody go with you
[16:01]and say, you know what, I felt so dismissed
[16:04]about X, Y, and Z, something is not right.
[16:07]Please explain to me what's going on.
[16:08]And if you don't know, help me find somebody who will.
[16:11]So there's an individual story.
[16:13]And then, as importantly, I think there's that collective
[16:16]sisterhood, so much about what we say about women
[16:18]is we cut each other down and we don't support each other,
[16:21]but I think that's ridiculous.
[16:22]I think in writing this book, you see, I've seen how much
[16:26]women are our greatest type party.
[16:29]And I think the more we can come together
[16:31]with the type of honesty and authenticity
[16:33]that you've shown so many people in your life,
[16:35]the more my hope is that women will feel less alone
[16:38]and say, this is what I've been through.
[16:40]these are the experiences that I've had.
[16:42]There's so much front facing in society
[16:44]with social media and certainly where we both live.
[16:47]But in reality, we are all simply human.
[16:51]And I think women need each other.
[16:52]And I think women need each other more now than ever.
[16:56]And as much as there seems to be support,
[16:58]I think there's always more that we can be doing.
[17:01]I recently did an event at my book
[17:03]Sir with Dr. Mary Claire Haver about menopause and women's
[17:06]health.
[17:07]And so after that, she's kind of opened my eyes
[17:09]to a lot of the things I didn't know about
[17:12]in terms of the second stage of life altogether.
[17:15]And that I feel like has been just so obvious of an example
[17:20]of where the health care system is lacking.
[17:23]And the data that we don't have and the dismissal
[17:27]of a bazillion symptoms and all of that,
[17:30]can you speak to that for a minute
[17:32]and how menopause is just, and it's way more than just
[17:35]menopause as women's health basically age 30 and up?
[17:38]Yes, yes, I think it's at every age.
[17:40]I think at every era, we have been dismissed throughout
[17:43]history and in some measure, it's getting better.
[17:46]But and when you talk about Dr. Haver,
[17:48]I think it's fantastic that you have this groundswell
[17:51]of so many amazing doctors and Halle Berry talking
[17:53]about menopause and Ria Shriver and all her initiatives
[17:57]with Dr. Biden and women's research initiative.
[17:59]But from my perspective, and I'd like to think I'm not that old,
[18:02]I will tell you that I never learned about menopause.
[18:05]Nothing in medical school.
[18:07]Nothing when it came to hormone replacement therapy.
[18:09]Everything I heard was this would cause breast cancer.
[18:11]And this is my field.
[18:13]So only very, very recently are we starting
[18:16]to think about these issues.
[18:18]And it really reflects society, though.
[18:20]It's a perfect example about how societies
[18:23]historically neglected the aging woman.
[18:25]We become powerless, we are not as attractive,
[18:27]we are not as capable.
[18:29]But it's like, damned if you do, damned if you don't.
[18:31]If you have your period, your two, your curial,
[18:33]your two hormonal, you could never be president.
[18:35]And if you're menopausal, whether you're just two olds,
[18:39]so where is our chance to be our best?
[18:41]Never, right?
[18:43]But I think that's just one example of how far we have to come,
[18:46]but yet the power of women coming together
[18:49]because there are so many doctors now
[18:51]that are really not just banging against a wall,
[18:54]but collectively banging a drum together.
[18:56]And I think medicine and society is hearing it.
[18:59]I love that.
[19:00]It's amazing.
[19:01]This is going to sound like a stupid question.
[19:03]I know you are an amazing-
[19:04]No, no, no questions.
[19:06]Come on, not at all.
[19:08]Ask me anything.
[19:09]This is your right hand.
[19:10]This is your left hand.
[19:10]What do you got?
[19:13]You are like an amazing oncologist.
[19:15]What makes, how are you an amazing oncologist?
[19:18]How does one, how is one oncologist better than another?
[19:21]Is it the information?
[19:23]Is it the bedside manner?
[19:25]Is it, how do you get better results
[19:27]than the next oncologist?
[19:29]How does that happen?
[19:30]Like, what does it mean?
[19:32]I think there's no perfect oncologists at all.
[19:36]There's different types of oncologists
[19:37]for different types of people.
[19:38]And sometimes you need a team of types of doctors
[19:42]to take care of you.
[19:43]Just like you don't have that one friend or maybe we do,
[19:46]but we all need a team.
[19:48]So I think I don't know.
[19:49]I can't tell you what makes me good for everybody else,
[19:53]but I can tell you that when I thought about
[19:55]what field of medicine did I want to go into?
