Elizabeth Comen, ALL IN HER HEAD

Elizabeth Comen, ALL IN HER HEAD

Zibby is joined by Memorial Sloan Kettering oncologist and medical historian Dr. Elizabeth Comen to discuss ALL IN HER HEAD, a groundbreaking and fiercely entertaining narrative of women’s bodies, and a call to action for a new conversation around women’s health. Dr. Comen delves into the egregious treatments women have endured for centuries, the systemic neglect of women’s health issues, and the need for women to ask questions, seek second opinions, and support each other. She also talks about balancing medicine and writing and shares her excitement for her new role at NYU.


Zibby: Welcome, Dr. Komen. Thank you so much for coming on Moms Don't Have Time to Read Books to discuss all in her head the truth and lies early medicine taught us about women's bodies and why it matters today. Congratulations. 

Elizabeth: Thank you for having me. 

Zibby: My pleasure. And as we were just discussing, I know your background as a doctor is just so amazing and you've helped So many girlfriends of mine and people saving lives, saved their lives.

So thank you for that from the bottom of my heart, honestly. 

Elizabeth: Thank you. 

Zibby: Okay. The book. Let's go there. Let's do it. Let's do it. Okay.

Elizabeth: I'm an open book. 

Zibby: You are an open book. I feel like I will never be able to ride a bicycle again after reading this story. Like, hearing what women do to their bodies. Oh my gosh.

Okay. Tell listeners what your book is about is about and when you decided to write it and all the backstory, everything. 

Elizabeth: The backstory. So I'm a breast oncologist, which means I take care of breast cancer patients. I've taken care of thousands of patients over the course of my career, also majored in the history of medicine.

And I've always been passionate about understanding the experience of illness. And then in my professional world, really the experience of illness for women. So the book is a walk through women's bodies. In history and by organ system, really tackling, I think one of the biggest myths, which is that women's health, women's healthcare is just our breasts and our, our uterus.

When in fact, we are head to toe different from men. We are not small men. So it is a walk through your body by organ system, told through stories, really gripping egregious stories from the past, but all the way through to the present interviews with expert physicians in every specialty and my experience with my own patients.

Zibby: And when did you become so interested? Were you a little girl who like loved medicine? Like where did this come from? 

Elizabeth: You know, my dad is a litigator and my mom is a therapist. And so I think I've always had an interest in questions and narratives and the stories that we tell ourselves and what's the facts, what are the, what's the evidence and science and history of science really tells us that it.

Nothing we do and think is about finding the truth is really just that. It's all the perspectives and science and medicine is inextricably linked to everything, culture, history, religion. And for me, I think as a little girl, I wanted to have some sense of authority in a home where Lots of other people had authority, but no one knew about science.

When I was a little girl, I loved Halloween. I still love Halloween. And I remember my mom, I grew up in Boston and she always would make me wear like these huge coats over my fabulous costumes. And one day I was about six years old and I'd read this book that germs cause the cold, not the cold. And I said, you know what, mom, I don't need a coat today.

I will not get sick. I'm going to go out in this bunny costume and I don't need a bigger coat because it's the germs, not the cold. And I, and I remember that moment as being like, wow, science is really powerful. Maybe I could do something with this, but no, in all serious, I've always, I've always been fascinated by the body, but equally by the humanities and.

And drawn to this extreme sense of how do we engage in the human experience and how could I be part of that? 

Zibby: I had one experience where I convinced my parents through data, but it wasn't through science. But I was trying to get my, this is totally irrelevant and I can cut this out later, but I was trying to get my curfew raised and all my friends had later curfews, like literally they did.

And I went through and like made a whole chart of all my friends names and their mom's names and their mom's names. phone numbers and their curfews. And I gave her like this whole presentation and I was like, this is why I need a better curfew. And it 


So anyway, yeah, brilliant. 

Elizabeth: We all have these pivotal moments in our lives where we have to find some sort of power within and figure out how we're going to use it for hopefully good in the world.

