The invisible GenX woman

By Karla Lester

Video killed the radio star by The Buggles launched MTV 45 years ago and changed things forever. GenX is the MTV generation.

GenX is the middle child generation between Boomers and Millennials. We had big hair and listened to Hair bands. We watched Brat pack movies like St. Elmo’s Fire, Breakfast Club and worked fast food. John Cusack, my favorite, held up his boombox in Say Anything, blaring In Your Eyes by Peter Gabriel. 

GenX made mixtapes for friends or their crush. The girls had big hair and the guys had mullets. Most of us weren’t Valley Girls, though we quoted the movie. GenX women had feathered hair and lots of perms. We put Sun In in our hair to make it lighter. Side ponytails were a thing and so was Madonna. 

Diet culture of the 80’s was really big. We were told to eat low fat and low calorie and marketed Dexatrim. It was never about health. Only about weight and seeking the male gaze. Jane Fonda started working out and the aerobics craze took off. Leg warmers and all. Food was convenient and not always healthy. Olivia Newton John sang Let’s get physical, which was about anything but fitness. 

GenX is smaller in population because of the introduction of the birth control pill in the 1960’s. The sexual revolution was stifled by the AIDS epidemic. We learned about “safe sex” and were taught to “just say no” to drugs by Nancy Reagan and her war on drugs. Some of us were Like a Virgin because we were more of the science olympiad and marching band ilk and others were navigating HIV risk and practicing safe sex.

In War Games, a teen hacks into a U.S. military supercomputer from his personal computer and accidentally simulates a nuclear strike against the Soviet Union. The Berlin Wall fell in 1989. We grew up in the silent fear of the Cold War, the Iran Contra scandal, knew all the words to Purple Rain, feared acid rain and Chernobyl. Though we had MTV, we were not watching cable news or following politics 24/7. Many call us the first tech-savvy generation.We were the first to have cable television and MTV and personal computers. We went from Atari to personal computers to iphones and now AI. ChatGPT did not write this blog, though they will likely steal it. 

The GenX woman is self reliant and independent. She is very achievement focused. The male centered life of their mothers didn’t always work out for them. Told we can’t have it all when we were just trying to make it work while working.

Sometimes, the forgotten generation or first generation of latchkey kids. There were more children of divorce, single parent homes, and dual income families. My parents got divorced when I was five years old, finalized in my first week of kindergarten. I was one of two kids in my grade with divorced parents and then over time, that grew. A lot of GenX women grew up in dysfunctional families that cared more about what people thought of them than what was happening at home. 

Between Saturday morning cartoons, School House Rock and watching Love Boat and Fantasy Island, we were marketed, “I can bring home the bacon. Fry it up in a pan. And never ever let you forget you’re a man.” GenX women said, “Gag me with a spoon.” 

The Equal Rights Amendment told us we could be a Girl Boss. We watched 9 to 5 and then went off to a very patriarchal workplace. More GenX women went to college and closed the gender gap in higher education, but the gender pay gap still exists. 

Work-life balance was the unattainable goal. GenX women were told to do it all, but we can’t have it all. GenX women were still doing most of the work at home. “The Second Shift: Working Parents and the Revolution at Home” by Arlie Russell Hochschild was published in 1989. I read it in a women’s studies class in college and was incensed to learn that women had been fed a bunch of lies. Women who go to work come home and work a second shift too. 

GenX women laughed off a lot of aggression, harassment and discrimination. We said sorry and still say sorry a lot for things that weren’t and aren’t our fault. 

Most of us drove not so nice cars. Some of us barely got access to really shitty cars that could be used only to go to work and then broke down on the way to McDonald’s where my Mom got me a job on my 16th birthday. That’s where Assistant Manager Barry shoved me up against the drive thru window, my fake topsiders dangling an inch off the ground, my polyester McDonald’s uniform and visor askew. “You and your Smart Ass mouth need to shut up.” I think Barry thought he was in Die Hard. 

“Thanks for calling me smart, Barry. Sorry I can’t return the compliment.”

Barry should have been fired. But, every GenX woman knows there’s no way he would have if I had reported him. I quit, even though I just got a nickel raise to $3.35/hour. Next job I worked at a bank opening accounts, CD’s and got paid $4.50/ hour. Take that Barry! The VP of the bank was a short guy with darting eyes who wouldn’t stop staring at my chest, his eyes searching for something that wasn’t there. So sorry, Jeff. I just need to know how to change the printer toner. 

