In celebration of Women’s History Month, this month’s narratives are dedicated to highlighting the voices of women. Each story is unique, intimate, and powerful. Readers, please come open-minded and ready to engage with the following stories. More importantly, be ready to interface with an intimate space and allow yourself to step inside someone else’s life. The following is the narrative of Mariah Johnson, a second-year medical student at KUMC. Enjoy.
Note: The fourth interview question is credited to the NYT article “The 36 Questions that Lead to Love.” The interview has been condensed for length and clarity.
Can you please give me a one minute rundown of your life?
I was born in Wichita, Kansas. When I was a kid, my family moved (back) to Oklahoma, which is where I ultimately graduated high school. I was raised by my grandmother, with whom I’m really close, and she had a lot of help from my aunt. They were my primary influences growing up, although I also have a good relationship with my mother. My father recently passed away. I went to Howard University (affectionately known as “The Hilltop” or “The Mecca”) in Washington D.C. for undergrad, and marched alto saxophone in the band there. That is also where I met my husband, Steven. Med school brought me back to Kansas. I have several siblings, a few nieces and a nephew whom I love dearly.
If you could choose only one word to describe yourself what word would it be and why?
Two words come to mind. Pragmatic is probably what comes to the forefront and maybe intuitive, for better or worse, comes second. Pragmatic describes me pretty well overall, I think.
Can you please expand on that?
I can think of one really specific example — this is a wonky policy related thing — when there was conversation where I worked at the time about sequestration before the federal across the board budget cuts first went into effect several years ago. The thought was that if Congress was faced with forcing itself to cut all line items, then both sides of the issue would come to the table and make the hard decisions, pass out a budget compromise and avert what was considered at the time a deeply unpalatable plan. But this was the beginning of what has turned into a decade of intransigence, and given the politics, I didn’t see anyone really compromising in that situation. And they didn’t. So, I tend to be a little bit pragmatic and try to look at the reality of the situation, whether or not the outcome is ultimately something I agree with, I kind of see things for what they are.
Given the choice of anyone in the world who would you want as a dinner guest?
So this is a difficult one because I don’t really have a whole lot of idols. I think people are people ultimately. But I think I came down to one [individual] and it may sound a little bit typical — that’s Atul Gawande.
I really appreciate the books that he’s written like Complications, Checklist Manifesto, etc. but [I] also identify with his career trajectory, at least up to my point of being in med school. After he finished undergrad, he worked in politics for a few years, specifically on health policy and at the Department of Health and Human Services before (and after) going to med school. And so now he has partnered with private industry to develop a model nonprofit healthcare company with the goal as I understand it to provide a better health care product. I use words like product, which are the antithesis of what I think health care systems should be. But the point being that he is someone who encompasses characteristics I appreciate and identify with — from both a policy and clinical perspective — [like how to] individually provide better clinical care that ultimately results in better patient outcomes, but then also from the broad systems perspective with what he’s doing now. I think it would make for a compelling conversation. And [he is] an example of how you can transform thoughts and ideals into measurable change. I’m looking forward to seeing what comes of it.
What is your favorite hobby?
It used to be reading but I have less time to read leisurely. Although, I did recently read this historical fiction novel, [called] Homegoing by Yaa Gyasi, that was really, really good. I highly recommend it. But I think [my favorite hobby now is] traveling. My husband and I try to travel internationally together at least once a year. We enjoy gaining insight and a bit of perspective on different cultures, how that influences how people live their lives and experience the world.
What is a topic you really care about?
Politics and policy in general. So many policies have historically, and of course do now, impact communities and individuals. There is a common viewpoint that all government is bureaucracy. I have this mindset, although not quite of the Citizens United variety, that institutions are ultimately made up of people – of individuals – and the policies that are implemented are created by people with biases, and they do impact, and at times harm, communities and individual lives.
I’m interested in how all those things work together. I reflect on the long, and violent, history of our country on issues from race, to education, to health care and women’s reproductive rights, to who qualifies as a person with rights under our Constitution. So much is shaped by how people with power (and money) come together and codify their viewpoints based on what they see as benefiting their constituency and interests. The generational impacts and human cost of those decisions are incredible, and inescapable. I feel them every time I walk down the street. So I think it is imperative to engage on those topics and to strive toward equity in political representation, and in the development and application of policy.
What is your journey into medicine?
This will be a longer answer, but it does give more context to some of my earlier responses. My interest in health care came really early, and it was influenced by predominantly two things. First were the family members who worked in healthcare, My grandmother is a retired Registered Nurse, who also had sisters who were nurses. My mother is in nursing now, as are several cousins. Another family member is a dentist. So there were always a lot of folks around me, engaged in one way or another, in the healthcare system.