Zibby: Exactly. 

Elizabeth: What'd you do with your late night curfew? 

Zibby: Oh, I don't know. I just, like, sat in somebody else's living room for longer and, like, hung out. I was, I was pretty tame, to be honest. Well, I don't know. Whatever. I don't know. Not much. I mean, I don't know. Honestly, the problem with curfews is that you're, you go home alone.

Like, I was having to go home alone versus with all my friends. Anyway. Yes. Anyway, all to say, harnessing data, very important, especially as a child who feels powerless. And now as, also as women, we can feel equally powerless when we are not getting the healthcare that we need or the advocacy that we need.

And you are, outline all of this and show us, like, all the things that we should know, that where this has come from. And it's empowering. The book is super empowering. How did you get started? Like, which organ system. Like where did you, how did you think to organize it this way? Tell me about the book writing process.

Elizabeth: So I'll tell you about the organization first and then I'll tell you what really sparked it. I was really struggling with how to organize it, how to structure it, because it really is a whole takedown of the body and what we know. And then I really thought Do you want me to repeat this? Do you hear the Siren in the background.

Oh, all right. Let me start over again. Sorry. It's my apartment. So I'll answer your first question or I'll answer the first part in why did I decide to structure it by organ system? And in all of my reading over really the past couple of decades about history of science and women's experience, The, one of the things that really struck me was how much our bodies are fragmented.

We all are seeking this holistic healthcare and this massive wellness industry, because we want to feel whole and well and seen and validated. And a lot of this made me think about, well, where did it all begin? And with the rise of medical science in the 19th century, that's really when you saw the rise of these medical specialties and experts in cardiology, gastroenterology, neurology, urology.

And for me, I wanted to go back and unpack the legacy that exists in our healthcare system today of these extraordinary specialties, but they've also fragmented our bodies in the process, in particular women's bodies, and many of our needs have been lost in the process. If you think about the field of urology, how many of us, me included, thought about women?

And the fact that we don't need to be jumping on a trampoline and peeing in our pants after we have a child, like that's not normal and it doesn't have to be, but yet there's this whole field that many women don't even know exists because he's accepted a certain level of suffering, accepted a certain sense of, well, this is my new normal when it doesn't have to be.

And I think that's part of the legacy that we've all inherited in terms of really what got me started. I always knew I wanted to write this book, but I didn't have. The courage to include the history, even though it was, it is my passion. I'm not a PhD in history of medicine. I'm not a professor at Harvard in history of science.

And I had a lot of imposter syndrome, but I stumbled upon this book, Nymphomania. And one of the cases in the book is about this man, Horatio Storer. Horatio Storer was 26 years old. He also went to Harvard med school. He had a penchant for sticking pokers up female cadavers vaginas. Because that's just what he thought was normal.

And there was this one case of Mrs. B. Mrs. B was married to an older man. And he wrote about this in a famous journal in which he titled her diagnosis, Nymphomania. Mrs. B. Was brought to Horatio store who became the founder of the Boston gynecologic society. And what was the problem? The problem was she wanted to have more sex with her husband who was older than he did.

He claimed that there is an obstruction somehow in her vagina when really clearly if you read this, he probably had erectile dysfunction. And in the course of this, Horatio store examines her pretty quite brutally and says, well, if, if, if, Your desire doesn't stop, you're going to have to put a chemical on your clitoris, replace your pillow with horse hair, I mean with needles, you're going to have to stop eating certain foods, not read romance novels, and if that doesn't work, we're going to send you to an asylum.

Your husband and I have agreed we're going to send you to an asylum. This was a little over a hundred years ago, it is not that long ago. And then I've read, well, Horatio Storr sent his own wife to an asylum at age 39 in Worcester, Massachusetts, where she died. This same man went on to found the Physicians Against Abortion Crusade.

And I thought, and this man is still lionized by certain groups in society today. And I thought, you know, I didn't know about this man. I didn't know about this history of the Boston Gynecologic Society. And I've taken care of thousands of women. What else don't I know? And once I started on that path, I just.

