"I might have gotten a Ph.D. in biochemistry."

Beth Lucas works as a pathologist in an academic setting in California. She is a forty-five year old mother of a teenage boy.

The high school I attended in my small, Southern state had 200 students. Out of a class of 85, four went to college. I am the first woman from my high school to attain any sort of doctoral degree, by my becoming an M.D. One woman has become a dentist and there are a couple of attorneys.

Quite honestly I toyed then not with medicine but with more of a basic science, studying biology or chemistry. I loved science, but I was intimidated by trying to study science in college. I didn't have counseling or guidance or role models or encouragement. It was be a nurse or a teacher if you were going to be a professional woman. Otherwise you got married and pregnant, or pregnant and married, and that was it.

My father had died of cancer, and I had been in a hospital somewhat. My mother had been a nurse and I did like the aspect of working with health care and patients. But I went into nursing thinking it was going to be more science-based than it was. From high school I went into a baccalaureate program at a prestigious East Coast university, an excellent school of nursing. Even today it's rated very highly.

The reason I stayed in nursing as long as I did was because the educators were very professional. They instilled in us early on a sense of professionalism, of nursing being an honorable profession, and that we were equal to physicians. In fact there were disparaging comments about the way physicians didn't always care about patients, whereas nurses really did. Sometimes I still have pangs of guilt. They must be ashamed that I became a doctor. In fact there were three women who half way through college did switch to medicine, and there were disparaging remarks from instructors.

My first nursing jobs were in community health nursing. I worked for a year as a public health nurse for a county in the eastern United States. We staffed the clinics and did well baby and prenatal and immunization clinics. We did teaching and assisted the physicians when they examined patients. We did house calls to encourage people to bring their children for immunizations.

We then moved to a large suburban area where I spent a year and a half with a home health care program. We were part of the hospital. When patients were discharged we followed up their care. It was primarily elderly patients who had had strokes or cardiac events who needed some assistance in the home as well as some nursing follow-up, monitoring their vital signs, making sure they took their medicines, and education.

When I worked in that home health program, we made a report to the patient's doctor. I remember being intimidated by the doctors, feeling they were far above me. I had a couple of negative experiences with them, especially when I was filling in as the discharge coordinator. You'd get a referral and while the patient was still in the hospital the discharge coordinator would go to see the patient and try to set things up before they went home. I vividly remember a couple times when these physicians screamed at me because I suggested the patient should have this and that done. When I'd ask, "Did you order X and Y?" they'd say, "Oh, she doesn't need that!" and growl. They were unpleasant experiences and I was glad I didn't have to work much with doctors. Maybe unconsciously it was part of why I didn't.

When we moved across the country I got a master's degree in nursing, specializing in community health nursing. That was a year's program and I got even more nursing instilled in me, again by very fine educators. After that I taught community health nursing at a state university campus for two and a half years. My students were getting a baccalaureate in nursing and community health nursing was a senior rotation. I did the instructing and supervised their visits to the various public health clinics, and to patients.

But I only had instructor status and to stay there I had to get some sort of doctoral degree. So I explored some options. I thought about getting a doctorate in nursing or in public health, which seemed appealing. The people at the top university weren't encouraging, they weren't interested in my background as a nurse. They were looking for more diverse people.

Around the same time, 1973-74, this role of nurse practitioner was coming along. The health departments in my county had hired a couple nurse practitioners who were working in their clinics. I decided to do that, but when I told other people, they'd say,"Why don't you just go to medical school?"

Now that was when, to be honest, for the first time in my life I considered going to medical school. I was 25, 26 and I'd been married for five or six years. I knew I wanted to have some sort of family. I thought, If I go to medical school when am I going to have a child? I was intimidated by the whole process and also, quite candidly, it was competitive. It was even more competitive to get into medical school then than it was later on when I did apply. The height of the baby boomers were applying.

And I was intimidated by the year or so of pre-med I'd have to take. I knew young, bright men with biology degrees who were having a heck of a time getting into medical school. A lot of them were going to Mexico. I thought, If they can't get in, what chance would I have? I scared myself out of it, without seriously trying. Actually, I always believed I could do it once I got there. I just wasn't sure I wanted to put in all that time and energy to try it then.

The nurse practitioner role was and probably still is a bit controversial for people in nursing who felt you were going to be a junior doctor, following the medical model of care. I attended the family nurse practitioner program, which took a year and a half. I got another master's degree with the program. I was idealistic and naive at the time, but I really loved doing this. It was fun to learn how to do physicals and exams and work with patients. It was very satisfying. We family nurse practitioners did general medicine, family practice. My basic training was here in the family practice clinic working with residents and family practice physicians. I did my six month internship with a family doctor in a suburban area. When I graduated I worked in his office for another two and a half years.

That was very satisfying work. I had proved to myself I could do this, and a lot of patients said things like: "Why aren't you the doctor? You should be the doctor. "Actually that doctor himself would say, "Honest to God, Beth, you're smarter than I am. You should be doing this. It's not too late." But I had baby fever at the time. I was getting close to thirty and the biological imperative took precedence.