So that was one half of it and then the other half was my personal experience in healthcare. I have allergy induced asthma and, particularly as a kid, I was sick often, along with two of my siblings. We were frustrated at times, my grandmother especially, by the feeling of not quite being heard in the management of our health. It was often amazing to see how the tone and approach of health care providers changed when she mentioned that she was a nurse herself. My eyes were wide open to what happens when your physicians, and people who are in positions of power in general, don’t share your perspective, or worse, make assumptions about who you are. I think that [experience] has taken a sharper focus as an adult. One of my sisters was diagnosed with lupus several years ago. To hear the challenges she has with accessing care and feeling supported by her medical team continue to be motivating factors for me in medicine overall.
But the crystallizing moment, in terms of deciding that becoming a physician was my goal, was during a follow up visit when I was really young. I had been seen by the nurse, and a woman came in and started asking a lot of the questions that we had already answered. I stopped her and said “We’ve answered all these questions. When is the doctor coming in?” She and my grandmother, I just remember them pausing and laughing. My grandmother then said “She is the doctor!” It was the first time I can remember having a woman physician and it was like a paradigm shift – an early challenge to my own assumptions. Prior to that I clearly had a very binary [mentality]: women are nurses, men are doctors. It’s what I’d seen, so I thought that’s just what it was. It had never occurred to me that there was something else that was an option.
Any way, years later I found myself at Howard University. I majored in biology but by the time I was in my senior year, I wasn’t ready to apply for med school. So I pursued policy — health policy. I was part of Barbara Jordan Health Policy Scholars Program through the Kaiser Family Foundation. (Speaking of another person who would be at my dinner party, if that included people who are no longer living, [it] would be Barbara Jordan, who was an amazing policy maker and orator from Texas).
Through that program, I was placed in Dr. Donna Christian-Christensen’s office. She is a former Member of Congress from the Virgin Islands. She was actually the first woman physician ever to win a congressional election and was instrumental in shaping the Patient Protection and Affordable Care Act. I was placed in her office as a health policy scholar. This was the summer after that bill passed, and the beginning of the implementation phase. Congress and the White House were figuring out how they were going to make this huge bill work. It was an instructive and formative time for me. I learned a lot about Congress and how bills really get drafted, voted on, and implemented.
It led to my becoming a full-time staffer for Congresswoman Barbara Lee, who is another formidable policy maker. She’s a leader on issues ranging from HIV, women’s reproductive health rights and health disparities, poverty, global peace. I can go on and on. She has very strong positions, in my opinion, on a lot of critical issues that impact people. As a member of the Budget and Appropriations Committees, she is also in a position to influence policy and funding on those issues. It was a privilege of mine to be able to work on many of initiatives aimed at strengthening the social fabric, and reinforced the importance of representative government.
After four years on the Hill, I began working at NASTAD, a nonprofit organization that represents Centers for Disease Control and Prevention-funded HIV and hepatitis programs. There, my primary role was working to increase federal public health funding to address the hepatitis C virus nationally. Part of that work was to help to bring what I think is still a pretty marginalized and often discriminated upon community of people to Congress to tell their stories, but also to support their efforts to improve the response locally as well. Much of that was a coordinating position, but the end goal was improving the public health response across the government to hepatitis C, which is ultimately one of the deadliest viruses that is still quite overlooked in terms of federal priorities, despite being curable.
My experiences there really solidified the fact that the skill set and the ability to provide what I hope to be culturally competent care to individuals was something that I wanted to pursue definitively. I think my time in all of those spaces, hopefully, will help me to influence healthcare on a systemic level as well. We’ll see.
What are your future hopes in medicine?
I’ve been a little bit surprised by where my interests have taken me since I’ve started medical school. I’ve continued to work and cultivate my interest in liver disease broadly, and viral hepatitis specifically as a Clendening fellow. I have been open to internal medicine from the beginning. I wasn’t quite sure if that would be in primary care or pulmonary/critical care. I’ve recently circled in on critical care medicine. But trauma surgery has captured my attention much more than I thought surgery of any kind would from the outset. I blame the SER weeks and my experiences in Guatemala through KUMCIO for that. A big question that remains is how I reconcile my clinical interests with my [interests in] public health and policy, and hopes for systemic change. I haven’t quite figured that out.