Did not stop with the rabbit holes. It became a complete obsession. What do we know about exercise? What do we know about cardiology? Why is heart disease the number one killer in women? And yet we've got all these women dying and not realizing their symptoms of a heart attack. And it just became absolutely compulsive.

Zibby: Wow. So when are, were you doing all this? You're seeing patients, you have your whole life where, when, when are you doing this? 

Elizabeth: So another pretty courageous move was there had never really been anybody in my hospital who'd worked part time in the type of department that I was in, and so it took a lot of courage for me to ask to cut back a little bit on my clinic time.

Take a massive pay cut and, and really commit to this project. So there were a lot of, I know you write about this too. There were a lot of four 30 in the morning wake ups, but you know, a lot of people asked me, was it hard to write this book? I think cancer is hard taking care of young women. Really, really, really sick is really, really, really hard.

Writing this book was the, one of the greatest joys of my life, if not the biggest intellectual joy of my life. 

Zibby: And how do you get through taking care of women, young women, and seeing all the sadness and things you can't maybe fix? 

Elizabeth: Yeah. So when I went into the field of oncology, my mom especially was really worried about me.

She said, you know, you have to be willing to be part of the process of caring for someone no matter the outcome. And you and I both know that there's only so much that we control about cancer. We've all been affected by it personally or, you know, physically. In in some greater way in our community, and I don't think I've fully comprehended that what it would be like to become a mother myself to become.

A daughter taking care of her parents and, you know, I take care of women of all stages of disease. And it is a huge privilege to be part of their lives, to hear their stories, to hear what they wish for themselves. But I don't think I fully grappled with what that would be like for myself. I'm a huge empath.

I don't have boundaries. I don't compartmentalize well, and I absorbed a lot of that over time. And I've had to really. And I'm still learning how to process all that. Writing this book was part of my own love affair with medicine again, with the whole person, with sometimes realizing that I've been in the valley of death a really, really long time and you have to see the sun too.

And that's what fills you with the courage to take care of the next patient, especially in the imperfect healthcare system where we exist today, where you might be compressed with time. You might not have the hours to. Find out that your patient's dog's name and everything that they love and everything that they want for themselves.

But what can you do with the time that you have? So I've had to learn a lot of new skills and I'm, I'm still learning, but that's part of why this book really saved me. Right before I wrote this book, one of my colleagues died at age 39, suddenly in, in my arms, really in the middle of clinic, he died of sudden death.

And it was right before I Really committed to writing this book, and sometimes you have these pivotal moments in your life where you also realize you're helping everybody else live. But what are you doing for your own life? And what will it take for you to thrive in it? And so as much as this book is about helping, you know, changing the legacy of women's health care personally, this was also a book that saved me.

Zibby: I'm so sorry that happened. Oh my gosh. What does that mean? Died by sudden death. 

Elizabeth: He, you know, in the interest of privacy, he, he, he was 39. He had an underlying condition that he did not know about, but he was walking towards me in distress and collapsed and everything was done to save his life. He had cardiac issues that were undiagnosed and that he would never have known, but it was horrible to do CPR on your friend too.

Oh my gosh. The awful, but I will tell you that right before he passed away, the last conversation, I confessed to him that I wanted to write this book. And he said, Elizabeth, you got to write the damn book. You have to write this book. And it was one of the last things he said to me next to saying that he liked my sneakers, which were leopard print.

And, you know, you think about, well, how do you, how do you honor someone's legacy? How do you do things that you feel like you were meant to do in this world? And that this is one of them. 

Zibby: Oh my gosh. Yeah. It's the ultimate, if not now, when, you know, kick in the pants type of thing and like the, in the most tragic of ways.


Elizabeth: Yeah. 

Zibby: Exactly. Oh, my gosh. I feel like I would be replaying that in my head all the time. That scene. Do you do that? You know? 

