Beyond the Dome: Suzanne Koven

Suzanne Koven, primary care physician and writer-in-residence, Massachusetts General Hospital

Published in Aequanimitas - Aequanimitas Fall 2022

Suzanne Koven (Osler intern and resident, 1986–1989, Janeway; assistant chief of service, Thayer, 1989–1990) grew up in New York City and earned a bachelor’s degree in English literature from Yale University and a medical degree from The Johns Hopkins University, as well as a Master of Fine Arts degree in nonfiction from Bennington College. After completing her assistant chief of service ACS year, Koven joined the faculty of Harvard Medical School. She practiced internal medicine for more than 30 years at Massachusetts General Hospital, until her recent clinical retirement.

She remains at Massachusetts General as the hospital’s inaugural writer-in-residence. In that role, she leads reading and writing workshops and mentors health care workers interested in narrative writing. Her essays, blogs and reviews have appeared in The Boston Globe and The New England Journal of Medicine, among other publications, and at Koven’s monthly Boston Globe column “In Practice” won the Will Solimene Award for Excellence in Medical Writing from the American Medical Writers Association in 2012.

Koven also co-directs the Media and Medicine certificate program at Harvard Medical School. Her essay collection, Letter to a Young Female Physician: Notes from a Medical Life, published in 2021, features musings on Koven’s experiences in medical training and practice, as well as personal struggles with self-doubt, sexism, and caring for ill family members while caring for patients. She lives near Boston with her husband, Carlo Buonomo (Osler intern, 1984–1985), a Johns Hopkins Hospital radiology house staff member from 1986-1990. Buonomo also practiced radiology at Boston Children’s Hospital, and retired in 2018. They have three children and two grandchildren.

When did you know you wanted to practice internal medicine?

I’d actually matched in neurology at Hopkins. A few months into my internship, I realized that what I liked most was the clinic, especially seeing people as outpatients after they’d been discharged from the hospital. One epiphany involved the late Henry Seidel, a beloved pediatrician and then dean of student affairs at the school of medicine. When I was thinking about staying in medicine and not becoming a neurologist, l called him and asked if I could still get his advice, even though I was no longer a medical student. He said, “Of course.” When we met, he asked me what I loved most about medicine. I told him that what I really loved most was building long-term relationships with patients and that I probably should be a primary care doctor. He advised to go home, look in the mirror and ask myself if I could live without that. I decided I couldn’t, and for 32 years, I was, indeed, a very happy primary care doctor. Those interactions validated for me the power of knowing people’s stories — a very important part of the therapeutic relationship.

Can you share a standout experience from your time on the Johns Hopkins wards?

On July 1, 1986, my first night on call as an Osler intern, a man was admitted with diabetic ketoacidosis, and it was my job to draw his blood every two hours and chart the course of his progress. He was a very kind man, who clearly — in retrospect — knew what a novice I was. He kept cheering me on. The next morning, when I looked in on him, he told me, “I think you’re really getting the hang of this!” The encounter served as a reminder that the difference between doctors and patients is not as great as we might imagine. He recognized my humanity at a moment when I was feeling insecure. I never forgot it.

Who were your role models?

First and foremost among them was David Hellmann. He was always — and, to this day, remains — a great supporter and role model. Another strong role model was the late pulmonologist Carol Johns, one of the few female doctors to have trained in the 1950s at Hopkins. She was beloved and a wonderful clinician. The revered, late Philip Tumulty was so humane and taught us this gem: “See in the face of every patient the face of someone you love.”

Another role model was John Stobo, now executive vice president, University of California Health, who selected me to be an assistant chief of service, at a time when only two women had ever served in that role — and never one who had a baby. Finally, I had deep respect for the late Victor McKusick. His love of medicine, bedside teaching and the history of medicine very much influenced me.

How has your Johns Hopkins Hospital training continued to inform you?

My Hopkins training not only molded me as a clinician but also as a writer, a teacher and as a person. I feel lucky to have trained in a program that valued excellence and compassion, tradition and innovation.

You write about the struggles some women physicians encountered during the 1980s, including sexism and harassment. To what extent have things improved for women doctors since then?

The good news is that there are more of us at the student, trainee and junior faculty level. But there is still gender inequity in medicine. Women earn lower salaries, are less likely to be promoted, are more likely to be harassed, are more likely to spend time on child care and domestic duties. I’m very interested in pregnancy during residency. People who wish to become pregnant in residency face a very difficult choice. They risk pregnancy complications and miscarriage and have high rates of infertility, if they delay conception. In addition, if they lose training time during pregnancy, they may jeopardize their careers. Policymakers are working to change this, but, in 2022, women remain unacceptably disadvantaged regarding pregnancy and residency.

You were an English major at Yale. When did you know you needed to pursue narrative medicine professionally?

There wasn’t a moment. When I was younger, I sort of thought that there was a fork in the road, where you decide whether to be a science or a humanities person. It wasn’t until my 40s that I realized how much I still liked writing. So, I took English and adult ed courses and wrote for fun, and later earned an MFA in nonfiction writing. And it wasn’t until my 50s that I became a newspaper columnist and essayist. I like to tell health care workers interested in writing that it’s never too late.