“Reproductive health is more than the biological clock” - Dr. Pam Oliver
Dr. Pam Oliver is an accomplished obgyn, public health advocate and corporate executive of Novant Health. She has dedicated her professional life to women’s health and in the process discovered her own talent as a leader and public health advocate, learning how to lead with confidence and setting clear boundaries between work and family life. Building on years of experience, Dr. Oliver uncovers the inconvenient truth about racial injustices in the maternal and infant healthcare systems and shares key health advice she wants all women to know.
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TRANSCRIPT EP1 - Dr. PAM OLIVER
This text has been edited for clarity. Please don’t quote without listening to the recorded interview.
00:02 PORTIA: Hey Pam!.
00:06 One of the things I'm really interested in, particularly when I talk to very successful women, is your definition of success. If you have one, what is it and how did you come to that?
00:24 PAM: I don't think I have a definition that I would write down that is clear and succinct and organized in any way. I'd say personally my idea of success and definition has evolved over time.
00:38 Forever I've thought about the big picture, what are the big things and accomplishments type of things. That's still important and that's the long-term success. For me that's about legacy and impact and it takes a while to see that sort of success. It's building and it's constantly evolving but I think as I've gotten older, and maybe it's becoming a mom or just busy and life changes, I start to see day-to-day small successes as just as important. It's those challenging things. Did my kids get up and get to school? Did my youngest son actually put his shoes on right?
01:20 POR: I can relate to that.
01:23 PAM: What are those little things that you can celebrate because it takes a lot of energy and time to accomplish. I saw a TED talk by this general who really hit home with it and he said “if you do nothing else make your bed in the morning”.
01:45 POR: I love that book! I got the book and it's so true, it's those small things.
01:50 PAM: What he gets home is if you do nothing else make sure you get in the habit of making your bed because if you don't accomplish anything else during the day you've accomplished that. So you already set your day up correctly by having that small accomplishment. That may not necessarily make some people feel successful but sometimes I think as a working professional it's easy to get bogged down and everything….
02:14 POR: Yeah so true.
02:17 PAM: ….overwhelmed and sometimes I just have to celebrate that I set a goal. I wanted to do something, I got it done. Not necessarily that it was the first time it ever got done or that I was going to win an award for it but I just accomplished it.
02:29 I kind of think short term and long term and like I said long term for me it's really about legacy and impact, how it all builds together because you can do a lot but what does it really mean and what is it accomplishing for me?
02:46 POR: I think it's so interesting that you talk about impact because when my co-author Jennifer Martino and I were writing and researching Kick Some Glass we interviewed so many successful professional women. That was one of the common themes that came out of those interviews, about wanting to make an impact and in fact I was surprised that most of them had said they'd never set out to become an executive vice president or a CEO or “fill in the blank”. It was all about understanding their larger purpose and being able to direct their energies towards making an impact so what you're saying really resonates for me very deeply.
03:28 I'm curious, you are an obgyn with over two decades of experience and you are also now a corporate executive. I wonder if you could just take me through a little bit around your career journey. Was that something you had always intended? Can you pinpoint a particular point in your life where you said “I want to be a physician and I think I'll be an obgyn”? Maybe just talk a little bit about your career trajectory?
04:01 PAM: When I was in high school I was always really good at math and so I thought I was going to be an accountant or do something with numbers. I also like biology. Science came naturally, I understood it. When I was in 10th grade my father was diagnosed with leukemia and we were there with him over a two-year battle with leukemia before losing him right after I graduated from high school. I think it was a lot of seeing him and his inner interactions with the health care team that really moved me to want to consider medicine as a career. The idea of helping others really hit home.
04:49 I come from a family of caregivers. Very much what's in the soil and what's in the blood for our family is taking care of others in a selfless way. It's all about community and I think that really was impactful for me to make this choice about medicine. I didn't know what kind of medicine I wanted to do and when I got to medical school we got to explore various rotations and I was with an obgyn and I really love women's health. There's something about taking care of women that to me was validating. I didn't know that I was going to like it but I loved surgery and the feeling of accomplishment and obgyn allows you to be a surgeon. You've got a little bit of continuity with your patients in the office. You see them through adolescence and menopause so you have a little bit of everything and I love that variety.
05:58 Once I got to medical school it just became one of those things that I really started to want to do more so I decided to do a master's of public health for maternal and child health. I love my engagement with my patients when I'm one-on-one but I would say even very early I always thought about the world more globally. What is that bigger impact? We keep coming back to that word...
06:18 POR: Right.
06:20 PAM: ...can I be involved with and change the lives of women or patients on a larger scale from a public health perspective even as I'm having that one-on-one impact in day-to-day practice?
06:36 POR: It sounds like early on you very much had a calling. I love what you say about coming from a family of caregivers and it sounds like finding a connection with women's health.
06:52 I actually want to come back to that in a moment because you're doing some really interesting work in that area, and now you've got another role. You are still seeing patients as an obgyn but you're also a corporate executive for Novant Health. So talk to me a little bit about how that happened and in the process of taking on this very senior executive role what was the thought process about what you were hoping to accomplish?