Elizabeth: Do I replay that scene over? I did for a long time, and the thing is, is that my clinic, so where I practiced my whole career, is the same place where he died. That never changed. So every day it's walking by that same place, but you try to do the best with, you know, the experiences that life throws you, I guess.

And he was a champion of women, a huge champion of women and of joy and of thriving and in patients loving him and helping them and And my hope is that this book helps change the stories for so many women and, and be part of a larger mission to improve the healthcare in this country, which I think is woefully lacking when, with regard to women's health.

Zibby: Do you feel that there is something we can do about it? I've been feeling very down lately about all the things that are not able to be changed, but have been identified as lacking. 

Elizabeth: Yeah. And I think that I, I didn't want to write a book that was just a Debbie Downer, but I really did want to say. You know, we can, we can fight for all these things today, but unless we know where it's come from, I really don't think we're going to, we're going to change the story all that much.

I think there's a couple of different things. First, as an individual woman, and I needed to do this myself. It requires a lot of thinking about what are the stories you've been told about your body yourself. Know that when we think about the experience of illness, two people can have the same diagnosis, but what they go through.

What their lives mean to them is so uniquely specific to who they are and all the things that go into the ineffable qualities of what it means to be an individual. And I think in that, my hope for women reading this book is that they think about the stories they've been told themselves, their experiences with the doctor, and And does this empower you just a little bit more to ask the questions you've always wanted to ask, to not feel shame about whatever it is you feel shame about, to get that second opinion, to have somebody go with you and say, you know what, I felt so dismissed about X, Y, and Z, something is not right.

Please explain to me what's going on. And if you don't know, help me find somebody who will. So there's individual story and then. As importantly, I think there's that collective sisterhood. So much about what we say about women is we cut each other down and we don't support each other. But I think that's ridiculous.

I think in writing this book, you see, I've seen how much women are our greatest hype party. And I think the more we can come together with the type of honesty and authenticity that you've shown so many people in your life, the more, the more. Yeah. My hope is that women will feel less alone and say, this is what I've been through.

These are the experiences that I've had. There's so much front facing in society with social media and certainly where we both live. But in reality, we are all simply human. And I think women need each other. And I think women need each other more now than ever. And as much as there seems to be support, I think there's always more that we can be doing.

Zibby: I recently did an event at my bookstore with Dr. Mary Claire Haver about menopause and women's health. And so after that, like, she's kind of opened my eyes to a lot of the things I didn't know about in terms of, you know, the second stage of life altogether. And that I feel like has been Just so obvious of an example of where the healthcare system is lacking and, you know, the, the data that we don't have and the dismissal of a bazillion symptoms and all of that.

Like, can you, can you speak to that for a minute and how like menopause is just, it's, and it's way more than just menopause. It's women's health basically age 30 and up.

Elizabeth: Yes. Yes. I think it's at every age. I think at every era we have been dismissed throughout history and in, in some measure it's getting better.

But, and when you talk about. Dr. Haver, I think it's fantastic that you have this groundswell of so many amazing doctors and Halle Berry talking about menopause and Maria Shriver and all her initiatives with Dr. Biden, the women's research initiative. But from my perspective, and I'd like to think I'm not that old.

I will tell you that I never learned about medicine, menopause, nothing in medical school, nothing. When it came to hormone replacement therapy, everything I heard was this would cause breast cancer. And this is my field. So only very, very recently are we starting to. Think about these issues. And it really reflects society though.

It's a perfect example about how society has historically neglected the aging woman. We become powerless. We are not as attractive. We are not as capable, but it's like damned. If you do damned, if you don't, if you have your period, you're too mercurial, you're too hormonal, you could never be president. And if you're menopausal, well, you're just too old.

So where is our chance to be our best? Never. Right. But I think that's just one example of how far we have to come, but yet the power of women coming together because there are so many doctors now that are really not just banging against a wall, but collectively banging a drum together and I think medicine and society is hearing it.

