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Invited Commentaries

The Women Before Me: My Journey Painting Honor Wall Portraits of Women Physicians

Chen, Pamela MD1; Kasper, Jennifer MD, MPH2; Khoshbin, Shahram MD3

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doi: 10.1097/ACM.0000000000004171
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Abstract

At the end of my first year of medical school, armed with discounted oil paints and a blank canvas my mom bought at a yard sale, I decided to capture the experience of being initiated into the medical profession with a self-portrait commemorating my white coat ceremony. I ultimately completed a series of self-portraits, 1 after each year of medical school, 1,2 showing the change in myself from the idealization of a career to the realization of it. When these paintings moved from my bedroom walls to those of Harvard Medical School’s Gordon Hall, 3 they were imbued with a new political significance beyond their original, diary-like purpose. Despite my newly attained educational and professional privilege, my portraits on display swiftly reminded me how my intersectional identity fit into this ivory tower. I was one of very few women, never mind women of color, on the walls.

I struggled with this realization for months, becoming keenly aware of how the portraits on campus, which almost universally featured White men, differed from the demographic composition of my classmates. The Association of American Medical Colleges has reported that women have officially comprised the majority of entering medical students since 2017. 4,5 At Harvard Medical School, specifically, more than half of my classmates were women, and about half were either Asian or underrepresented in medicine. In a recent controversial move, dozens of paintings of White male department chairs were removed from the Brigham and Women’s Bornstein Amphitheater, where my classmates and I sat through our medical school orientation, 6,7 and were redistributed throughout the hospital. Nevertheless, hospital hallways filled with portraits of White men remain the norm. Even though I was sure the featured men had accomplished great things, more often than not, I avoided looking at their portraits.

Such portraits contribute to unconscious bias, 8 silently repeating the narrative that White men are intrinsically better scientists and physicians than others, without acknowledging the centuries of exclusion, suppression, and bias that continue to prevent people of other genders and races from pursuing the same opportunities. The lack of diversity in these portraits can serve as ever-present reminders to minority medical trainees like myself that maybe we do not belong here, that we are impostors after all. 9 Indeed, female medical trainees and people of color are more likely to report impostor syndrome, 10 experience mistreatment during training, 11 and remain underrepresented in academic medicine. 12,13 The structural inequalities that serve as barriers for women and minority physicians—the root causes of why we are disproportionately underrepresented in senior leadership positions and in honor wall portraits—are often insidious and hidden. 14,15 Nevertheless, art, by its very nature, can shine a spotlight on the previously unnoticed and make visible the invisible.

There is a centuries-old tradition to portray people in positions of power—emperors, kings, and, more recently, politicians and the new professional elite—in larger-than-life oil portraits. 16 Portraits of this scale have always carried cultural connotations of class, and contemporary portrait artists have used the meta-understanding that this type of portrait should be reserved for the important or powerful to subvert expectations and refocus attention toward unexpected subjects or those thought to be disenfranchised or powerless. For example, Mary Beth Meehan’s banner-sized portraits of residents of color in a small town in Georgia resulted in significant backlash from other residents. 17 Kehinde Wiley, an artist who paints Black subjects into grand classical art tropes, considers this practice a “bittersweet dissonance” and was notably commissioned to paint Barack Obama’s official presidential portrait that now hangs in the National Portrait Gallery. 18 MacArthur Genius Titus Kaphar’s portraits force audiences to reconcile with America’s history of slavery and racism. In his “Enough About You” piece, Kaphar repainted a massive oil painting of Yale University trustees and framed only the enslaved boy who appeared in the background of the original, with the rest of the canvas crumpled and hanging off the wall outside the frame. He quite literally reframed the audience’s understanding of who is important in the image. As these examples demonstrate, paintings can send a message. The question for medical schools and hospitals then is, “What message do you want to send?”

