Medicine, Marriage and Motherhood
A Keynote Address
About the address: when Janet Travell was eighty-one years old she asked a young friend of hers, Peter Costa, who was living with her at the time, how she could improve the remarks she had prepared for the Keynote Address that she was going to give at the upcoming Celebration of Women in Medicine at Hahnemann University in Philadelphia in March of that year, 1983.
She was satisfied with the speech she had written but wanted to add something extra to make it more meaningful to herself and to her audience. The Keynote Address was entitled "The Woman Physician of Yesterday and Today." It was divided into three main sections, "Medicine, Marriage and Motherhood."
Pete suggested that she bring onto the stage with her three props representing the most important aspects of her life, those that she had tried the hardest to balance successfully. As she was giving the address, when she was speaking about her career in the field of medicine, she should pick up a stethoscope from the lecturn and place it over her shoulder. Then, when she was talking about her husband, the late John W.G. "Jack" Powell, she should take up a pearl necklace and place it over her shoulder next to the stethoscope. Finally, when she was referring to her two daughters, Janet and Virginia, (who were married and the mothers of her six grandchildren), she should hold up a camera and lay it, by the strap, over her shoulder next to the other two objects.
As she was reaching the end of her address, she should purposefully twist the three props until they were hopelessly entwined and, as she talked, she should struggle to get them untangled. She did just that and the talk was a great success!
Here is her keynote address.
The Woman Physician of Yesterday and Today
A Keynote Address
by Janet G. Travell, M.D.
Given to Women Doctors on March 6, 1983
At the Celebration of Women in Medicine
Hahnemann University, Philadelphia, PA
I am privileged to speak to you today. It is an honor which stems, I know, from my years in the White House with President Kennedy and President Johnson.
In the Author's Note to my autobiography, "OFFICE HOURS: DAY AND NIGHT," published in 1968, I raised these questions:
"What inner drives and forces of circumstance had molded me? Where did I acquire my energy? Had the rewards outweighed the regrets and personal sacrifices of my demanding profession" (1) of medicine? I will try to answer these questions today and to give you some guidelines for happiness in the combined professions of medicine, marriage and motherhood.
Medicine:
Concerning your professional goals, the basic objective is: BE YOURSELF. Do not compare yourself with anyone else. No two people in the world have the same thumb print, not even identical twins. You are unique.
I was never a rebel. From childhood on, my world was filled with love, understanding and the support of family, friends, teachers, and later, of my husband. When I was seven years old, I said that I wanted to be a doctor and no one discouraged me from that goal, especially not my physician-father.
I had no desire to be different from my peers and I was a conformist whenever I could be. However, my long-range goals held top priority. When I was a senior in high school (I graduated in 1918), and we were at war with Germany, I elected to study German which was offered in the curriculum. I thought that I would later need to read the German medical literature. A special German teacher was finally assigned to me at my insistence. My classmates called me a traitor to my country!
My mother used to say that I was the most stubborn child she ever knew; eventually I got what I wanted.
I was never a truly competitive person. I enjoyed playing tennis and wanted to play well. I was a college champion at Wellesley in doubles with my sister and in singles. I played in the Women's Nationals at Forest Hills but tournament competition never really commanded my interest. Winning was incidental to the fun of playing the game.
Nor was the winning of top academic grades in high school, undergraduate college or medical school ever one of my major goals. In fact, at Cornell University Medical College we were never told our marks in any course (only passed or failed) until we graduated. I was astonished to learn that academically I ranked first in my class. It seems that I was endowed with a good computer inside my skull, and it was well-programmed.
At medical school, I never felt discriminated against by our male faculty nor by any of the men students in my class. Neither did my sister who was a year ahead of me at Cornell.
At that time, about 20% of the medical students entering Cornell were women because so many of this country's young men were still on military duty overseas in the Army of Occupation after the first World War. Nor did the men seem to feel threatened by the women students. We all worked together for the same goals. We worked for the joy of learning and to equip ourselves for the career of medicine.
Later, when I asked Dr. Harry Gold, my pharmacologist colleague at Cornell, whether I should undertake a certain project, he advised me, "Would you lie awake at night dreaming about it? If not, it isn't worth doing." I realized then that this had always been my guiding rule; I pursued what interested me.
But to tread this primrose path, you must know where your interests and talents lie and what you ultimately want, at least in the overall plan.