07:31 PAM: I feel like I've built my leadership skills and foundations over time. Even in undergrad I was part of a leadership development program but leadership comes in many forms and so I didn't have this path, I didn't aim to be an executive in health care. That was not my route. I really wanted to think about how to practice medicine. I thought at some point maybe I'd do global medicine for a public health agency, but I wanted to practice and use my skills. About three to four years into practice I was the lead physician for our practice, which was helping coordinate at a local level, nothing huge. One of the leaders for our group who actually had the position that I'm in now, they were posting a position for a physician leader in the Winston-Salem area. He asked me, he said “hey did you hear about this and what do you think about it? I think you would be good for this” and this is classic. I think women do this all the time. I wasn't thinking about this...
08:33 POR: You didn't feel ready for a position like that?
08:38 PAM: I wasn't thinking about it and I wasn't thinking that this is what I want to do. I actually told him “well you know I'm more of a public health person. I don't know if I'm doing corporate health” and he said “I think some of the best leaders are reluctant leaders and if you look at where healthcare is going there's so much opportunity for you to do that”. Population health, which is evolving in what we call value-based care now, it's about taking care of the whole person and community health as much as anything else. It totally fits in with everything but I couldn't see it then. I was practicing, I had young kids, I wasn't really thinking about it. I hadn't planned this journey and thinking that this was step one, it wasn't predictable.
09:29 I took a chance and said “okay”. I interviewed for it, I got it and over the next few years I slowly took on roles that advanced me at different levels within the company. Even when our CEO called me to talk about this position that was available, which is my current role, and would put me as president of our entire medical group for our health system. I'd be over all of our 600 clinics and 2 500 physicians and APPs, a big thing, and when he called me and wanted to know what I wanted to do with my life, once again I wasn't ready. The conversation evolved and what he really spoke to is that he needed a different type of leadership and it was very mission focused, a change for where medicine was going and that he had complete faith that I could be, that person. It was a leap. I would say that like many women, we read about this.
10:47 POR: We've written about it!
10:49 PAM: I fell in all those holes of “well I'm not ready, give me a few years” and you know there were all these men who really had been in leadership much longer than me that I almost was like “well what about them?” you know.
11:07 I will say that God looked out for me. They say God looks out for babies and fools and he looked out for me. Let me screw it up and walked with me as I decided to take this big leap. I didn't set out to have the title. I had to get comfortable and I talked to my husband about this and what it would mean for our family. I also had to go into it with the mindset that when we have a certain level of comfort and practice I can control my practice and there's a, outside of a pandemic, stability with medical practice and the corporate world.
11:41 POR: Sure.
11:46 PAM: You feel a little bit exposed “what if there are big changes in leadership that can affect my job?” or whether I'm doing a good job or not. I had to get comfortable with that and also with the fact that ultimately if I was going to do this I had to do it my way. Make the decisions and do the things that I thought were best. I wasn't going to be like “yes man, yes woman” for things. I always had to be comfortable with the fact that at some point in the future I might have to make a change. That I'd be okay with that.
12:24 POR: I think there's so many powerful things in what you've just said Pam. One thing I hear, and I've heard this consistently with really successful women and I think it should be comforting to listeners, is that when you see these successful people out there they don't always have it all figured out. You're kind of just feeling your way along in the dark and if you're lucky if you've got some mentors out there, some sponsors. It sounds like you had a sponsor who said “hey you ought to go for it” and sometimes they believe in us more than we believe in ourselves. But the other thing that I hear that resonates, and I think would resonate a lot with our listeners, is being comfortable with being uncomfortable.
13:12 PAM: Exactly!
13:17 POR: Most of the ”big jobs” out there you're never a hundred percent ready for until you're in it. I've heard this over and over again and whenever I'm coaching women who have opportunities to say exactly what you said “just leap, you will figure it out”. The other piece that I think is so important about what you've just said is “you do it your way because we can't be anything other than who we are”. And if you're going to screw it up, screw it up because you did it your way and not because you were trying to be somebody else.
13:55 PAM: The great fallacy is that for some reason men are always prepared for these roles. I'm in the room with lots of men at various points and one or two colleagues of mine we're always the only females in the room. I'm the only person of color in a room and sometimes it's... I'm an introvert, not extremely but to a point where I think about things. I don't vomit all my ideas out onto the table and sometimes when you hear this conversation and you're thinking “oh I don't know anything about this” so I don't know how to possibly lead in this space. It can be a little bit daunting and then you realize that when you get into deeper conversations with the men leaders who we may be engaging with it's not that they have all the answers. They just aren't afraid.
14:47 POR: That's exactly right.
14:49 PAM: They're not afraid to speak up.
14:50 POR: They're less inhibited and they don't worry about being wrong.
14:54 PAM: Right, they don't and so I had to get really comfortable with failure. I'm not a perfectionist but there's a healthy fear of failure. I had to get comfortable with the 80/20 rule to get it mostly there because otherwise I paralyze myself with consensus building and trying to make sure that I'm pleasing everyone. That has been probably one of the most important things for me because working with physicians in general, a lot of us feel like we know what we're doing, we're the experts. I don't need anyone telling me what to do and I'm not trying to tell people what to do but you have such polar extremes of what people want and need and are comfortable with. There's no one solution for everyone and I had to make sure that in the end I was aligned on the big picture. At first I thought I could make decisions that were going to be the right decision. Then I realized there's no right decision, there's a best decision for the moment and then we will evolve it. We'll fix things as they come up and roll with the punches basically.