From a ‘what I hope for medicine overall’ is for [medicine] to be a little less about the bottom line and a little bit more altruistic and about people. I get that capitalism is king. That’s kind of how our system is set up, but I think health should be an exception to that. I didn’t choose to be an asthmatic. My sister didn’t choose to have lupus. I think when we’re making healthcare decisions based on primarily on someone’s ability to afford care or not, it’s really deeply problematic. I believe the long game is that we’re heading towards a more empathetic health care system. My hope is that we will get there sooner, rather than later, because lives hang in the balance. [My stance is] not necessarily the argument that’s going to win over pricing negotiations and stakeholders and investors. We’re an instant gratification society and the long term benefits of some of these investments are lost in the debate.
Would you mind sharing some of your ideas about how you can reconcile your interest in policy and politics with your interest in medicine?
One day, after I left the Hill I was in a meeting with Senate staff. We were discussing some of the issues with the response to HCV. The staffer stopped my colleague and I and asked, “So are you a physician? Are you a physician?” They appreciated what we had to say, but they wanted to hear directly from the physicians treating this population. That was one of those wake-up moments for me. It highlights an opportunity lost in one sense – I wasn’t then in a position to provide the perspective that was being sought. However, at a bare minimum it represents one way I intend to engage on behalf of my patients, regardless of specialty.
There are many physicians in positions of leadership at public health agencies who are able to continue to practice medicine while also overseeing large programs, and others who act in an advisory role. Those opportunities are appealing to me. I had the opportunity for a couple of days over the summer to work with a small group of patients with liver disease to brainstorm what a strategy could look like to educate stakeholders (patients, policy makers, physicians) on a potential new medication. Physicians were leaders in that discussion as well and it was a refreshing space to be in. But honestly, as I mentioned earlier, I see the impact people like Dr. Gawande has had, and if his next project is successful, the potentially transformative nature of that work. It’s exciting.
Something that everyone can do though – you don’t have to go and testify before Congress, you don’t have to go to Topeka and testify, you don’t have to draft a bill, or write a letter, if that’s not your thing – you can show up and vote in every election. Vote. I was shocked to see some data recently that said physicians vote at a lower rate than every other professional industry. Given the issues that impact medicine and patients, [the low physician voting rate] is a big issue.
Something that MSA and SGC are looking at for students is how to make it easier for students to be able to show up and vote on election day. I think that’s really important and hopefully the administration and faculty and students can come to a new understanding on that, but I think just moving forward in our careers, at the very minimum, performing our civic duty is something everyone could do.
The last few questions for March’s narrative address the topic of womanhood. First, do you identify as a woman and if so how strongly do adhere to the identification? In other words, if I were to ask you, “How do you identify yourself?” will the identity of being a woman come to mind in the forefront or later?
This is a really interesting question, and one that at different times gets debated pretty hotly – in terms of which identity should be at the forefront. I identify as a black woman, who is also a member of the Muscogee Creek Nation on my maternal side. A woman of color. My lived experience has reinforced my identity.
What does being a woman mean to you and how has your identity as a women shaped or impacted your life experience?
Overall I believe my identity as a person of color equally impacted my life experience. I felt that acutely while in grade school, and it was one of the reasons I sought out Howard University for my college experience. It is also occasionally felt professionally. I am more often the only person of color in a room than the only woman in a room. I am aware of the responsibility that brings, and the shoulders upon which I stand.
I grew up in a household with prescribed gender roles or expectations. My grandmother always encouraged us all to shoot for the stars. She’s a huge advocate for education. She supported us and all of our extracurricular activities and everything. I never noticed any gender differences as it pertained to that. There were differences in the types of chores you were expected to do, the messages you received about relationships, family structure, and future responsibilities as a wife and a mother. There were very clear messages that we received as far as what those expectations were, and they came at a young age. Even as an adult, and not just among our families, I have at times felt pressure to explain our decision to delay children. That happens much less frequently now, but the pressure somewhat remains. The restrictiveness of that construct made me a bit resentful at times, a feeling I have now mostly overcome.
In addition to being raised by strong women, I’ve been blessed to work with amazing professional women, some of whom are mothers and also fulfill what I would loosely describe as a more traditional role in their households, but many who completely break the mold. I have friends and colleagues who are business owners and stay-at-home mothers, medical students, consultants, teachers, single mothers. These women are diverse in every sense of the word, I think it now goes without saying. They prove every day that women are as qualified to be in positions of power and influence as men. We can govern effectively, treat patients, run businesses, be surgeons, switch careers and start again from the beginning. And, if we choose, build families. It’s been a very rich experience.
Med Intima 