My son is now almost fifteen. I worked up until I had my baby, took off a couple months, and then came back to work. That was different; it wasn't as much fun. It was hard to balance child care and all these things. I'm sure it's very stressful for everybody. And I got to thinking: Is it really worth it for this sort of job? Maybe I should go to medical school. Some people would say, "This would be a great time, while he's a baby. You could take classes and get ready." My youngest brother was in medical school. We have always been close and talk frequently on the phone. And by then there were lots of women in medical schools. Things had changed. My brother said, "I've got women in my class who have little kids. You're not too old."

I worked until my son was six months old and then quit. Because of my marital situation I knew I wasn't going to be able to leave the area, so I went to the advisor of the local medical school, who wasn't all that encouraging. But a woman in pre-med advising was wonderful. She said, "Go for it" and referred me to the local state university. Nothing stopped me after that. I had to do a full year of pre-med. I got into three medical schools, but I was pleased to get in here because the family situation could be stabilized.

There was something about me that knew I only wanted to have one child. When I had a healthy child--I didn't care if it was a boy or a girl--I was content with that. By the time I started medical school he was three and a half and easy to put into a pre-school. It worked out well. I thought, I won't have time for more kids, but I felt fine with that. I didn't feel I gave anything up.

Medical school was difficult, but it was a tremendous growth experience. I worked hard, but I enjoyed it. I was very successful academically, got honors, etc. What was personally traumatic was that I got divorced half way through. I was in my third year, in the middle of my clinical rotation in surgery. It was very stressful.

The divorce was not because I went to medical school; it was because I was finally realizing who I was and what I wanted to do and be in my life. Then I had the courage to face up to what was not a great marriage. The marriage would have dissolved eventually. It took me a long time to decide that I really wanted to be a physician, and it took me a while to realize what was going on personally and in my marital life.

My first husband was an independent businessman and we were very comfortable, so when I started medical school my lost income did not affect our family to any degree. When I got divorced we came to a financial arrangement that helped support me until I finished school. Especially during my internship year it was a little tight but I wasn't impoverished by any means. That was the first time in my life I lived alone, and I supported myself and my son on an intern's salary.

Entering medical school--and this again was very influenced by my brother--I knew I wanted to go into pathology. Back when I was a nurse practitioner we had a patient die and the family had an autopsy. The pathologist called to say, "There are some interesting findings." It was the first time I'd seen an autopsy and I was fascinated. Pathologists are hidden doctors. You usually don't know about pathologists unless you have some reason to.

The pathologist was so excited to have somebody there because he worked in community practice with no students or residents around. We formed a real friendship. His wife was a pathologist who practiced part-time because they had four kids. It's a specialty where it's easy to have a family. That did influence me because I could project myself ahead with a young child as a pathologist. And my brother had ended up in pathology. So I entered medical school 98% sure I was going to go into pathology. Plus I would finally get to do that biology and chemistry I always wanted to do back in high school. We're in the field of medicine where we get to integrate what's going on in the laboratory with patients. We even do research.

Looking back on it, I might have gotten a Ph.D. in biochemistry or something, given a different kind of advice in high school. I might have been doing research somewhere and I'd probably have been happy doing that. But pathology suits me to a T. I love pathology.

I don't know what we would have done if I hadn't gotten accepted into the university pathology residency program. I had and still do have an active joint custody arrangement with my son's father. Luckily I matched here, and my son spends about half his time with his dad. As a student I really did try to excel, because I wanted to have a perfect record so the university wouldn't turn me down.

Pathology is a five year residency, if you do both anatomic and clinical pathology, which I did. You come out boarded in both. They are independent specialties and if you do one, it's three years. But doing both gives you the most flexibility. A five year pathology residency doesn't even compare with a surgery residency. That would have been extremely difficult, especially as a single mom.

The women who do difficult residencies with kids must have wonderful marriages and supportive husbands who say, "Sure, if you're gone all that year it's fine. I'll get the kids, I'll take them to Brownie Scouts. It's no problem." I didn't have and still don't have extended family around, so I don't know how I could have done a residency like that. I would have had hardly any time with my son.

About the second year into my residency I remarried, which has made all the wonderful difference in the world. But those options were not available to me at the time I started residency. Surgery does appeal to me. That's probably why I'm in surgical pathology. If I had been twenty-five and had all that energy I probably could have done a five or six year surgery residency. By then I was thirty-seven, not about to stay up all night.

When you're in internal medicine or pediatrics, you're very quickly taking care of patients. Your attendings are academic people who come over once a day or once a week. By the second year you're managing teams of patients. Pathology residents learn how to do what we call "gross the tissue." The specimens come in and we have to dissect. We learn how to do that very early on, and then the microscopic sections of tissue come out the next morning. We are supposed to look at them first but we can't issue a report or even a diagnosis until we've shown our attending. Even then we don't sign the reports, the attendings sign. At the equivalent level in medicine or surgery we would be doing our own surgeries, being in charge.