GenX guys didn’t always have it going on. 

“All the nerds love Karla,” my Mom, Barb, used to tell everyone. “It’s because she’s so nice to them.” 

Just to shut him up, I went out on a date with a guy who kept bugging me. He put his arm around me in the movie and I thought I was going to barf. I told him I had to go to the bathroom and I called my Mom on the pay phone outside the movie theater and asked her to come pick me up. She couldn’t, but told me to tell him I just want to be friends. He was leaning in for a kiss as I broke the news. One foot out the door, “Hey, let’s just be friends.” He was bragging about the gas mileage of his Dad’s Ford Escort the whole date. Boring was this guy’s first, middle and last name. 

GenX women don’t like disappointing people. Another guy I hung out with wore a trench coat, had a beat up car and spray painted U2 on it. He asked me to prom and I said no because I didn’t have romantic feelings (not that I would use those terms) for him. He didn’t go to his senior prom. I was a junior. It wasn’t until a couple of years ago that I stopped feeling bad about it when my own son asked a girl to Homecoming and she told him she wouldn’t have time to get a dress. They were friends and he was bummed. But, I thought good for her to say no if she didn’t want to go with him. 

Roe v. Wade passed in 1973. It’s been undone. Peri menopause and menopause hit GenX women hard and we didn’t even know we were in it. We were the generation of women who couldn’t have hormonal replacement therapy and are now past the window where it might be helpful. We lathered baby oil all over us to get tan and are now going to the dermatologist to get checked for skin cancer . 

Though we screamed until we lost our voices at concerts, our voices have often been silenced. We are invisible at times. We are non confrontational and have no clue what we are really feeling because no one was ever listening or asked us. We had the empowerment of being free range kids in the neighborhood and no one caring about where we were and no one asking or caring about our feelings. It’s time to get internal and to stop saying Sorry. 

GenX women can grind out a goal and become exhausted and burnt out. Like women of every generation, there is invisible labor that is layered on GenX women, many sandwiched and caregiving. Moving into the next chapter of our lives, GenX women can get intentional about what we want. Instead of self-reliance, GenX women can rely on each other. 

There is an authenticity, a humanity, a sense of humor that is GenX. Girls just want to have fun. Yes, and we also want meaningful and impactful lives and connection with people we love. 

Don’t stop believin’ that GenX is the best generation. For sure, the coolest generation. A rad generation of resilient women. Totally. GenX women, I see you. I hear you.

The Wisdom of Mature Women

By Chelsea Klinkebiel

I am 25 years old….well....actually, I turned 40 this year, but this seems to be my internal “default” age, the point in my life at which I had graduated from college and was in the beginning years of graduate school. Does this happen to others?  When I hear about international postgrad internships and postdoctoral fellowships, I think, “Ooh! That sounds interesting.” Somehow, I am permanently stuck in those exciting years when I was still designing my life and when a lack of sleep or a hangover didn’t derail me for days. However, all too often, I am quickly reminded of my age when I hop out of bed too quickly, go a day without supportive shoes, or eat exactly one donut hole and have raging heartburn all day.

In 2011, I got the opportunity to travel to Beijing for a week with my aunt Marilyn as a part of a Nebraska Educators Tour of China. I was the youngest member of the group by at least 10 to 15 years. In my 25-year-old naiveté and utter lack of research into our activities, I wore flip-flops and a skirt on the day we toured the Great Wall of China. I remember coming down to the hotel lobby and hearing the gasps from the more mature and much wiser women. I shrugged it off in the lobby, and I shrugged off the steep hike awaiting us when we arrived. At the time, I was training for a half marathon and climbed past the rest of the group for quite a while, ending up by myself with many Chinese tourists. I don’t remember pain or soreness that day or the following days, but I cannot imagine wearing flip-flops for longer than an hour at this point in my life.

I now fully understand the reactions to the flip-flops, and I am so grateful for the many things I have learned from mature women. I say mature rather than “older.” Many of the women whom I have learned from are older than me, but I also think of maturity as it relates to emotional stability and emotional intelligence, social and relational skills, and wisdom. 