When I was a full-time instructor in the Department of Pharmacology at Cornell, I was given a year's leave of absence during the latter part of my first pregnancy and for several months after the birth of our first daughter, Janet, in December 1933. I returned to the department part-time, for a short period, at the end of the academic leave. Then I realized that that was what I wanted - a permanent part-time plan. I applied for this just when the entire New York Hospital - Cornell Medical institution was converting to a full-time system. Clinical staff members who refused to change from part-time to full-time appointments were being fired. Of course, my request was refused.
So what did I do? I resigned my full-time faculty post. I would devote more time to motherhood and also to clinical practice from my father's convenient office in New York City. Research and teaching could wait. (I soon had a second daughter, Virginia, born in 1935).
Dr. Hatcher, chairman of the Pharmacology Department, asked me if I would reapply in a year. The climate for a part-time position might be better then, he said, and in the meantime, he would not appoint anyone to take my place. The department staff would assume my teaching duties and work harder during that year.
I agreed. A year later I reapplied for a half-time position and my request was granted. It was a unique appointment in a basic science. Many colleagues warned me that by electing this course I had ruined my future in medicine. Fortunately, it did not work out that way.
Marriage:
Marriage came at a good time in my life. I had already completed my two-year internship in medicine at the old New York Hospital on 16th Street. (I was the second woman intern in the second oldest hospital in this country). The combination of hospital internship and a pregnancy creates many problems for women physicians which I did not have to solve.
When Jack Powell, the handsome, genial, Tar Heel, man-of-business and I were married in 1929, I held a research Fellowship at Bellevue Hospital, sponsored by the Rockefeller Institute, to conduct a collaborative, controlled study of the value of digitalis in lobar pneumonia. Twice daily, I made rounds on the ten medical wards of three university services - Cornell, Columbia and New York University - dragging an early Einthoven electrocardiograph on wheels (with the aid of a technician) and analyzing the yards and yards of the tracings that we took. The startling findings were that the full digitalizing dose, which was given routinely, was toxic and increased the mortality in lobar pneumonia, and the drug was not indicated unless congestive heart failure was a complication. I learned to deal with many points of view among the attending staffs of the different universities.
Jack and I had met at a dance while I was a New York Hospital intern and we danced through life together. Nothing marred our marriage. A poem I wrote was titled, Our Love Would Stand the Test of Time; I will read it to you.
"Our Love Would Stand the Test of Time
My Jack was different: he married me.
He recognized better than I what sort
Of love was relevant to the full free
Union of our lives. Bitter jealousy
Had no home with us. I need not resort
To feuds of dominance since I could see
That I had his heart. He gave me support
To reach for excellence; hours I worked he
Did not resent -- he held my heart, you see.
The love we wrought the years would not distort." (2)
During our courtship, while I was an intern, Jack had learned that medicine was an integral part of me and he did not intend to dismember me.
My two-year New York Hospital appointment had included several months of service as ambulance surgeon, with the rank of Police Lieutenant, on a New York City ambulance. Once, when Jack and I could not see enough of each other, I put an ambulance surgeon's cap on his head, gave him an emergency medical bag to carry, told him to behave like a doctor, and he went with me.
I rode about a thousand ambulance calls in mid-town Manhattan with both heart-breaking and amusing experiences. A man whom I was called to see had been in a fight with razors and had suffered ten clean long slits on his chest and back. I brought him in to the Emergency Room at the Hospital and neatly repaired the two yards of lacerations with 123 stitches. My mother had taught me well how to sew.
One Sunday morning, I was called to Madison Square Garden at Fifth Avenue and 23rd Street. Police escorted me through a crowd of neck-craning spectators to a park bench where a little old man was hiccuping at a rate of about one per second. He had been hiccuping for a week, he said, and was exhausted. According to the technique of Sir William Osler which my father had taught me when I hiccuped as a child, I wrapped a square of sterile gauze around his tongue and pulled on it with steady traction for about a minute, until his hiccups stopped. The crowd applauded. My problem was that I had taken along for the ride a friend, a free-lance writer, who published the story. After that, whenever a patient on any of the wards or in the private pavillion had persistent hiccups, a call would be sent out, "Get Dr. Travell. She does something." My know-how never failed me!
My interest continued and, in 1977, I finally published a paper, "A Trigger Point for Hiccups," (3) which I discovered lies in the uvula palatine, the pendulum-like tissue which hangs down in the back of the throat. All that I had to do was to use the handle of a fork, or spoon, or a tongue depressor, to lift the uvula backward. The earlier technique of pulling on the tongue (which was painful) accomplished the same change in the position of the uvula.