Indeed, I recalled the jolts of validation I felt the few times I saw a woman or person of color in an honor wall painting on campus and trusted that there had to be many women before me who deserved this formal recognition but had not received it. As a medical student, I recognized I could not yet fix the deeper issues around the recruitment, retention, or promotion of women and people of color in academic medicine. 14,15,19 But I also knew that, armed with my paints and canvases, I could channel my impostor syndrome into action and make others notice who was missing. I could join a nationwide effort to not censor the inequality of our medical history but to correct the gaps in the record by diversifying the artwork on the walls. 20

Between subintern shifts and Step 2 exam preparation, I began connecting with multiple Harvard Medical School alumnae, starting with a member of the first class to include women in 1949. Although I only had time to paint a handful of portraits, it was deeply affirming to realize there were dozens and dozens of women physicians who deserved to be on the walls. These were women who represented multiple intersections of identity and career paths, who surmounted barrier after barrier to achieve their leadership positions in academic medicine, and who worked tirelessly to help the vulnerable and voiceless. Interviewing these women was revelatory. Despite a diversity of career paths, many of them highlighted similar moments of systematic discrimination that also have been described in the literature 15: they had been denied opportunities over inaccurate assumptions of their ability, they had to grapple with societal and personal expectations of motherhood, they had been passed over for promotion because their work was not taken as seriously as that of a White or male colleague. The old adage about the minority experience rang true: twice as hard for half as much.

Nonetheless, these women also spoke about how their identity formation and ability to self-advocate turned into unexpected connections between their marginalized identities, an increased awareness of the issues faced by Latinx, Black, and immigrant communities, and witnessed relief from their patients when they entered the exam room. They often referenced how this experience expanded into a passion for advocating for other disempowered populations with pride. These women all emphasized the importance of mentorship and self-care. Often, they addressed their advice specifically to me, calling me “future Dr. Chen.” I could not help but feel I had just gained new mentors, women who saw their young selves in me, women whom I could see myself becoming.

During residency interviews, I answered questions about my 5- and 20-year plans and found my answers increasing in confidence as I continued to have conversations with these women. I then came home to reflect on how to paint these pioneers.

A good portrait does not solely capture an individual’s anatomy. Regardless of realism, good portraits make a statement on personhood, on psychology. 16,21 In capturing a likeness, indeed I was performing a detailed, repeated mental status exam with the subject—appearance, behavior, emotions, thoughts, judgment. With each layer of paint, I steeped myself in each woman’s story and perceived internal state, creating an unspoken dialogue between myself and the subject. I carefully considered how we have been socialized to see women’s bodies, to minimize their size and age, to emphasize how they dress over how they think and act. I thought about how carefully women have to dress to appear professional. At the same time, I cherished each brushstroke of lipstick, of jewelry, of these unapologetically feminine things. I grappled with the Renaissance dichotomy of scientists and rational thinkers facing right in their portraits and women and emotion facing left in theirs. 22 I became very aware of the potential pitfalls of caricature, to avoid whitewashing or over-darkening skin tones, or altering racialized facial features, knowing the complex history of colorism that often exacerbates discrimination against those with darker skin tones, even among those of the same race. 23 I recognized that some of these portraits would be the only portraits of individuals of each race at the medical school.

In painting their eyes, their mouths, their wrinkles, their fingers, I tried to capture their resilience, their setbacks, their hard-won confidence. In this labored, layered way, paintings, perhaps unlike headshot photographs, become equally a representation of the artist and her subject, a physical manifestation of this reciprocity. 21 In their creation, the subjective can be made objective and the objective subjective. Figures 1–4 comprise my portraits of Raquel Cohen, MD, MPH; Eve Higginbotham, SM, MD, ML; Yeu-Tsu Margaret Lee, MD, FACS; and Gina Moreno-John, MD, MPH, respectively.