The mature women I know could not care less about beauty standards. They are not concerned about the wrinkles and saggy skin that come with age. They are not chasing the latest diet or concerned with shape or weight. They are less concerned about what they look like and more concerned with what they are looking at. Mature women gave me the confidence to embrace my unruly, curly hair, and it has given me so much time back in my life. Although mature women could not care less about beauty standards, they care for their bodies. They nourish them with delicious and often healthy foods, walk religiously come rain or shine, practice yoga and meditation, and work to retain their strength. Mature women know that caring for themselves comes first if they will care for others. 

However, the mature women I know also do not center the needs and lives of men above their own. They have their own work, hobbies, volunteering, and friends. Along with these values, mature women value experiences over things, and people and relationships over status and possessions. I am so inspired by the women who give their time and resources while living simply. 

The mature women in my life provide authentic examples of practicing radical acceptance. They have experienced and are living with chronic illnesses, cancer, loss, the stress of aging family members and partners, disappointments that come with life experiences, estranged family members, the current events we are all living through (waves around vaguely). They allow those experiences to take up space in their lives and do not struggle against them. At the same time, they experience joy and hope, they seek out new experiences, they incorporate fun and excitement in their lives, and they keep moving forward. 

I do have to make one generational comparison as well. This is solely based on anecdotal evidence and my observations, but I think mature women make and keep friends well. As a millennial mom who has relocated many times, I have struggled with keeping in touch with same-age friends and finding a consistent friend group. This may be controversial, but I think my generation and the generations that came after ours have a tendency to expect perfection in our interactions with others, think more rigidly, and experience social anxiety. I think we have a hard time tolerating discomfort with disagreement and a tendency to disengage with uncomfortable interactions. From the time I have spent with mature women, I have witnessed their friendships in action. There is debate, disagreement, and clashes of personalities. I witness repair after conflict, and I also witness friends simply “moving on” and enjoying one another. Perhaps they know that it is not worth their time to worry and ruminate.

I am working on embracing this attitude in my quest to spend more time with friends. I am so grateful, though, that much of my social life involves working alongside and spending quality time with the mature women in my life. They have much to teach us.

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A gratitude drop-out

By JoAnne Young  

A doodad on our fireplace spells out Gratitude in an interesting shade of turquoise, with a little bell attached that seemingly would ring each time I am grateful, or each time a breeze would shake it to remind me of the message. 
 
If that’s not enough, a sticker on our bathroom mirror says simply: Grateful. 
 
It’s a gentle nudge, a heads up, that there are so many people, places and things worthy of acknowledging. 
 
But ... in these times there are equal numbers of miscreants, bad deeds and tribulations that make gratitude more of a chore. I’ve tried to combat these with a gratitude journal or a daily list of what I’m grateful for and have failed at it every time. I’m not sure why. I know it’s supposed to be really good for us, especially when we’re feeling mentally challenged. It works for a lot of people. 
 
I feel like a gratitude drop out, having to work so hard to make that list every day. 
 
Then I discovered a writer on Substack, Kate Bowler, who describes herself as a “human with big questions.” Last month she seemed to understand my dilemma when she offered up prompts to substitute when writing what you are grateful for “just isn’t going to cut it.” Just in case you are interested, I will share some. Feel free to join me. 
 
Q: What minor inconvenience has become your entire personality this week?
 
A: My television service with formerly ALLO, now DirecTV, has taken too much of my time  and brain space trying to make it work as it is supposed to work. ALLO, once for me a trusted local company, ended its TV service and encouraged all its customers to switch to DirecTV, touting that it would cost less and deliver the seamless entertainment I deserve. Maybe I don’t deserve seamless entertainment, because it is quite glitchy and has to be rebooted daily. After a multitude of phone calls to both ALLO and DirecTV and a change in equipment, the problem persists, and a woman in a faraway state told me that maybe our Samsung TV, which we bought in 2020, is too old for the Gemini device that is paired with DirecTV. That, I told her, would be an expensive fix. She chuckled and agreed. 
 
First world problem, I know. I’ve run out of solutions, and am now just disappointed with ALLO, and consequently untrusting of local companies I once had faith in. I’m back to thinking, 'well, that’s how our world works these days.' But also grateful that was my biggest problem this week. 
 