16:09 POR: That resonates for me as well as I work for a very large engineering firm and there are two women on the executive team in our business. I am not an engineer but I'm surrounded by engineers and I remember my first couple of months like “oh my, it's precision technology and its climate technology” and I remember thinking “why am I here? I'm never going to understand this”. A similar journey in terms of thinking “I have a point of view”. Especially the business strategy is changing and that's why they hired me because they're trying to be less of an equipment company and more of a services company and that's my expertise from a marketing standpoint. You find these points where “you know what, it's the 80 procent or sometimes it’s even the minimum viable, right?”
17:04 POR: Luckily I don't have to deal with people's lives but I do think that's a lesson so many women wish they understood earlier in life. Perhaps they would have taken more risks if they realized that nobody's got the answer to this sort of thing called life.
17:27 I want to pivot a little bit because as I'm listening to you talk and listening to the journey, you also have a very busy home life. Your husband is a dentist with his own practice, you've got teenaged twins and an elementary school student and a dog. So I have to ask the question because I get asked all the time and I think women are grappling with if they can I have this big job, and big is relative of course, but “can I have a big job and have a family and be successful and not feel like I'm running around like a chicken with my head cut off?”. So I'm wondering if you have found any sort of, I'm not going to use the work life balance, let's call it integration. Have you found any integration in terms of managing the demands of the job plus the demands of a very active young family?
18:30 PAM: I will acknowledge upfront that it's difficult and that if anyone thinks you can do it and it's seamless, like a fairy tale or whatever's in the movies, you're just fooling yourself. It's okay to struggle through it. It takes a village and so I leaned very much on my support. I had my twins right as I was joining our practice and when they were 11 weeks old I went back to work and I was on call 36 hours working, coming home exhausted.
19:11 POR: So you were pumping while you were delivering other peoples’ babies?
19:15 PAM: Pumping in my call room between and storing them, I mean there's just all these things. My mother was a lifesaver. My mother came and she was going to stay with us for a couple of weeks but realized how hard it was and ended up staying for six months. We knew that we were going to need extra help. There's no way we could figure out daycare drop offs with our schedules the way they were so we did end up hiring a nanny. From the very beginning I think expectations are huge, right?
19:46 POR: Yeah, sure.
19:49 PAM: My husband understands my role. He understood what he was getting into when he married an obgyn who’s going to be on call.
19:56 POR: Because he doesn't have calls right? His practice is probably nine to five or eight to six or whatever.
20:06 PAM: But he's busy. He runs the administrative portions of his practice so we both have a stressful job and we had to align very early. We couldn't do it alone so we decided to get help with the things that didn't add value to our lives or our relationship with our kids. It could be outsourced. So if it came to cleaning things, lawn care, it could be outsourced and even when it came to nannies or sitters and au pairs over the year. The very important stuff so going to the school plays.
20:40 POR: Sure.
20:41 PAM: You know big days, that's stuff I needed to do. We would try to weave in dropping off or picking up because it's special for them. Did I feel like I needed to physically drive my kid to school every day? I didn't and I still don't. I think that's one of those sacrifices for me that I felt was a good trade-off. I did a leadership program several years ago that I thought was phenomenal in pointing out for me the importance of being present. I could get up in the morning and work hard during the day, come home and I was very intentional about turning off all the work and being present with my kids and family for a period of time. Whether it was while we ate dinner until they went to bed and savor those moments. We take walks now in the evenings or when my kids were little we were reading books and had a bedtime routine. Enjoying those moments and being present and not letting work spill over into that.
21:52 There are definitely times when I have to answer an email or a call when I come in so I don't think that every day is perfect but trying to make sure I validated being present with them when I could so I didn't feel like I was always out and absent. And the other thing is I'm lucky I have a husband who understands what I do and is very supportive. He never pushed for or put this pressure on me being a traditional housewife of any sort or having that role. My mom was a stay-at-home mom and she will make jokes sometimes about “Pam you're not gonna make Mark dinner” or “you're not gonna have warm food on the table when he gets home” because it's not uncommon for me to call him and we're coordinating what we're gonna pick up for dinner. He actually told her one time “okay miss Austin I got this, I don't need help, we're good. She does what she does, I do what I do, and we're okay, you don't need to worry about that”. That's been tremendous because I do feel that I’ve seen patients of mine or colleagues who even though they want to do more, their partner, or their spouse, still has this expectation of them that may be a little bit more than what is reasonable. You can drown in that and it's okay to say “I just can't”. I've told [my husband] before “this is a bad week, I'm not cooking so let's just go ahead and figure this out”. Just being up front. It's not a weakness, it's just reality, there's only so much that any one person can do. I have great weeks where I feel like work is going smoothly and I get a lot more done at home and then I have weeks where I feel like I just don't have anything left in the tank and so it's about balancing it out over time.
23:50 POR: It took me a while to grasp that too. We were talking before we got started about, we're recording this during the pandemic and I haven't been on an airplane in eight months, there were weeks where I would be traveling every single week or every other week. I always did try to make it home. To your point, the drop-off has never been something that I have a huge desire to do. I think the kids like it when I do it but if you're commuting an hour each way you've got to get on the road early but the one thing I always wanted to make sure is that I made the games, the basketball games. I would move heaven and earth to get to a game, a play or an open house. I think you're right and as I’m listening to you talk Pam I think about choices and trade-offs and I think every woman, every couple right because it takes the partnership, has to think about “what are we gonna trade off?”. Some of those trade-offs are what you're not gonna [have]. “We're not gonna have a fresh meal on the table every single night because some days we're gonna do takeout“.