Medicine fascinated Jack and it became part of his life, as well as mine. We hosted many an elegant party but never invited solely physicians. His business and artistic friends made an exciting mix with my scientific colleagues.
Motherhood:
Motherhood did not change Jack's and my relationship, except to make our love stronger. Jack shared equally the joys and chores of parenthood. Without his constant help, I could not have accomplished all that I succeeded in doing in my profession. When the children entered our lives, every moment of time became incredibly precious to me. Friends asked Jack how his wife could write so many papers. He replied, "Ask her what she does between midnight and bedtime!"
My hostility towards clocks led me to write a poem:
"The Clock God: A Lament
The time of my life is ruled by a clock
Authoritarian as a traffic cop.
The moving hands direct the pace. Tick, tock,
Tick, tock, counts down the race. . . Oh, stop!
Delay! Alas, we can not stop the clock.
The future's hours are not ours to unlock.
We bow to the Clock God, image enshrined
In every home on mantel, table, wall,
Atop of buildings, billboards to remind
Us fools: Jump, run obey the Clock God's call.
The clock face grins but it is deaf and blind.
Not mute, its voice repeats alarms unkind.
The calender is its high priest supreme.
Each day we're boxed in little squares of time.
Their prison walls shut out the right to dream,
To seek the truth in beauty. The gods chime;
We see the calendar and clock, a team,
Drag past the days, months, years of life's mainstream." (4)
Every professional person lives by a schedule and I put our children into my schedule. During their school days, I made sure to attend their performances and special events. Janet starred as an opera singer, and Virginia, as a modern ballet dancer. Other mothers, with less demanding schedules than mine, were often absent from their youngsters' performances.
I learned that the quantity of time which you spend with your children is less important that its quality. Give them your individed attention. Turn off the telephone (get an answering service) and listen, listen to what they want to tell you. Lose track of the clock temporarily and avoid the sense of hurry like the plague.
Do not be a compulsive perfectionist in matters of secondary importance like housework. If your child does not make up his or her bed occasionally in the rush to get off to school, do not scold. Actually, paid domestic help is usually essential to combined motherhood and medicine, but the regular help of an older retired member of the family may suffice.
Children should not come home from school to an empty house. Jack and I were fortunate in securing reliable domestic employees and one of them was always there at night. Until our girls went to college, Jack and I never traveled away from home together unless they went along with us to share in our holiday merrymaking.
One Sunday in 1949, I read in the Westchester Medical Bulletin the results of a poll taken of 100 hospital chiefs of staff - all male, of course, to answer the question whether women should study medicine. Some of the views were: "Women talk too much...They are always on the defensive...If they are childless, they are frustrated...If they become mothers, they neglect either their practice or their children." I handed the article, without comment, to Virginia. The next afternoon, when I returned from work, I found her reply on my bed. I will read it to you.
"Are the Children of Women Doctors Neglected?
I am the daughter of a woman doctor, and I couldn't say that I have been neglected during one of my fourteen years, or my sister during any of her fifteen. Nor can I say that our mother neglects her practice. The truth is, she practices on us. She turns us into guinea pigs with as much loving care as the housewife changes milk and flour into a cake. If any one is neglected in our family, it's Daddy, but he is Pappa Guinea Pig when he is needed.
I suppose we have turned out to be almost normal children, despite what some people think is a great barrier to contend with. Although, sometimes I wonder. I've learned to dislike bubble gum because it is 'bad for my jaws' and murder mysteries on the radio because 'they poison my mind,' and I admit my friends sometimes get annoyed when I say, 'You'll get a stiff neck sitting like that,' but they forgive me because I'm a doctor's daughter. I get stuffed with huge pills for the slightest ache or pain, but I can go barefoot and step on all the rusty nails I want because Mom will fix me up! And I guess I go to as many dances and picnics, and talk on the phone as long as any average teen-age girl.
I admit we aren't 'Mamma's little pets' like some - who I think see too much of their parents and become pampered babies who never grow up. We are on our own most of the time, we have much more freedom than most, and I guess we learn responsibility earlier, but I'm not complaining! I don't feel neglected!
And we are one up on most children. Mom takes vacations from her work, not from us, and we go along on those Family Honeymoons.