Q: What are you pretending not to care about?
 
A: That my country’s food inspection system has seemingly been dismantled and we’re going to continue to find out the foods we depend on in our grocery stores and restaurants may or may not be safe, depending on the day. What can you do but stop eating salads and raw fruits and vegetables and eggs and other foods amid the mounting recalls. I’ll just cook everything. And wine hasn’t been recalled yet, has it?
 
Q: What is something that brought you unexpected cheer recently?

A: An afternoon at the zoo with a best friend. The flamboyant crest of blue feathers on the peacock’s head. The spider monkeys racing around grabbing branches with tails, hands and feet. The young boy who was a butterfly magnet. They landed on his Under Armour hat and his shirt without him even trying. And the arguing flamingos at the water hole, and the one nearby that slept through it. 

 

Q: Name three things that are currently holding your life together. 
 
A: The people with whom I can share truth, insight, laughter and comfort. It’s important, as Anne Lamott says, especially when your mind is cranky, cringey and trying to figure out who to blame. Sharing what’s troubling me always seems to lessen it. 
 
Treats. I have a quote on a shelf I pass frequently by Irish writer and philosopher Iris Murdoch that says: “One of the secrets of a continuous happy life is continuous small treats.” A dark chocolate square. A top-spiral notebook with a Starry Night cover. A Pilot G-2 bold tip pen. Drinking my kombucha out of a Bodum double-wall glass, in which the kombucha seems to float. A brief talk with a stranger. A chocolate chip pancake. Fresh air. 
 
Books and writers. I’m reading an 18^th-century gothic novel by Ann Radcliffe an enjoying the way people talked and wrote in late 1700s England. “She immediately withdrew from the casement, and though much agitated, sought in sleep the refreshment of a short oblivion.” Ahh, yes. I could use a short oblivion. 
 
I also find respite in female essay writers: Randon Billings Noble, Sue William Silverman, Judith Kitchen and Suleika Jaouad. In the Isolation Journals on Substack, Jaouad, who is herself going through long-term cancer treatment, wrote about an older chihuahua she and her husband Jon Batiste are watching after. The dog, Nonna, was near death when she came to their house, and somehow through medical care and love, she lived on. Still, Jaouad knows this will be a short love story. 

 

“When time shrinks, everything sharpens,” she wrote. “... Earlier this week I sat on my porch and watched her have her best day yet. She tiptoed onto the dewy grass, froze, then decided to scamper across the lawn anyway. She investigated every dandelion as if it were a revelation. ... She’s even started to play. 
 
“I used to think love was proven over time” she wrote, “accumulated, measured in years. But this experience has me reconsidering. Maybe love has nothing to do with time at all. Maybe it’s the decision to show up fully for something fragile and fleeting even when you know it will break your heart. Especially then.” 

 

Gratitude. 
 
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What Would You Do?

 

By Marilyn Moore

Say their names:

Anita Hill

Christine Blasey Ford

Lonna Drewes

Jenny Racicot

You remember them….among the hundreds of thousands of women who are sexually harassed, abused, assaulted each year, these names stand out.  We’ve heard about them, because they stepped forward to credibly accuse a man seeking office of sexual harassment or assault.

Anita Hill described the sexual harassment she had experienced while working as a legal advisor to Clarence Thomas, who had been nominated for a seat on the US Supreme Court.  She described persistent sexual advances and lewd comments.  Her testimony was heard by a 14-member Senate committee, all male, all white.  Clarence Thomas was confirmed by the US Senate in 1991, and he still sits on the Court today, the longest-serving justice of the present Court.

Christine Blasey Ford described in detail the sexual assault perpetrated on her while she was a 15-year-old in high school, naming Brett Kavanaugh as the perpetrator.  She provided testimony to the US Senate Committee charged with conducting confirmation hearings for his nomination to the US Supreme Court in 2018. He was confirmed by the Senate, and he sits on the Court today.

Lonna Drewes described being sexually assaulted in 2018 by Eric Swalwell, a US Representative from California.  At the time of her accusation, in 2026, he was running for the Democratic nomination for Governor of California.  She is one of five women to make a public report of an alleged sexual assault by Swalwell.  Rep. Swalwell denied all accusations, but he ended his campaign for the gubernatorial nomination and resigned his seat in the House.