Soon, these portraits will hang in the student center of Harvard Medical School. I hope they will serve as a lasting reminder to future trainees, especially women of color, that they belong here. I hope these portraits will challenge implicit assumptions of what the medical community looks like, what a leader in medicine looks like, and what kind of physician is valued. 8 Of course, diversifying the artwork on the walls is just 1 step in creating an inclusive environment. There is so much more work to be done to promote equity for trainees of all backgrounds, across not just the visible axes of gender and race but also across the hidden ones, such as sexual orientation, religion, disability, socioeconomic status, and others. As the COVID-19 pandemic deepens existing racial and socioeconomic health disparities, as another year of police brutality against Black Americans forces us to desperately reiterate that Black Lives Matter, and as hate crimes and xenophobia against Asians and Asian Americans increase secondary to misplaced anger, this institutional-level interrogation of who is worth celebrating with an honor wall portrait becomes all the more essential.

I know for myself that painting these women and placing their portraits and biographies on the medical school walls has been cathartic. It has inspired me to be bolder with my own ambitions, knowing that there have been so many others who have paved the way for me. It has increased my conviction that there are countless others whose contributions to medicine have yet to be recognized, who belong alongside the women I painted. Although I often find myself once again in auditoriums and hallways where no honor wall portrait subjects resemble me, occasionally, I catch glimpses of a changing tide. 24 Through painting these portraits, I know now, viscerally, that I am not alone. One day, 20 or 30 years from now, perhaps someone will paint me for an honor wall portrait.

F1
Figure 1:
“Portrait of Raquel Cohen, MD, MPH,” oil on canvas, 24” × 30”. After emigrating from Peru, Dr. Cohen was 1 of 12 women who graduated as part of Harvard Medical School’s first class to include women in 1949. A distinguished life fellow of the American Psychiatric Association and professor emerita of psychiatry at the University of Miami Medical School, Dr. Cohen was an international leader in mental health interventions for survivors of disasters. Here, she is portrayed sitting serenely and gazing at the viewer.
F2
Figure 2:
“Portrait of Eve Higginbotham, SM, MD, ML,” oil on canvas, 24” × 30”. Dr. Higginbotham is the vice dean for inclusion and diversity at the Perelman School of Medicine at the University of Pennsylvania, a senior fellow of the Leonard Davis Institute, and a professor of ophthalmology. She has held multiple leadership roles, including senior vice president for health sciences at Howard University, dean at Morehouse School of Medicine, and the first female chair of an academic ophthalmology department in the United States. Here, she is painted sitting and smiling with calm poise.
F3
Figure 3:
“Portrait of Yeu-Tsu Margaret Lee, MD, FACS,” oil on canvas, 24” × 30”. Dr. Lee is a surgical oncologist and clinical professor of surgery at the University of Hawai’i John A. Burns School of Medicine. She participated in more than 50 international medical missions and reached the rank of colonel in the U.S. Army Medical Corps. During deployments, she treated both U.S. and Iraqi soldiers. She recently received the American College of Surgeons’ Mary Edwards Walker Inspiring Women in Surgery Award for her service. Here, she stands, mask down, arms resting on her hips, fresh off a surgical case.
F4
Figure 4:
“Portrait of Gina Moreno-John, MD, MPH,” oil on canvas, 24” × 30”. Dr. Moreno-John is a professor of medicine at the University of California, San Francisco. Being a first-generation Mexican American and the first in her family to go to college, she deeply believes in supporting the underserved. She has dedicated her primary care clinical efforts and research to improving the health of elderly Latinx and African American patients, which led her to cofound the Social Justice Committee in the Division of General Internal Medicine at the University of California, San Francisco. Here, she stands with her arms crossed, welcoming the viewer with a confident smile.

Acknowledgments:

The portrait subjects featured all consented to the publication of their stories and portraits. The authors thank them for their time, trust, and wisdom. The authors also wish to honor the memory of Dr. Raquel Cohen, who passed away a year after her portrait’s completion, and they thank her family members for supporting this project. The authors thank the Countway Library, the Office of Recruitment and Multicultural Affairs, and the Harvard Alumni Association for assistance in identifying and connecting with these women, and Dr. M. William Lensch in the Dean’s Office for making this art installation on campus a reality.

References

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