25:09 I always joke I don't do housework, I don't clean toilets because I have so much to do that I want to spend whatever energy I have on the kids, being a good wife and as much as possible creating some boundaries around work too. That's the other thing I hear you talking about is this idea of boundary setting. I think it’s really important and as women we continue to buy into the myth that we should be doing it all by ourselves and it's laughable. Nobody can do that and especially when you have multiple kids. A good friend of mine once told me when we adopted our second [child] “Portia, two is not double” and I didn't really understand that until the second one came. It's four times as much work!
26:05 PAM: It's crazy too that, when we started off talking about success, when you add children to the mix you have no idea what you're getting. You don't know the personalities and I would say that most parents go into this and think “they're going to be valedictorian, they're going to graduate because they're so smart”. We have this vision of our kids and they have their choice of colleges but they're going to be an engineer. We have these things about what we think are success and along the way I remember having conversations with so many people around kindergarten. That decision seemed like it was going to be a make-or-break.
26:45 POR: Right, like it was the most epic decision ever.
26:46 PAM: Where do I send them and what do I do and are they reading at age three because my friend's kid is reading at age three. That early on, I mean, we just had to let go. We have two boys with adhd and my youngest has dyslexia and so those aren't setbacks at all but they were learning points along the way for us to grow because we just [went] on autopilot and all of a sudden we had to pause and build out what we needed for each individual child. My idea of success for my kids has changed. It's not about what their job is when they grow up or career, it’s about them being happy and having a strong self-esteem.
27:38 POR: Yes, absolutely.
27:40 PAM: Whatever they do in life that they are able to have a sense of mission and accomplishment and they're good citizens.That’s it. What we'll instill in them is ”if it makes you happy [and] you can support yourself and ultimately continue to strive to improve yourself then I'm stepping back”. I'm not trying to force all of them to be doctors and dentists because that's our idea of success.
28:16 POR: I think the longer you parent the more you realize that we often imprint our own feelings of inadequacy or insecurities onto our children and we try to subconsciously make up for that and we end up over parenting them. There's a reason why there's kids running around with extreme anxiety and all kinds of challenges because we put so much on our children when in reality they are their own people. I think it's exactly as you say, you want them to grow up being healthy, well adjusted, contributing members of their community and develop their own path in life.
29:10 A good friend of mine once told me “you're only as happy as your healthiest child”. One of my children had some health problems and it totally reframed my thinking around what successful parenting was. When you see your child struggling you would give your right arm for them to not be struggling and so once my child, my son, started to get better I just remember thinking “okay this is the opportunity to do this a little bit differently”. Take our foot off the gas, not put too much pressure on them. Again we all like to think we are amazing parents who would do no harm to our children but the reality is there's so much we can do to just help them be more of who they are. Help them become who they're meant to be.
30:11 PAM: It's tailored to the child and I know we're going to go on but...
30:14 POR: No, let's keep going.
30:15 PAM: ... I have people ask me all the time “oh my gosh, how do you do it all?” and it's almost like this whole reverence for this perfect life and there's no such thing first of all. I will be exposed for the failure that I am when one of my kids gets admitted to the hospital with ricketts because they don't get the right nutrition because my son eats too many fruit roll-ups or hasn't had a vegetable in three days. Then you'll start to see that it's not all perfect.
30:52 POR: It's not, as long as we're going to turn this into a confessional I got a text from one of my mom friends who's a lawyer and she's got two little boys and they're playing video games because we're all at home right now and there's no camp. There's nothing for the kids to do and parents are working and so the kids are essentially recreating their community online through video games. She said “you know I was feeling really bad about the screen time but then I realized that Gideon [Portia’s son] was also [playing video games] so I figured I can't be that bad of a mom if Portia's kids have been playing for six hours a day…”
31:42 PAM: We're in it together.
31:44 POR: We're in it together. I use the word minimum viable but we're just trying to survive this summer, that's all. I feel like one summer of continuous screen watching is probably not going to kill them.
31:56 PAM: They'll be okay.
31:58 POR: They're going to be okay, knock on wood. We do the best that we can.
32:03 But speaking of kids I think if I think about my own journey I was a hardcore career woman for a really long time and I didn't have to start really seriously thinking about kids until my mid-thirties and to be honest Pam I don't know what I was thinking I had friends who in most of my circle because living in big cities New York and Chicago and traveling abroad most of my circle were professional women like me. We got married and if you go to places like New York people aren't getting married until they're in their late 30s. They have kids late 30s and I just figured when I was ready to get pregnant it would just happen and surprise it turned out to be a really big struggle for me and I'm blessed that I was able to have my son but I had a ton of fertility problems. I know I'm not the only one because I talked to other friends who did the same thing and who either ended up doing surrogacy or multiple rounds of IVF or not having kids at all because it was just too traumatic.
33:13 When I 'm out speaking and I get asked if I have any career regrets and frankly in my career I don't have a lot of regrets but I am on this bandwagon of “have children early” you have no idea. I think we look at these celebrities whether it's in US Magazine or People and we see Halle Berry had a baby and she was 49 or 50. I just think women have no concept of their reproductive health and so I would love for you to talk a little bit about what do you want women to know about not just fertility but because i think that's part of it, but with their reproductive health and what should we be thinking about probably much earlier than any of us are thinking about?