Jenny Racicot described being sexually assaulted by Graham Platner, the Democratic candidate for US Senate from Maine.  She said in 2026 that after a two-year on-again and off-again relationship, he entered her home uninvited and assaulter her.  Platner’s story is complicated; he’s a veteran, who has suffered from PTSD.  He has also asserted in the past that women who are victims of sexual assault should take some responsibility for themselves.  Voters selected him in the primary; when Racicot’s story became known in the following weeks, supporters withdrew endorsements and finances.  He denied the accusation, but he withdrew from the campaign.  

Four stories, spanning decades, sharing in common one of the oldest stories of humankind…men in power assaulting women.  In none of these stories did the survivor of the sexual assault contact the police….for all the reasons women have always understood.  They would likely be blamed for what happened…what were they wearing, how did they act, had they been drinking, did they say no.  They would not be believed.  They would be ridiculed and shamed.  They would be targets for revenge, retribution, or further assault. Their families would be targeted.  

And yet, each one of them, at the point when their alleged abuser was being considered for, or running for, a highly visible, highly responsible, public position, one in which he would be in a position to make decisions regarding the health and welfare and safety of women and children, decided to speak out, to make their story, and their names, public.  What courage, and what a difficult decision.  Because, as they anticipated, they were disbelieved, or ridiculed, or blamed, or their families were threatened.

I’ve not been in that situation, though I certainly experienced sexual harassment as a female leader in a male-dominated profession. The stories that came out a few years ago at the height of the Me Too movement were illuminating; most women have had similar experiences.  

An acquaintance, however, finds herself with that dilemma today, the one experienced by Anita Hill, Christine Blasey Ford, Lonna Drewes, and Jenny Racicot.  Sue (not her real name, of course, and I’m not disclosing the state in which she lives) was married to an abuser.  He assaulted her.  He is running for public office today.  An organization that works to keep abusers from being elected has contacted Sue, asking her to make her story public. She is torn, describing the dilemma in which she finds herself. She does not believe her ex should be in public office.  She recognizes that going public with her story will result in threats and attacks, verbal and perhaps physical, upon her. She is prepared for that.  But…and it’s a huge “but,” she has children…and she’s afraid for what might happen to them.  

It's important to note that any decision is a brave decision.  To tell your story, to bring that experience to light to inform an electorate, knowing that your story might be disbelieved or simply disregarded, and your safety might be at risk, is a brave decision.  To choose to stay quiet, knowing that you have protected your family in the best way you can, is a brave decision.  Any woman facing this decision does not need the judgment of others; it’s an excruciatingly difficult decision, without adding the weight of “what people will think.”

Sue asked me what I would do.  I said I didn’t know….I think I would be willing to take whatever harmful consequences would come my way…but would I be willing to endanger my family?  My nieces and nephews and their children?  I do not know…nor do I know of a rubric, a balancing scale, a pros-and-cons system, for weighing the issue and coming to a thoughtful conclusion.  She asked me what I thought the readers of Five Women Mayhem would do.  I said I didn’t know….but I would ask.  So I’m asking…if you are in Sue’s shoes, what would you do?  

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Sisterhood, holding onto our memories

By Mary Kay Roth

When my parents were well into their 90’s and dad’s dementia was becoming more pronounced, much to their dismay we took away their car keys (though not their actual vehicles).  So, one summer afternoon when they were running low on bread, mom crawled into the driver’s seat while dad pushed their truck down the driveway – attempting, they claimed, to jump start the vehicle so they could head for the grocery store.

Our family still giggles over this tale, one of the many escapades of my mom and dad. 

It’s different this time around. My sister isn’t supposed to have dementia.

Rose Ann is my older sib, the person I shared a bedroom with – who I tormented as a child, making fun of her parade of boyfriends – tattled on when she backed our car into a light pole. She tolerated and survived being the oldest of four, eventually finding her way to physics and computer classes at the University of Nebraska-Lincoln – at the time, often the only female in class. Crazy smart, she went on to become an executive at IBM, battling her way up the ladder in a man’s world.

She lives in Texas nonetheless, has been my occasional anchor through life, sending care packages when I had morning sickness, offering advice through my divorce, listening with understanding as my then adolescent daughter went bonkers. She remembered every single birthday and milestone.