In answer to the question, 'Do I wish Mom was not a doctor?' I say, 'Don't be silly! I wouldn't change places with anybody on earth. I like being a guinea pig!'
by Virginia Powell, September 13, 1949"
At my suggestion, Virginia sent her reply to the Editor of the Westchester Medical Bulletin and it was published two months later in the November 1949 issue. Years later, it was reproduced in my autobiography. (5) Her composition is one of my most prized possessions.
Medicine, Marriage and Motherhood:
To meet the challenges of these three combined careers, you cannot be a Superwoman without optimal health. Your greatest enemy is usually not disease, but fatigue, and a large part of that is muscular fatigue combined with tension.
This is not a new problem. In 1831, Dr. James Johnson, whose title was "Physician Extraordinary to the King of England," wrote about what he called the Wear and Tear Syndrome. He said:
"There is a condition, or state, of body and mind intermediate between that of sickness and that of health which is daily and hourly felt by tens of thousands of people, but I do not know that it has ever been described. It is the wear and tear of the living machine which results from over-strenuous exertion of the intellectual faculties conducted in a state of anxiety of mind and bad air." (We now say: "stress" and "pollution" and the "sedentary life").
Dr. Johnson adds, "The Wear and Tear Syndrome makes much work for the doctor ultimately, if not for the undertaker."
All of us have experienced this lack of stamina. We forget the difference between getting up tired every morning and waking with a wonderful feeling of well-being. All too often people put up with average rather than optimal health.
In some people, skeletal asymmetry, such as shortness of one leg, of even small degree, may be a major cause of muscular strain and fatigue of the back and neck muscles. The tendency, when standing, is to bear more weight on the shorter leg and, in walking, an abnormal seesaw movement of the pelvis and shoulder-girdles results.
It is a matter of record that I prescribed a heel lift for John Kennedy for teatment of his back pain.
The net effect of a heel lift correction was expressed in a letter to President Kennedy from a Representative in the U.S. Congress whom the President had asked me to see professionally. The letter (quoted in my autobiography) read in part:
Dr. Janet Travell "has added strength to my backbone, which is a good, if dangerous, thing for a politician...By the appropriate use of felt shoe pads, [she] can correct a tendency to lean too far to the left or to the right. The potential political results from the application of this technique stagger the imagination."
In case you - my audience today - have a question in your minds, I will tell you that according to the Congressman's deductions, since President Kennedy's left leg was a trifle shorter, the heel lift that I prescribed must have leaned him towards the right - but not beyond the center. (6) An appropriate heel lift can, if needed, straighten you up and improve the quality of your health.
It is difficult for me to understand why people tolerate that common environmental stress on the body caused by an ill-fitting, ill-designed chair. Everyone should realize the importance of sitting comfortably, which reduces skeletal muscle strain and fatigue. The new science of ergonomics is moving fast to provide adjustability of seats and their suitability for the task to be performed. Thanks to my part-time academic plan, I was able to devote some of my energy to industrial seating design - including airplanes, tractors, bicycles, work-station high stools for telephone operators and even toilet seats!
Sitting long in one position is disastrous to the muscles. Immobility reduces their circulation and leads to aching pain whereas isotonic movement (shortening and lengthening) increases blood flow which provides more oxygen and washes out the waste products of contraction. To insure movement, I have often prescribed an interval timer, set to go off in 20 or 30 minutes and placed across the room. When it rings, the preoccupied sedentary worker must then get up, walk across the room and reset it for its next cycle. The timer does not tell you the hour and minutes, and need not interrupt your train of thought.
For physical fitness and an alert mind, exercise is truly essential. But that statement needs qualification.
Like medicine, exercise must be of the right kind, in the right dose and at the right time. A weekend orgy of exercise, when you are out of condition, can be as distrastrous for your muscles as no exercise. We must not accept pain as a normal side-effect of a physical fitness program.
When I moved to Washington in 1961, I was impressed by the high value which top government officials set on the quality of their health and by their insistence on getting regular exercise. President Kennedy swam, and President Johnson walked, almost every day.
It was not easy for the White House Physician, on 24-hour call, to do as well in that respect. It took some innovative planning. I brought a couple of jump ropes to my White House office. Behind closed doors, in my soundproof treatment room, my secretary, nurse and I took turns jumping them. We tied one end of the rope to the nose-and-throat examining chair and one of us twirled it while another jumped in and out.
Exercise should be fun. One evening at about 7:30, the Mansion was very quiet - it seemed to me like being inside the eye of a hurricane. President and Mrs. Kennedy were out and the children were upstairs, I thought.