34:06 PAM: At first I want to applaud you for bringing more attention to that. For women especially who are career driven, who are in this mode of what success and accomplishment looks like and almost on a track, it is so true. I feel though that our generation got a little sideways with that. The generation right before us those women were the first to break into many fields. Some female leaders and academics intentionally chose either not to have children or when they did have children they were not able in some instances to be as present because they had to prove that they could be like the guys. I'm just as good, I'll be here, I'm not gonna let you down. And so when I came through I remember thinking to myself “all right, well it'll happen when it happens” and I got married and we decided to have a family at a time when it didn't end up being an issue but it is an inconvenient truth that there is such a thing as a biological clock.
35:26 POR: Say that again for the people in the cheap seats!
35:28 PAM: I think we want to ignore that we can’t slow that down, that is the way our bodies are designed. We start ovulating and our eggs start being utilized when we start having periods whether that's [at the age of] 10, 12 or 14. As we age those eggs begin to age and over time the quality of the eggs, which is important for being able to get pregnant and getting pregnant with a baby that doesn't have chromosomal abnormalities or birth defects, all that matters. I'm not advocating for us going back to my grandmother's generation where they all got married and had babies at 16 or 18. I'm not advocating for that at all. I think it is very important for us to think about the big picture when it comes to having children, what is the family life like?
36:25 I advise my patients all the time “don't rush into this relationship just so you can get pregnant” because you feel that biological clock and then you're in a bad relationship. It's not healthy for the baby or you end up splitting up. All that's super important but it is important for women who are focusing on their career to just have it in mind what is happening with their relationships.
36:51 POR: Right.
36:52 PAM I am building on one that I feel is going to get me to a point where I will have a family and when do I need to start focusing more on that?
39:59 POR: Yeah.
37:02 PAM: That's one important part. The other part is how important is it for you to have children? Some women don't want to have children.
37:06 POR: Yeah or maybe they don't want to have their biological [children]. They're open to adopting and they're not wedded to having a biological child, right?
37:13 PAM: Yeah and how that opens many doors when it comes to age. I have couples where they absolutely won't consider adoption because they just won't. Well, that limits you. Then you have to really think about what you need to do to be able to have your own child, your own DNA. And then there's some who say adoption is no problem so if we need to do that we'll do it. So if you're 43, 45 and you end up not being able to get pregnant on your own, you can still have a family but you have to be open to that. So yes, as we get older and I would say that the time period I really focus on in these conversations is when women are between 30 and 35...
37:55 POR: 30 and 35?
37:58 PAM ...and that's mostly because you know as we're getting into that age after 35 we know the risk of chromosomal abnormalities like down syndrome go up. We know that the chance of getting pregnant starts to decline in general year after year but especially between 35 and 40 and then 40 and up and I also want people to hear this: when you hear about the celebrities and people who are having babies, you don't know what they did to get pregnant.
38:24 POR: Yeah.
38:28 PAM: Private matter and technology and fertility treatments today can go a long way but did they freeze their eggs or did they have an egg donor you don't know about? So it's biologically not their egg but could be their partner’s sperm and they carry the baby. It's not about the uterus, the uterus is a vehicle to carry the pregnancy [and] doesn't age.
38:53 POR: So my uterus is still good, is that what you're telling me?
38:56 PAM: The uterus is still good. Most women, I mean there's some women who have fibroids [and] other things but sure [the] uterus is not an issue when it comes to ages. [It’s] about the eggs and I like just to have women do a little bit of an inventory. Do they want children or not? From a relationship standpoint I have some women who don't have anyone in mind but they want to have a baby and they do it with a sperm donor on their own. I have some who will freeze eggs or do things to be able to have babies later and then ultimately there are people who just wing it and say “we'll just see what happens and whatever happens happen”.
39:42 POR: I want to touch on egg freezing because I actually have a number of friends who work in Silicon Valley and whose companies actually paid for egg freezing as well as fertility treatments. I'd love for you to talk about this. The one thing I wonder about that is, and maybe I have my own bias because after I had my son in my early 40s with my own eggs I went through a bunch of fertility treatments but it was mentally challenging to go through the shots and the process and no one talks about that, and so when I hear women say “oh I've got my eggs frozen and I'll just get them implanted and no big deal” I just wonder if there's a sense of realism around what the pros and cons are? Do you have a perspective on egg freezing; when is it good and what should women be thinking about when they're thinking about freezing their eggs?
41:01 PAM: Egg freezing has been around for at least a decade now. Before that we had to freeze an entire fertilized embryo so you would have to have the sperm and you have to make a choice, either you had a partner, so if you were married and the two of you weren't ready yet but you wanted to keep the idea open you could take his sperm and your egg at age 33, 35 whatever and have the entire embryo frozen. We knew the chance of success with that was pretty good and then later putting it in when you're ready. So we didn't have the ability to just freeze the egg and then when that evolved that really changed the game for women who didn't have a partner. Where was the sperm going to come from? So I actually think it is a really good option for women and it comes down to cost you know. Some women have the resources to do it, some women don't.
41:58 POR: It's not cheap at all.
42:02 PAM: I don't even remember the cost now but yes it's got to be thousands of dollars.
42:05 POR: It's very expensive.