It's probably similar in radiology but I'm not sure. We're very interpretive disciplines. Attendings ask the resident, "What do you think it is?" first and get them to make the diagnosis independently, but the residents are not allowed to sign it. That's why the transition out of residency to being a practicing pathologist is tough. It was scary the first time you signed your own report, the first time you did your own frozen section, which is when we're really on the line: The patient is under anesthesia and the surgeon needs to know whether to cut or not cut. They need a decision. The first time you do that on your own it's intimidating.

Hospitals don't want you to do sign reports until you're finished with residency, until you are at least board eligible. That's too much of a risk for them. They could get sued because it wasn't a board certified pathologist, who could also have made a mistake but at least they were board certified.

The only patient contact I get is when I cover our fine needle aspiration service, which I do three or four days a month. Patients are referred to our clinic and we take the sample. You meet the patient, have your needle ready, say "Hi, I'm your pathologist, I'm going to take the sample of your tissue," take it and then you examine it, make the diagnosis, etc. I enjoy that; it's rewarding. Our cancer center is a wonderful place, beautifully designed, and the whole staff there is very professional. Patient's are appreciative.

As pathologists we're the doctor's doctor. On occasion, patients are confused and call here to ask for their results. But you have to tell them, "No, we'll tell your doctor and your doctor will explain to you." If the results are positive or negative there are consequences, and that's not for us to deal with.

I had a situation once where a Russian lady spoke very little English. I did her aspirate and it was positive. I happened to see her across the parking lot, three or four days later. She was a real sweet lady, with a babushka, and she came up to me and asked, "Maligna, maligna?" I had already called and told her doctor, but obviously she hadn't been back to that person yet. We hugged each other and she cried and I cried and then I walked her over to the cancer center. Here's this lady who's seventy years old and she knew it was positive. So I broke my rule that you don't tell the patient first.


My goal is academic pathology. In July I'm going on track as an assistant professor. Academic achievement was highly prized in my family, so even in high school I was salutatorian. I still have that drive in academics. I've been here a couple of years as a staff physician. I want to get tenured, I want to be a professor, I want to get grants, I want to publish. I'm still jumping through hoops, chasing goals.

I work with residents all the time and they're integrated into all of our services, so that's a big part of my job. Most of the time I'm on surgical pathology and our residents are also on the rotation, so I'm basically supervising their work of grossing tissue, making the microscopic diagnosis, writing up the reports. The resident does the dictation and then I correct it, and I'm the one who signs it.

When I become an assistant professor, my job will only change in that I will be doing a little less service time, and I'll have more research and academic time. Right now about 25% of my time is on service, about a fourth of my time I'm permitted to do research and academic work. When I become an assistant professor, it will be almost 50-50. Though I like the service work, I'm starting to really like research and I'm getting good results. There's part of me that wants to be doing more of that. Also, you're a member of the Academic Senate, where you start having more say in what goes in the university, the power part.

I like working here. I worked for a short time in some community hospitals but I got recruited to come back. I like the diversity at the university--a lot of women, people with different sexual preferences, different ethnic groups. And the pathology is more interesting because we get fascinating cases that are very rare, that you would never see in private practice. We had two cases of a very rare tumor, where there are only twenty reported in the world. That's really stimulating.


My husband is a cell biologist. He has a Ph.D. and works in biomedical research. He's a pure researcher. I might have done that had I gone straight through. I find his work fascinating and he does mine, too. We actually have one project we're working on together. He's doing some experimental methods of cancer treatment and I analyze the cells from the standpoint of a pathologist. We're in our own spheres but I can help him learn how what he's doing on a very basic cell level would affect patient care. Having a lot in common professionally is rewarding.

We've been married five years. He's a wonderful person and he loves my son. He had been married before but had no children. We were both forty when we married.

I was the only mother in my medical school class, though there were several fathers. No matter how old or young a child is, the whole experience makes a lot of conflicts and complexities. Overall, because I became a happier person, I know it was a positive experience for my son. But I also recognize that I had to push him to grow up faster, or at least be more self-sufficient than other children were. He never complained about it, but he may not have known any better. Being an only child, I thought it was important for him to be in daycare and in preschool, to be out with other kids. He loved that. When I got into the clinical years and had to stay overnight, we were in the middle of this divorce, so that was difficult for him. It's hard to separate out what part was me in medical school versus the divorce part. My son seems to have come out on the other side pretty well, but he has absolutely no interest in medicine. Now that he's in high school, he's started to ask me a few questions about my work, but I don't think he'll be a doctor.

He's a great kid. He's very sensitive and intelligent and attuned to women and sensitive to those issues. We have a good relationship, but obviously medical training does have an effect on your parenting. Though I see it mostly as positive, I'm sure there were times he might have been mad that I wasn't home. I don't think it was as traumatic as it would have been if I'd done some other residency. In that way I did try to attend to his needs.