Rose Ann is brilliant, solid and stoic.  She faces life head-on with honesty and guts.

And yet.

Almost a year ago I started noticing she was repeating things during our phone calls, rationalizing she was tired.  At the same time, my daughter noted that her aunt was missing birthdays, and my niece said Rosie was getting names mixed up. Her dear best friend was concerned.

One evening last summer her son, Ben, texted and asked if we’d noticed anything different about his mom. 

We all needed to face the truth.

Several months later I was traveling in Greece when I got a call from my sis.  I stepped outside a local market, sat down on the ground and listened as she reported results from her brain scan: She had abnormal protein deposits (amyloid plaques), building up between brain cells.

Indeed, she was one of 7 million adults in the U.S. – 65 and older – living with dementia.  One of 57 million worldwide. 

And there we were, across continents in Greece and Texas, heartbroken and crying together.

My sister – who has trekked to almost every corner of the world – was having trouble maneuvering her way around Austin.  She has journeyed to Russia, Europe, South America … down the Nile River … zip lined and scuba dived … taken countless vacations at beaches and Disney World.  

But her traveling days were over, she reported.  “I’m starting to get lost.”

Strangely, I also found myself lost that day, the ground shifting beneath me.  

I wasn’t surprised my dad had memory issues. My sister was closer to the bone. My childhood is drenched in my larger-than-life big sister. Our histories are intertwined. We share the stories of childhood traditions and family vacations – mom’s homemade cornflake chicken and water skiing with my dad on Nebraska lakes. 

And yet here we were, standing on the edge of new territory, no compass to guide us.  

So, last week, we pointed that compass south as our family headed to Texas. My kids, niece, grandkids.

It was a wise trip.  Yes, my sister’s world was getting smaller, but she seemed happy and content in a warm household alongside her husband, Wendall, and their two cats – with her sons and their families nearby. 

Our entire family is still a bit befuddled, navigating the contours of this new woman. This new mom, wife, grandmother, sister.  But Rose Ann seems to be handling the transition with grace and honor. 

Perhaps the rest of us merely need to catch up.

Now a nurse practitioner, my daughter Anna has worked extensively with older people who have memory issues. She advises families to focus on the positive, understand every day is different and every person is different – and practice acceptance.

One of Anna’s favorite stories as a nurse was dealing with a particular veteran constantly agitated and frantic, believing he was getting bombarded by grenades. Anna didn’t argue. She merely got down on the floor with him and suggested they throw the grenades back toward the enemy. They did and life calmed.

We were pretty blessed with my dad’s experience. He remained cheerful and happy through most of his dementia years – our only major challenge happening when Mom died.  After sitting beside her bed, holding her hand and bidding her a loving goodbye, Dad broke down sobbing as we held him and told him she was gone. 

Two hours later he was asking where she was.  And since we had been counseled that retelling and retelling was almost cruel, we started making up yarns. Mom was visiting relatives. She went to the beach. She was taking sky diving lessons. She went off on a motorcycle trip. She was swimming with sharks.

My dad laughed every time we gave him updates, chuckling, “Well, good for her.” 

Rosie, meanwhile, is holding her own.  She has survived losing a child and a bout of cancer. She is one tough broad.

She forgets and gets discombobulated sometimes, but also laughs at life and was so very happy we were all in Texas together.

Admittedly, none of us knows what lies ahead. This road could get quite bumpy. How can we all come together to support Rose Ann? How can we balance honesty and bravery?  Will I get dementia? Our brother? My kids?

I've been reading countless accounts recently about how incredibly hard this could be. But I like to believe that in the coming years we’ll also learn from one another, find riches in a deepening sense of trust and compassion. 

“You can’t come to us, so from now on we’ll come to you,” we assured her.

During a quiet moment in Texas, with just the two of us, I asked Rose Ann if I could tell some of her story. She didn’t hesitate, “Of course you can.” 

I prodded a bit more. “How are you doing, really?  How are you handling this?  What can I do?  I’ll take you anywhere in the world you want to go.”

She said she was grateful for her extensive travels in life. “I’ve really gone everywhere I want to go. It feels good to be home.”

Then, for one brief moment, she teared up and whispered, “I’m a little scared and a little sad. What if I don’t remember something really important?”