Zibby: I love that. It's amazing. This is going to sound like a stupid question. I know you are an amazing. 

Elizabeth: No. No questions. Come on. Not at all. Ask me anything. This is your right hand. This is your left hand. What do you got? 

Zibby: You are like an amazing oncologist. What makes, how are you an amazing oncologist? How does one, how is one oncologist better than another?

Is it the information? Is it the? Yeah. bedside manner? Is it, how do you get better results than the next oncologist? How does that happen? Like, what does it mean? 

Elizabeth: I think there's no perfect oncologist at all. There's different types of oncologists for different types of people. And sometimes you need a team of types of doctors to take care of you.

Just like you don't have that one friend, or maybe we do, but we, we all need a team. So I think. I don't know, I can't tell you what makes me good for everybody else, but I can tell you that when I thought about what field of medicine did I want to go into, like I love sports medicine, I would be a terrible orthopedic surgeon because I'd be like, Oh, it looks good enough.

Like I'm a little messy. It wouldn't have worked. But I thought when shit hits the fan, that's where I'm good. I'm really good in that existential crisis, and I'm, I'm pretty good at biology and chemistry and all those things, but how it all comes together. That's, that's, I think, where my strength is. I didn't anticipate the toll it would take on myself, but that's where I'm good.

So I think I am empathic. I think I really, really care. And I think the secret is you don't have to be a savant in biology to be a good oncologist, but you have to know who are the people that have that skill and to be humble enough to say, I have this really challenging case to somebody in the lab, like who may never talk to a person, but can you, can you look at this sample?

Can you tell me what you think about it? I think it's the humility to know what you know really well, what you do really well, and know what you don't know well, and to never think that you can do it all for every patient, and to use the power of the people around you to be even better for your patients.

And I think it's the humility, I think it's the compassion, and I think it's the willingness to never give up, no matter the outcome. And a lot of, The sadness of what I do is also being present for extreme suffering, and that includes the palliative care of medicine, and I don't know that we do that so well in our society because we, we give so much credit to the first breath of life, less so to the last.

Zibby: Hmm. 

Elizabeth: So for me, I think it's part of a willingness to be present no matter what. 

Zibby: And how do you feel now that the book has come out and been such a wild success? 

Elizabeth: It's been life changing. It's been life changing. So a little piece of news is I've only had one job and that's, well, one professional job as a doctor and that's working at Memorial Sloan Kettering Cancer Center, which has been an incredible experience.

When you talk about working with experts and excellence, that's That's where it has been for me, and I'm so proud to have worked there, but I'm really excited to also share that as a result of this book, I'm moving to NYU to help them build a women's health program there really devoted to tackling the issues constructively that I talk about in the book and I'll continue to see breast cancer patients there.

Zibby: That's amazing. Well, I'm actually kind of sad about that because I'm on the board of Mount Sinai. So I feel like I wish they had, uh, stepped in and, you know, snatched you up if you were leaving. But anyway, that's great. Good for you. That's really amazing. Congratulations. Do you see more books in your future?

Elizabeth: Oh, what a gift it would be. I have some ideas for the next book, but from an intellectual standpoint, nothing has been a greater joy. I'm sure you know how hard it is to write a book, but how, what an incredible life fulfilling process it can be to have that time. And I would love, I would love the opportunity to write another book.

Zibby: And what is advice to aspiring authors that you can share? 

Elizabeth: Be brave. Go for it. Don't try to do everything all on your own. Ask for help. I was lucky enough to have a great agent, and I have a great publisher, Harper Collins, and uh, today's the first day of the rest of your life. Put pen to paper. 

Zibby: I love it.

Amazing. Dr. Komen, thank you so much. Thank you for coming on. Thank you for advocating for women's health, and there is, I mean, there's nothing more important. It's like, this is it. This is all we have is our bodies. So thank you. 

Elizabeth: Thank you so much. I really appreciate your having me. 

Zibby: Of course. Thank you.

Elizabeth Comen, ALL IN HER HEAD

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