Structural Integrity

July 1975. The first year had ended for the Class of 1978. A three-day weekend lay ahead. It could have been a weekend of relaxation, of catching one’s breath after the rigors of preclinical coursework. But it wasn’t. In Vanderbilt Hall, one young woman, troubled to a degree unrecognized, ended her life. The tragedy stunned the School’s community.

Roberta (Robbie) Apfel, a resident at what was then Beth Israel Hospital, observed the effects that this death had on certain of the women students. Now an HMS associate clinical professor of psychiatry, Apfel had taken a position doing gynecology at the University Health Service during her residency; she had been doing gynecology in North Carolina before coming to Beth Israel.

“A number of the women were unsettled,” says Apfel, “in part because it reminded them that they, too, were feeling kind of lonely and down. The transition to medical school had not been an easy one. In college, they had enjoyed close female friendships.”

By the time the students returned for second-year studies, the School had a plan of action. Susan Okie ’78, a Maryland-based medical writer and clinical assistant professor of family medicine at Georgetown University School of Medicine, recalls: “I think the administration felt that this was perhaps an issue for the women students in particular and that we may not have been receiving enough support.”

“So the School supported an effort to start a support group,” Okie adds. “An open invitation to attend was sent to the women in our class.”

The group of women that gathered for the first meeting winnowed itself over time, and, by the end of the second year, a core group remained. Those women decided to continue to meet as a group. “It provided a sense of belonging,” says Apfel.

Today, the group, referred to simply as the women’s group, still meets, usually during class reunions. For four decades, the ten HMS alumnae who form the group’s core have, according to them, found it to be a source of unconditional support and continuity, a shared experience, an island of respect, a community, a touchstone, a sounding board, and a place of trust.

Hub-bub

In addition to Okie, the group comprises Sandy Kopit Cohen, Anna Fels, Pamela Hartzband, Vanessa Haygood, Roberta Isberg, Ourania Malliris, Nancy Rigotti, Cathy West, and Patricia Williams, all members of the Class of 1978.

Their 165-member class was only the second at HMS to boast a notable number of females: 54. That robust representation mirrored changing times in the nation’s culture.

The percentages of females enrolling in medical schools began to swell following World War II. But after the passage of the Civil Rights Act of 1964 and, even more so, after 1970, when a successful class action suit filed by the National Organization for Women compelled compliance with the Act by U.S. medical schools, women began entering in significant numbers. By 1974, when the members of the group entered HMS, enrollment percentages for women had quadrupled from those in the 1950s. At HMS, that growth has continued; the percentage of females in the Class of 2018 hovers near 50—and has for more than a decade.

The city that greeted those ten women was far different from the one that greets HMS women today. In the mid seventies, national politics played out on Boston campuses as the debate over the conflict in Vietnam continued. A court-ordered public school desegregation action, which initiated citywide busing of children, spawned anger, fear, and violence that spilled onto the city’s streets, and burrowed deeply into the population’s psyche.

The city also was an active hub for gender politics. The limits of the Supreme Court’s ruling on Roe v. Wade were being tested in the manslaughter trial of a Boston City Hospital physician who performed early-term abortions. Foreign-language editions of Our Bodies, Ourselves, the landmark publication of The Boston Women’s Health Book Collective, were being published in Italy and Japan, and the recently formed Combahee River Collective had begun dissecting the oppressive effects of racism and heterosexism, work that would produce the Combahee River Collective Statement.

R-E-S-P-E-C-T

Just as Boston’s social conventions were being given a vigorous shake, academic traditions at HMS were being tested.

Before coming to Boston, West, an assistant professor in the Department of Primary Care at Touro University College of Osteopathic Medicine in Vallejo, California, had received endless support from her undergraduate colleagues at the University of California, Irvine, as well as from a group of orthopedic surgeons in whose practice she had worked since age 16. “I had done research. I had graduated in three years. As a woman, I felt I had established my credentials. But in lectures there were sexist jokes. The idea that there could be that sort of discrimination, well, it just kind of shocked me.”

Says Haygood, an obstetrician-gynecologist in private practice in North Carolina, “There was a sense that the men belonged here and the women were, ‘Well, let’s just see how it works out.’ There was a kind of naturalness to the men’s movements that I certainly didn’t feel. I felt awkward in that space for a good little while.”

Fels, a psychiatrist in private practice in New York City, and a writer, says, “There was a feeling of being anomalous. Various attendings were dismissive. I was at one hospital where they didn’t have any jackets that fit women; they were all too big.”

Rigotti, an HMS professor of medicine at Massachusetts General Hospital, recalls a conversation with Isberg.“We were talking about the words we used to describe ourselves,” she says. “I remember thinking we needed to start calling ourselves women instead of girls, because we needed to be taken seriously—and because words matter. But,” and she laughs lightly, “I also remember thinking, ‘I still feel more like a girl than a woman.’ ”

The feeling of being outsiders was given fresh emphasis each time the women walked the tradition-filled halls of the School. On walls everywhere were portraits of men. Only men. 