42:07 PAM ...and when you get ready to use it later you have to go through more technology to be able to fertilize the egg and then put it in and so there's more cost on either end. Some people are very naturalistic, they just don't want any intervention. If it happens, it happens but I do think it's important in that 30 to 35 zone. You need to freeze your eggs before they get old enough. So if you freeze your eggs at 38 they're still 38 year old eggs that may have a lower chance of you actually conceiving when you try to put them back in later or higher risk of chromosomal abnormalities. So what you pointed out is true, it's not as simple as it's an automatic “it's going to happen”. Depending on the age that you freeze the eggs the chance of getting pregnant with those eggs later varies so the younger you are the higher the chance is that it will be successful.
43:06 The reason I don't focus on women in their 20s, I talk to them about fertility and what to consider as far as being healthy and if they were to get pregnant, but if they freeze their eggs in their 20s they still have a long period of time that they might actually end up conceiving on their own or getting married and not using those eggs. But when you're getting closer to 35 I think that you're pushing on it. Every year we'll have patients who come in who are thinking they're menopausal and they're pregnant. They're 49, 50 years old and they're pregnant.
43:42 POR: Don't tell me that!
43:45 PAM: It hits them hard because they think “wow I'm old then you tell me that it's hard to get pregnant when you're in your 40s”. Well, most of the time those women have had babies before. There's something about [what] we call “prime the pump”. When you've had a baby and you've had this lapse in time for an ovulation or if you breastfeed, all this time that your body's had a break it seems to extend your period of fertility. So getting pregnant the first time is very different from getting pregnant afterwards. Women who've had babies when they're younger tend to be able to get pregnant later in life compared to women who are trying to have their first child.
44:22 POR Oh interesting.
44:25 PAM ...later in life.
44:29 POR: Oh interesting. We've talked a lot about fertility and having babies but I'm wondering, you've been practicing for a long time, are there things now having cared for so many patients where you said to yourself “gosh I wish women would just understand xyz more”. What are those things that you see over and over that you wish women understood more around caring for their reproductive health over time?
45:04 PAM: Reproductive health is more than the biological clock and what your ovaries are doing. It's still very much tied to your overall health, your general well-being. I will have women come who are wanting to get pregnant soon and maybe they're right at that 35-36 age range but they are severely overweight or they have uncontrolled diabetes or high blood pressure already and it's difficult at that point to say “well, what if you took a year or two and lost some weight so you're healthier”. If you wait that long to get pregnant you want to have a healthy pregnancy and a good outcome. You don't want the risk of dying or having complications during pregnancy to be high, you want your baby to be healthy and so one thing I would really encourage women to do is to take care of themselves during that time period, both before they conceive and between pregnancies.
46:07 It's not about being a model image, like a size two, it's none of that stuff. It's about being in a healthy range where your heart's healthy and that your weight is healthy so you aren't increasing your risk for lots of things. I would say just taking care of that and for any woman in a relationship I should say that protecting yourself against sexually transmitted infections affect your fertility or affect it when you carry a baby later. Last but not least the emotional health. Pregnancy and being a parent is hard and so if you are completely stressed out or depressed, build out your toolbox on how to take care of that because it doesn't get any easier with just having a baby. I think people think “well, I'm depressed because I haven't had a baby, once I have a baby it's going to be all better” and it's not.
47:10 POR: It's not like that, is it?
47:13 PAM: It's challenging and so everything you can do to prepare yourself emotionally to be able to handle the ups and downs of parenthood and hormones of pregnancy, investing in that early on, is very important.
47:25 POR: I actually want to take a related but slight detour because you talked about the health of the mother and making sure you don't have uncontrolled diabetes or high blood pressure and you are the chair of the Forsyth county infant mortality reduction council. I know that a subspecialty in your public policy degree is around maternal and child health and so just talk a little bit about what that council is about and why did you decide to get involved in it?
48:03 We're both black women and I have been pretty alarmed at the statistics in particular around the mortality rate for black women [and the] infant mortality for black and latinx babies. Our county in particular here in North Carolina is surprisingly high, at least for me as a lay-person, so just talk a little bit about the work that you're doing.
48:30 PAM: Perfect, so the infant mortality reduction coalition really aims to try to impact the number of babies in Forsyth county specifically who died before they reached their first birthday; whether through education, through advocacy or through access. North Carolina happens to have a higher infant mortality rate than many states and Forsyth county within North Carolina happens to have one of the highest infant mortality rates.
49:05 POR: Why is that related to poverty or access to health, or all of those things?
49:11 PAM: All those things play into it and what we find is that the rates are higher and when we dig into our community here in Winston-Salem there are definitely zip code patterns. We have a couple of zip codes where we see more babies that die any given year and so access is always something we look at. I could put a clinic in the middle of that zip code but do those women have coverage for their health insurance and is the world validating and confirming to them that they need to get prenatal care? So there's a gap sometimes in our communities [between] being open to and appreciating the importance of prenatal care or care for themselves. One of the biggest reasons for babies dying in our county happens to be [that] babies are born prematurely and they're born before a period of time where it's easy for them to survive.
50:15 POR: Is that 25 weeks or 30 weeks?