No worries, I responded, holding her hand. “I’ll carry all your memories for you, as long as I can.  After all, we’re sisters.”

Misogyny and racial bias in medicine; I believe her.

 by Karla Lester

Dr. Janelle Green Smith died from the complications of childbirth in January

Nothing activates patriarchal medicine more than a female doctor who decides to have a baby. I thought he was going to punch me in the face. It was 2001 and his name, Dr. Ben G. (as Taylor Swift sings, the smallest man who ever lived), an Emergency Medicine doctor in St. Louis, where I worked as a pediatric hospitalist in the ER and covered the newborn nursery. My job included going to the delivery room and taking care of babies who may be born prematurely or in distress. I was just out of residency training when I took the job as my husband was completing two years of fellowship in pathology at WashU. Over my two years of being a hospitalist in a community hospital, I took care of many children, adolescents and babies who were very ill. I loved working nights with the ER nurses and the labor and delivery nurses. They were awesome at their jobs and good friends and threw me a baby shower before our daughter, Katherine, was born. It was an exciting and stressful and sleep deprived time with our first baby. To say we were obsessed with Katherine is an understatement. We had decided to join practices in Lincoln, Nebraska and move in July to our new home. 

I had an agreement with the administration that I would come back after maternity leave (unpaid, of course) for 16 shifts. I was hired to be an employee of the hospital and had full time benefits with the PTO that I built up to take when Katherine was born. We were paying our medical student loans and my husband was a fellow and I was going to be off work, without pay, so I very much needed the few thousand dollars I had built up. We were notified just before the end of the year that an agency would be taking over staffing the ER and the physicians would no longer be employees of the hospital system, but would be independent contractors under this company and Dr. Ben G. would be in charge of me and the other pediatricians and ER doctors. We would lose our benefits, which would include my PTO I built up. The administration at the hospital told me I would need to come back after my leave and work 16 shifts in order to get access to my PTO. By the way, this is happening across the country with private equity buying up healthcare systems. It’s bad news all around, especially for patients. 

Back to when I thought he was going to punch me. It was my first shift back after maternity leave and Dr. Ben G. just heard that I was moving. I got paged to the ER. “I need to talk to you.” He pulled me into the trauma bay, got in my face, pointing and spitting, “I’ve bent over backwards for you. You lied to me. You deceived me.” I literally didn’t know why this little man was stroking out over my life decisions. How are you relevant in any way? I think the hospital administration told him I was staying, so when he found out I was moving to Lincoln, he flipped out on me. That meant he would need to recruit a new pediatrician and without benefits to offer, was going to be a heavy lift for a weak man. 

Misogyny in medicine. Didn’t give it a name at the time. I went on with my work day (night) and finished out my shifts. It was aggression though and it was harassment and abuse. It was actually quite scary. Shoutout to my MIL who came and stayed with us for a month to take care of Katherine so I could work. 

We moved to Lincoln in July, 2001. My second pregnancy was in 2002, but after a rough night on call without sleep, I started to bleed and cramp at clinic when I was seeing patients. The next day, the ultrasound showed nothing. I had miscarried at 12 weeks and went back to work. At the next partner meeting, a few days after my D&C, after a full clinic day of seeing patients, one of my partners, Sole Bread Winner, as he referred to himself to evoke pity from me many times, came into my office, stood over me, patted me on the shoulder, and instructed me to, “Get back on the horse.” The comment was crude and cruel like Sole Bread Winner. Believe people when they show you who they are. 

Misogyny in medicine. I didn’t give it a name at the time and went on with my busy life. I followed through with my prenatal visits with prospective parents at St. Elizabeth’s and watched the baby bumps grow as mine didn’t. I had panic attacks in the bathroom stall before going into the group prenatal visits. It was never a question that I would continue to do the group prenatal visits because the practice was growing and if I would have brought up my panic attacks, I would have appeared weak and would have been chided. I knew that much. Didn’t name it. Didn’t call it what it was. 

Pediatric call was very busy. I never had a problem with it. I actually enjoyed it and did fine with grinding it out. But, after my miscarriage, when I became pregnant with Audrey, my third pregnancy, I was worried about taking call during the first trimester, so my OB wrote a note to my partners to let them know I shouldn’t take call the first trimester. Again, just like most women in America, there is no paid maternity leave and so I took 12 weeks off and it was during the holidays that I came back and was put on triple call to make up for my absence. After falling asleep driving to one of the hospitals in the middle of the night, after clocking three nights of no sleep, jolted awake when I hit the median, I decided to speak up. I was met with, “Karla, are you okay with taking call like the rest of us?” 