[19:57]Like, I love sports medicine.
[19:59]I would be a terrorist.
[20:00]or what orthopedic surgeon, because I'd be like,
[20:02]oh, look good enough.
[20:03]Like, I'm a little messy, it wouldn't have worked,
[20:05]but I thought when shit hits the fan,
[20:07]that's where I'm good.
[20:09]I'm really good in that existential crisis.
[20:13]And I'm pretty good at biology and chemistry
[20:16]and all those things, but how it all comes together?
[20:18]That's, I think, where my strength is.
[20:20]I didn't anticipate the toll it would take on myself,
[20:23]but that's where I'm good.
[20:24]So I think I am empathic.
[20:28]I think I really, really care.
[20:30]And I think the secret is you don't have to be a savant
[20:35]in biology to be a good oncologist,
[20:37]but you have to know who are the people
[20:39]that have that skill and to be humble enough to say,
[20:42]I have this really challenging case to somebody in the lab,
[20:45]like, who may never talk to a person,
[20:47]but can you look at this sample?
[20:48]Can you tell me what you think about it?
[20:51]I think it's the humility to know what you know really well,
[20:53]what you do really well, and know what you don't know well.
[20:55]And to never think that you can do it all for every patient,
[20:58]and to use the power of the people around you
[21:01]to be even better for your patients.
[21:03]And I think it's the humility,
[21:05]I think it's the compassion,
[21:06]and I think it's the willingness to never give up
[21:09]no matter the outcome.
[21:10]And a lot of the sadness of what I do
[21:13]is also being present for extreme suffering.
[21:16]And that includes the palliative care of medicine.
[21:19]And I don't know that we do that so well in our society
[21:22]because we give so much credit to the first breath of life
[21:26]less so to the last.
[21:28]So for me, I think it's part of a willingness
[21:31]to be present no matter what.
[21:33]And how do you feel now that the book has come out
[21:35]and been such a wild success?
[21:39]It's been life-changing.
[21:40]It's been life-changing.
[21:41]So a little piece of news is I've only had one job,
[21:43]and that's one professional job as a doctor.
[21:46]And that's working out more of Sloan Kettering
[21:48]Cancer Center, which has been an incredible experience
[21:51]when you talk about working with experts in excellence.
[21:53]That's where it has been for me.
[21:56]And I'm so proud to have worked there,
[22:00]but I'm really excited to also share
[22:01]that as a result of this book.
[22:03]I'm moving to NYU to help them build a women's health
[22:07]program there really devoted to tackling the issues
[22:10]constructively that I talk about in the book.
[22:12]And I'll continue to see breast cancer patients there.
[22:15]That's amazing.
[22:16]Well, I'm actually kind of sad about that
[22:18]because I'm on the board of Mount Sinai.
[22:19]So I feel like I wish they had stepped in
[22:23]and snatched you up if you were leaving.
[22:25]But anyway, that's great.
[22:26]Good for you.
[22:27]That's really amazing.
[22:28]Thank you.
[22:29]Congratulations.
[22:30]Do you see more books in your future?
[22:32]Oh, what a gift it would be.
[22:34]I have some ideas for the next book,
[22:36]but from an intellectual standpoint, nothing
[22:38]has been a greater joy.
[22:40]I'm sure you know how hard it is to write a book,
[22:42]but how would an incredible life-fulfilling processing
[22:45]be to have that time?
[22:48]And I would love the opportunity to write another book.
[22:51]And what is an advice to aspiring authors that you can share?
[22:55]Be brave.
[22:56]Go for it.
[22:57]Don't try to do everything all on your own.
[22:59]Ask for help.
[23:00]I was lucky enough to have a great agent.
[23:02]And I have a great publisher, Harper Collins.
[23:04]And today's the first day of the rest of your life
[23:07]put pen to paper.
[23:08]I love it.
[23:09]Amazing.
[23:10]Dr. Come and thank you so much.
[23:12]Thank you for coming on.
[23:12]Thank you for advocating for women's health.
[23:15]And there is, I mean, there's nothing more important.
[23:18]It's like, this is it.
[23:20]This is all we have is our bodies.
[23:21]So thank you.
[23:22]Thank you so much.
[23:23]I really appreciate you're having me.
[23:25]Of course.
[23:26]Thank you.
[23:28]Thanks for listening to Mom's Don't Have Time to Read Books.
[23:31]If you love it, please leave a review.
[23:33]And follow us on social at City Owens and at City Readers.