50:18 PAM: Between 23 and 24 traditionally babies can survive but a 24-25 week baby is much more likely to have some type of complications or developmental delays than a child who is born a little bit closer to 40 weeks. So yes, preterm birth, preterm labor and many of those factors we've been studying for decades and do not understand why some women have their babies earlier than others. We can do interventions for that, getting prenatal care and monitoring and intervening when we can to try to delay when the baby's born. We do all of that but the thing that gets me [is that] some of the maternal health stuff goes back to some of the social determinants of health and what's happening in the community. You as a professional educated black woman with a great job and great access, your risk of having a preterm delivery or a baby that dies in labor is as high as a caucasian woman who dropped out of high school.
51:31 POR: That blows my mind!
51:32 PAM: Why is that right? How in the world?
51:36 PAM: We know that this is the inconvenient truth too, unfortunately we know that there are stressors as we call it. It’s the way that systemic racism and the stress of things that happen to women of color at young ages and maybe even in their moms when they were pregnant with them, predetermines what happens with you. That's what we find in some of the communities where we have higher infant mortality rates. In Winston-Salem there are clear boundaries between certain sides of town. You can see where some of those systemic factors over decades and generations are setting up for this and it'll take even as we fix things now, or we think we're fixing things now, we may not see that impact for a generation or so because it ingrains in us and in our DNA and in our eggs. Everything that we pass on to our kids, a potential higher risk for obesity or high blood pressure, because of that stress. That is so complicated but it's rewarding to see the community coming together to try to tackle it because this isn't a medicine I can prescribe. A medicine or a doctor can’t prevent this. It's about the entire community tackling access to food and job training and education and all those things that will level the playing field and hopefully have an impact down the road.
53:05 POR: I'm glad we took that little detour because I think it's a really important time for women, especially black women and other women of color, to get into positions of leadership. Where we can have a policy influence that allows us to make the kind of change that improves the outcomes because when we succeed everyone succeeds. If we go back to the beginning of this conversation about how you got into your role as a physician and then becoming an executive, and in some ways the nudge that you got to move into your roles. I think about the impact that you're going to have as a result of being in your role and the kind of influence you have. Imagine if we could do that times a thousand, times two thousand.
54:12 PAM: In terms of we're all working?
54:16 POR: Right, if we're all doing this. I want to pivot back to you in the last couple of questions. One of the things that Jennifer and I talked a lot about when we were interviewing women for the book Kick some Glass was around failure. We actually touched on it a little bit earlier and there's something we talk about in terms of “glorious failure” because the f-word is something I think we as women starting when we're little girls are socialized to think is bad. We're socialized to think that failing is somehow some horrible thing. That it's a reflection on us as people, on our character, when in reality it is something that happens to everyone. In fact failure is great information. It provides us a data set from which to evaluate that particular circumstance. So maybe with that as a kind of background I'm wondering if there is a sort of pivotal “glorious failure” you had in your life or in your career that changed your perspective or helped you make a decision that you didn't know you would ultimately make? Talk about that, what failure is or the role that failure has had in helping to shape who you are?
55:37 PAM: I think that me facing certain challenges and tackling them and then understanding that I'm not going to be good at everything was important for me early on. I was blessed from a school perspective, school came easy to me. I was smart and that was great so in ninth grade one of my best friends wanted to go out for the track team. It was the first time that we could do high school sports and I was that girl who was always fast at field day. I had these blue ribbons from field day in fourth grade. I was fast, I got these long skinny legs so she just wanted a partner. She wanted me to go out with her because we could do it together and I was like “okay, whatever”. I don't run in general but I could do this because I'm good at most things that I do. It was very humbling. I sucked at track. My mom to this day talks about coming and watching me come in last or second to last in race after race. But I kept training. I stuck with it. I went through the entire year and I actually loved being part of the team so when it ended I remained part of the track team but I was the manager. I think there's an early transition in the leadership. I didn't give up on the track team, I just wasn't running anymore.
57:23 POR: So that was the beginning of you as a leader right?
57:28 PAM: It felt good I enjoyed, it came [natural] to me. I would say that it was a very early failure of sorts and I was like “it's okay, I'm not gonna be a superstar at everything that I do”. I faced challenges when I got to undergraduate math. Math was always my thing, I remember struggling through one of the hardest math classes at UNC, it kicked my butt. I think it would have been the only C I ever got in my life. I moved on and brushed off and said “I'm not majoring in math so let's keep it moving”. It didn't deter me and I don't know that I have a glorious [failure]. I've had a lot of micro learning opportunities along the way. In medicine definitely there are times where you end up not doing the right thing and you have to learn from it but get up dust yourself off and keep moving.
58:41 In this leadership role that I'm in now [I have worked] with people with so many different viewpoints. They're definitely been points along the way where I thought I knew the plan, I had it down, and it didn't work. I thought I was communicating but whatever I was saying wasn't connecting, or resonating, with my team or with the people that I'm talking to. All of those things I consider constant learning opportunities for me to figure out how I do something differently the next time and the most important part for me is to not let that deter me.
59:27 I think it's my ob training where I have to compartmentalize things. I have to be able to sit with a woman in a room and mourn with her because I have to tell her that she's had a miscarriage or a loss. Then I have to move over into the next room and celebrate with the couple who just found out they're having twins, and that's a lot of emotional control that we have to learn really early to be able to take care of everything on a daily basis. I have to do that with these things too. I have to say “all right, this didn't work”. I need to put it in this box over here and move on to be able to be successful here. Or come home and have something for my family and not be constantly down and depressed. I'm still on that journey.