“Of course, I’ve always taken full call. It’s not okay to schedule me for triple call.”  I was dehumanized. Produce for the patriarchy. Punished for my unpaid absence. 

I was always so full of dread to tell them I was pregnant. With Andrew, my fourth and last pregnancy, I was too busy to care about the comments. I also didn’t care about their opinions of whether I should have another child or not. The aggressions continued. Their business plan was for me to be an employed physician, but as a former owner, that wasn’t going to work for me on any level. Call it providence, but this was the time when the vision for my nonprofit, Teach a Kid to Fish, the love of my career, came to me. So, I left my practice of patients and families I loved to move forward with my vision of “creating community solutions for children’s health”. 

This is barely a glimpse into what was to come in my career and the blatant misogyny and entitlement to what I created. I’ve faced so much blatant misogyny in my career as a doctor, she’s her own walking and talking being who could write her own book. But, I didn’t give it a name and I didn’t center myself because there are more pressing issues and crises that exist and deserve my voice and all of our voices. 

Medical misogyny is deadly for patients, especially when mixed with racial bias. Black women in the U.S. are 3 to 4 times more likely to die in childbirth than white women. Black women have the highest maternal mortality rate of any racial/ethnic group in the United States.

Dr. Janell Green Smith, a doctor in nursing and midwife in South Carolina, advocating to end preventable black maternal death in her daily work, died in January from complications of childbirth at age 31 after delivering her first baby at 32 weeks by emergency C-section. Dr. Green Smith focused her work on helping Black women deliver safely, but developed pre-eclampsia and died from complications after childbirth. 

The causes of maternal death driving the Black-White gap are from eclampsia, preeclampsia, postpartum cardiomyopathy, obstetric embolism and hemorrhage. The gap is not explained by individual-level patient risk factors alone. The Black maternal death crisis in the U.S. is multi-causal, related to systemic racism, implicit bias and disparities in healthcare. 

Things will get worse before they get better. Trump and the GOP’s OBBB guts Medicaid by $880 Billion and has created urban and rural OBGYN deserts of care. Dr. Oz says we are “underbabied” in the U.S. as reproductive rights are being stripped away. Erika Kirk recently told young women to have more babies than you can afford. The audience cheered. Their goal is more MAGA babies and silenced women. The Save America Act, if it passes, guts voting rights for women. 

To turn the tide, there are things we can do. Acknowledge that misogyny and racial bias in medicine are real. 

Believe her.

Give it a name. 

Learn how to be an ally.

Go on social media and listen to the stories of black women. I learned from a creator on TikTok who shared the ways white women can support black women and how to be an ally.

“If you work in healthcare and you see that a black woman is in pain and being looked over, pay attention to her. If a black woman is crying or says she’s in a lot of pain or she’s in labor, believe her.  Believe her and treat her as you would a white woman. Make no deference, have no difference. Treat her with empathy, with care and with the oath that you took. If you see a black woman speaking and she’s getting cut off, speak up for her. Don’t sit in silence. ‘I think Kathy was saying something that affords our attention. Let’s give her the opportunity to continue her thought.’Refrain from dismissing lived experience that is happening right now. Seek unity, allyship and connection. When voting, vote for all women.”

My perpetrators were irrelevant in my care for patients who I loved and cared for. My journey in medicine and my role as a mother has been my own. I intentionally didn’t give it a name. Now, grateful for not centering myself, I can learn to be an ally for black women and babies. I listen and I believe fully, knowing the impact of what I went through is multiplied for Black women. It is a call to action to advocate to end preventable Black maternal deaths in America. 

Resources:

Sheshavingababy is a content creator I follow on TikTok. She is an excellent advocate for Black maternal health.

Licia, MD just started residency in OBGYN and is great to follow.  

“Birth Vibes” by Jen Hamilton is a good book to check out. 

Shannon M. Clark, MD, FACOG is a recommended doctor on social media. 

Check out Black Mamas Matter Alliance and download the Impact report to learn more.