Lives, Examined

Within their group the women worked through both the difficult and the delightful aspects of life in medical school—and of life in general. The value of peer-support groups such as theirs may be found in the understanding that positive relationships with trusted individuals can boost confidence and serve as a buffer against shared stresses and adversities. As Haygood puts it, “There’s just always been a very caring, listening ear available to each of us.”

Isberg, an HMS assistant clinical professor of psychiatry at Boston Children’s Hospital, remembers the questions considered during the group’s early years. “How were we going to figure out how to do this? How could we have a life that was dedicated, at that moment, to studying and learning, but also to working very hard, to having other interests and, one day, to having families? We wanted to know how we could have full lives.”

Prosaic issues were tackled by the group, such as how to help two members work through a housing rearrangement in a manner that would preserve their friendship and the group’s harmony. So were challenges that were rending society, such as the hostile environments women were confronting at home and in the workplace. Sexist comments, lobbed during lectures or outside dorm rooms, shook the women. They analyzed and parsed the insults, and then moved forward, if not with tools to overcome, then at least with the confidence that the indignities were not theirs alone to suffer.

Perhaps at no time was sororal support more needed, and tested, than when Haygood’s presence, and that of other African American members of the class, was challenged by a member of the School’s faculty. In a May 1976 issue of the New England Journal of Medicine, a noted microbiology professor and HMS alumnus argued that the academic standards of the nation’s medical schools had, according to coverage in the New York Times, “dropped because of the admission of many minority students with substandard academic qualifications.” News of the NEJM paper burned through the School. Haygood says, “As this was festering, we had a meeting of our group. We went through many things, but nobody said anything about the paper. So I said, ‘You know what? There’s something going on here that affects me tremendously, and nobody has said anything about it.’ ”

Reactions to Haygood’s statement elicited a range of reponses: “We didn’t bring it up because we didn’t want it to be hurtful to you.” “We didn’t want to dwell on its negativity.” “We didn’t want to give it life.” Haygood explained that she needed to talk about the situation with them because, outside that circle, there were many people who judged and attacked her without knowing her. “I told them I needed them to shore me up so that I could go out and meet all those people—and not react to them by believing what they said.”

Okie, too, recalls the circumstance and its lesson. “Because of our group, I remember becoming attuned to learning more about exactly how those claims made one of my friends feel.”

The importance of the individual remains a point of pride with the group. “We’re not little cookie-cutter, identical types,” says Malliris, a pediatrician in the Seattle-based Ballard Pediatric Clinic.

Says Fels, “I think that because we were inventing lives in ways that men didn’t have to—cultural roles, family roles, professional roles—our careers have been more inventive and diverse.”

“Everybody’s story continues,” adds Malliris, “our lives have common themes—having children, not having children, being married, not being married, having aged parents, dying parents, sick parents—that are expressed differently because of our life choices.”

The experiences from their professional lives are also shared. Says West, “A big part of our group, for me, is the pleasure we take, the really intense pleasure we take, in something that someone does. When we get together and hear about each others’ lives, it enriches all of us.”

Time Travel

The 1970s may have been an opportune time for such a group to coalesce, and the manner in which it formed, then functioned, may have been critical to its success.

Says Hartzband, an HMS assistant professor of medicine at Beth Israel Deaconess, “Women’s lib was an active sort of social construct of the time. We saw ourselves as forging new territory. We were women professionals who were going down a path that not many others had followed. As a group, we really came together.”

Williams, who, in addition to being an adjunct professor at American University, works as a consultant in organizational development and training, a role that includes leadership training and coaching, says, “Having a facilitator early on was critical to building a healthy and robust dynamic for the group. When Robbie stepped back as leader we were a pretty healthy group and could continue on our own.”

Cohen, who is a clinical assistant professor of psychiatry at Weill Cornell Medical College and firmly associated with the Academy of Organizational and Occupational Psychiatry, would agree. “There’s an important ritual to structure; having a facilitator was important to giving a formal nature to our group. It was structured to keep going, even if individuals couldn’t come at one time or another. It continued to feel like a group.”

“The fact that the group has stayed together has surprised and delighted me,” says Apfel. “Its value to all of the women has been repeatedly demonstrated. These women know the importance of touch, a vanishing commodity in medicine these days, and of keeping in touch. Of connection. Of support. Of understanding. The group has given them all strength as individuals.”

The Class of 1978 will gather again in 2018 for a reunion. No doubt, so will the members of the women’s group.

Ann Marie Menting is editor of Harvard Medicine magazine.

Images: Harvard Medical Alumni Bulletin (top); Radcliffe Archives