60:21 POR: I think a lot of the underlying things you're talking about are really around resiliency and the ability to bounce back from adverse events. Certainly I think this whole year that we're living in is an exercise in resiliency, right? Nothing in 2020 that we thought was going to happen has happened. So many big disappointments to manage and I am sure that some of our listeners are dealing with things like job losses and illness, which are not failures, which are just big stressors. Learning how to be more resilient is, I think, a really important skill.
61:11 So thank you, thank you for sharing that.
61:47 This is the sort of fun thing I always like to ask everyone I'm interviewing. I'm a huge reader and so I want to ask you; do you have a favorite book or podcast that you recommend that you find yourself recommending over and over again because it's resonated for you?
62:20 PAM: I went for years without reading anything substantial when my kids were little. I felt that I was reading medical literature, we have to keep up with all these articles. I was reading that if I wasn't reading The Magic Treehouse books with the kids and when I was on vacation I just couldn't focus. I needed to just turn it off, I needed something mindless and I would find myself reading books for pleasure that were nonfiction then. So I went through this really long gap and then I did discover Audible because I commute sometimes an hour and a half-two hours back and forth any given day and so I started using Audible for that time.
63:10 POR: I love Audible!
63:13 PAM: There are several leadership books that I started listening to on Audible that I love. I wouldn't say that there's one of them that I recommend over and over but there's Start With Why by Simon Sinek (link).
63:26 POR: That’s a terrific book, I give that a lot as gifts. .
63:33 PAM: The Speed of Trust with Stephen Covey (link) when it comes to working with our teams and so there are several that have resonated with me.
63:44 POR: Jocko Wilnick.
63:50 PAM: Yes, I love listening to their voices.
63:53 POR: His podcast is terrific too.
63:56 PAM: I haven't even discovered his podcast.
63:57 POR: It's called the Jocko Podcast (link), it's really good.
64:04 PAM: I love it. I don’t have one specific one. I love Malcolm Gladwell, I learn a lot from him about people and sociology kind of topics. I just have a plethora of things that I reach for at any given time. I try to change it up a little bit based on what kind of mood I'm in.
64:25 The only book that I give over and over again, and this is going to sound simple, is Oh, the Places You'll Go! by Dr Seuss (link). I was valedictorian and got to give my speech at high school graduation and I used excerpts from that book and at the time it was brand new, he had just released it When kids graduate or sometimes when people are just going through tough moments or you're older, sometimes it takes some simplifying this motivation. It rings true across generations as we age, and so that is the only [book] that I would say I consistently give out more than anything else.
65:10 POR: Okay, so we're going to make sure we include that in the show notes so people can read it, if they haven’t had the chance. It really is so delightful like all of Dr Seuss. Do you have a motto or a favorite saying that you come back to?
65:33 PAM: The one that I come back to over and over again is Mahatma Gandhi who said “be the change you want to see in the world”. That motivates me and inspires me. I never accept the status quo, this is the way that we do it, this is the right way etc. I always feel that there's an opportunity for change and that I want to leave this world better for my kids and my grandkids. So that is the one [motto] that keeps me going “be the change you want to see in the world”.
66:14 POR: That's such a nice full circle to the beginning of our talk because you talked about wanting to make an impact, so it's very on-brand. So last question for you Pam; what advice would you give to a 20 year old Pam?
66:33 PAM: I would tell Pam at 20 “be you and enjoy every moment”. I do feel that I enjoyed life along the way, that I wasn’t deferring everything until later. I've always had the mentality of “work hard, play hard”. We use my mother to watch our kids so we can go away without the kids and enjoy each other.
67:10 POR: Which is highly underrated I will say to any of the parents out there. It's super underrated.
67:16 PAM: I talk to people all the time and they're like “we're going away for the first time ever, the kids are 16”. I do think that I've been blessed with someone that I trust who can stay with my children and I understand that everyone doesn't have that, but finding a way to be able to do that is super important. It's super important to have time without your kids.
67:46 POR: Yeah, you can love them to death and still have them drive you crazy, right?
67:49 PAM: Exactly and they need time away from me too. They need playdates and I need playdates. I would say “enjoy life and just savor the moment”. As you age, I have to work harder to stay in shape and take care of myself and my husband. My daughter, for her birthday, my sister-in-law had asked what she wanted. She wanted a two-piece swimsuit and she plays tennis, she's in great shape. She's not trying to do it to show off, that's just what she wears. My husband was moaning about “she doesn't need a two-piece” and I was like “look, I wish I had worn more two-pieces when I was 15 years old”.
68:33 POR: Oh my gosh!
68:38 PAM: So embrace the moment for who you are and just have faith. I was a first generation college student, I didn't know where I was going. I had a plan but a lot of us want that crystal ball. We want to see where we're going, we want to know. It's hard to have faith that it's going to work out. We always stress because we're worried that we're not going to get there. So I would just say “have faith, enjoy life and do you”. Be you.
69:15 POR: Pam, perfect way to end the conversation. It's been so great talking to you and I can't wait for our listeners to hear really your just lovely and sage advice, thanks so much.
69:38 PAM: Oh Portia, I'm so proud of you and I'm happy for the impact that you are having on women everywhere and the support that you're given, just tremendous, so we owe you a lot. Thank you.
69:49 POR: We're gonna do it together. Thanks so much Pam.