I was tempted. I took a rope and skipped it down the long red-carpeted hall outside my office - past the surprised White House guard, past the line of statues on pedestals, the marble staircase and past the main entrance to the Mansion from the South Grounds. I had reached the far end of the hall and started back when Caroline and John, with their nurse, entered from the South Portico. I was caught and the children were enthralled with my act.
After that, Caroline would run up to me at a most embarrassing moment and say in her clear voice, "Dr. Travell, I want to see you skip rope down the hall again."
Later, when Lynda and Luci Johnson, and their friend, Warrie Lynn Smith, came to live in the White House, I could not compete in rope-jumping.
Take care of your muscles and they will take care of you.
In the current craze for physical fitness, overload of the skeletal musculature happens too often. If 20 sit-ups are the right dose of that exercise, 100 sit-ups may cause long-lasting harm. Muscles are different from other tissues. When injured, the skin, bones and ligaments heal, but when a muscle is injured, it learns. It learns to protect that part of the body from movement and this splinting and guarding may continue for months, even for years. Muscle memory explains many of our chronic pain syndromes that are refractory to frequent forms of treatment, especially immobilization or overexercise. Overload occurs readily during fast repetitive movements and also during sustained, fixed (isometric) contraction.
Abuse of the muscles in housework, as it is usually performed to get it done as fast as possible, accounts for many such cases of chronic pain. Housework can be as strenuous as digging ditches. Most people can afford to take a little longer for it but they can not afford muscle injury. I will give you a few simple rules for efficient body mechanics that can preserve your muscle energy.
1) Vary your task each day. Do not iron for hours at a stretch or combine jobs which all involve stooping and bending. To achieve variety of movement, you will need to scramble your housework.
2) Cultivate a rhythm of movement. This discourages prolonged, fixed contraction that tires muscles and encourages pauses in which the relaxed muscles fill up with new blood and fresh fuel. Music helps.
3) Slow your working pace and avoid quick jerky movements. Muscle contraction is more efficient at the slower speed of shortening, just as your automobile uses less gasoline at 40 miles per hour than at 60 miles per hour.
4) Take short rests frequently. After an hour, or less, of housework, lie down to rest for a couple of minutes, if only on the floor. In the nearly horizontal position, your muscles are relieved of the constant anti-gravity stresses that cause reflex tension in the upright position.
5) Do not sit too long in one position. Sit in a rocker or in a chair with changing angles so that it, too, moves you.
6) Don't try to lift a heavy piece of furniture by yourself. Do not carry excessively heavy grocery packages into the house from the supermarket. It would be better to divide the weight into more packages and to make more trips.
To maintain optimal health requires strict self discipline in all these activities of daily living. It requires attention also to total body nutrition and the avoidance of known health hazards such as cigarette smoke. I believe that the woman physician of today is basically concerned, and rightly so, about her optimal health and that she tends to seek medical care earlier in the course of a health problem than does her male counterpart.
Myofascial Pain Syndromes:
My clinical research for many years has dealt mainly with the performance of the skeletal muscles under stress, usually unrelated to disease. It is the old "wear and tear" syndrome. The skeletal musculature is the largest organ in the body, with some 500 muscles, and it accounts for nearly half the body weight. Without our muscles we can not eat, speak, walk, jog or carry on any of life's functions. The muscles are also the most neglected system of the body.
* * *
Dr. Travell ended her talk by saying that she wanted "to show the women physicians of today, and the men who are here also, a few lantern slides related to myofascial pain syndromes. The muscle that I have chosen," she said, "is the quadratus lumborum which in my experience is the most commonly overlooked cause of low back pain."
Footnotes:
(1) OFFICE HOURS: DAY AND NIGHT, The Autobiography of Janet Travell, M.D. by Janet Travell, M.D., NAL/World Publishing Company, New York and Cleveland, 1968, p. ix.
(2) OFFICE HOURS: DAY AND NIGHT, p. 183.
(3) Journal of the American Osteopathic Association, 77:308 - 312.
(4) OFFICE HOURS: DAY AND NIGHT, pp. 21 & 22.
(5) Westchester Medical Bulletin, The Westchester County Medical Association, Purchase, NY, Vol. 17, pp. 22 & 39, Nov. 1949 and OFFICE HOURS DAY AND NIGHT, pp. 246 & 247.
(6) OFFICE HOURS DAY AND NIGHT, pp. 409 & 410.