“Why should I be on my deathbed before I tell my secret?”
Joanne Roberts had a remarkable career; an internist, a palliative care doctor, senior hospital administrator, editor at the BMJ, editor of BMJ USA. It’s been a successful academic and medical career, but it’s been a life with a difference.
Three careers, two genders, and one terminal diagnosis is how Dr. Joanne Roberts sums up her life. She is retired as a physician executive from Providence, a large West Coast health system. Joanne, born amid racial tensions in the south, has used her personal struggles to build a rich career as a journalist, where she learned the power of asking questions; a practicing palliative care physician, where she learned the power of presence, silence, and vulnerability; and a healthcare executive, where she focused her work in finding and building great leaders among young doctors.
Joanne was born in Nashville and through a circuitous route graduated from the University of Nebraska, then worked eight years as a newspaper reporter before entering the University of Minnesota Medical School. After residency, she began a Robert Wood Johnson Clinical Scholars fellowship, leaving early to study with and then join the staff of the BMJ, serving as a part-time North American editor while directing the general internal medicine residency at Johns Hopkins University. She then turned to practicing palliative medicine in the Pacific Northwest, and because she has a long history of studying healthcare systems, became a hospital chief medical officer for Providence, a 51-hospital Western US health system, then completing her career as Providence’s systemwide chief value officer. She has two adult daughters, Alex, a nurse in Alaska, and Zoë, an environmental engineer in Los Angeles. She lives in Saint Paul, Minnesota.
“…being a physician leader as a woman versus a man, and having been socialized as a man but now living as a woman, and recognizing how powerful receptive leadership can be. I think my friends who are women who were born women struggle with that socialization, of being receptive, and often see leadership as more masculine – command control kind of leadership- and my experience has been that if I use the same skills as I do in palliative care and just keep my mouth closed and ask questions and use silence, I can get a whole lot more done from people than if I try to tell them what to do. In many ways I found that a feminine way of leading is a much more powerful way of leading…”
Joanne has had a fascinating life but it’s been a life ahead of its time. Joanne, tell us your story…
Joanne Roberts: Where do you begin a story? I grew up in the south of the United States and ended up in Ferguson, Missouri, a place that has been in the news in the last few years. But I also grew up with a big secret and kept that secret from my family, kept that secret from my friends, and managed to somehow struggle through school. I was pretty quiet and didn’t stand out, on purpose, and ended up flunking out of college. My father had wanted me to be a physician but, after flunking out of college, I decided that wasn’t going to happen. So, off I went and became a journalist, a newspaper journalist, and I loved it. I loved being a journalist because I got to tell the stories of other people’s lives, because I didn’t want to tell my own story. After about eight years of doing that, I found myself writing more and more about healthcare and decided I would actually go to medical school, and I did.
It was during medical school that I finally became honest with the secret I’d been holding all my life and that is, my transgenderism. Back then it was called transsexuality. It overly simplifies it to say that I was living in the wrong body. I don’t think that’s a very good description but that’s what people say and it does describe the discomfort. Anyway, I was always ashamed of myself, I was always holding secrets and I finally came out and went to a program in human sexuality at my medical school.
I was quite sure when I came out that I was transgendered but the experts back then had different diagnostic criteria than they do today. They interviewed me several times and at the end of the interviews they said, “You don’t meet our criteria for transsexualism”, because the criteria back then were that you had to present yourself in public as extremely feminine, which I’m not, I’m a pretty androgynous person. You had to be “straight”- that I had to be seeking men as sexual partners and marriage partners, which was probably not true. And I had to drop out of medical school because of course people like me couldn’t possibly be doctors. I listened to the experts and thought, “Well, they know more than I do” – and so I told myself that I’m just an androgynous man.
Off I went, finished up medical school, finished up my residency and I went into internal medicine, and then palliative care. Oddly enough, it was during my years doing palliative care that this all came together again. After about 15 years, after working for the BMJ, and during the time I was doing palliative care and taking care of patients at the end of life, one of the things I found to be fairly universal about people on their deathbeds is that, on their deathbeds, they let go of their secrets and their shame. I was just so impressed by that. Talking with people, talking with farmers who had never been sick, and they were tough guys, and then on their deathbeds they would become extremely vulnerable and say, for example, “I’ve never told my wife that I’m a drinker on the side… and you know I’ve always held this secret.” It was just patient after patient after patient and after taking care of patients like that for a few years I thought, “Why should I be on my deathbed before I tell my secret?” And then I came out again with this gender issue.
In the meantime over those 20 years, the science had changed and suddenly I met all the criteria for being transgendered and I ended up transitioning around the turn of the century. Life has been wonderful since then and, if someone asked me why has life become so much better, I would say that, before I transitioned I constantly worried about what people would discover about me. And it was all about me. After I transitioned, it was me worrying about other people, and I became a much better doctor because I had nothing to hold secret. I could talk about anything, I could make eye contact for the first time, and it was odd because people would say, “You have a magnificent way of holding eye contact that I’ve never seen before.” and it was because I had learned just to be present with people rather than trying to keep myself hidden. So that’s my that’s my personal story and it overlaps with my professional story.
“I loved being a journalist because I got to tell the stories of other people’s lives, because I didn’t want to tell my own story.”
DMacA: Let me take you back a little because when we have this conversation now it seems easier. But you were so far ahead of the game. When you say the ‘turn of the century’ you’re actually taking us back beyond that. It must have been so difficult. How did you cope?
JR: I just kept myself hidden. For those of us who are old enough to remember… when I first started discovering about transsexuality, I was probably about 14 years old when I first discovered the word. And these were the days when Christine Jorgensen made the news. She was a woman who served in World War II, she was a tabloid sensation, and this was scandalous. This whole idea of being a transsexual was just scandalous. And the thought of having that kind of notoriety was just terrifying to me. And, being pushed to the margins of society. I wanted to fit in like we all do. I think we all hold secrets. I think that’s a universal thing. We all have our own closet, but mine was a pretty big closet and some people I came out to could not handle it. I mean, I was married, I was married twice. I married young, to a woman, and when I went to medical school and went through that process we divorced about that time. My gender confusion was the cause. And then trying to live androgynously as a man I got married again. When I came out the second time, that ended up as a divorce. I had children by then and, for them and both my first partner and my second partner it has been hard, but we maintain contact. My daughters and I are close. My parents were great when I came out. But what I think shocked me most was that my colleagues universally embraced me. Universally.
When I finally did transition I was living in Bellingham, Washington, far up into the northwest corner of the United States. I was working there and my now-ex wife and I agreed I would move an hour or so away from Bellingham to give my her some space. I didn’t think I was going to be able to work as a doctor but I interviewed anyway and the day I interviewed was the first day I ever walked out of the house as a woman. On many levels that interview was terrifying. I interviewed for the job and next day the medical director called me back and offered me the job and I said, “Before you offer me this job, John, I need to tell you I wasn’t born a woman,” and he said, “So what?” And that’s been pretty much my experience with the medical community.
It’s never been a secret that I’m transgendered. The odd thing about coming out of a closet is that once you come out, you don’t know who knows. I tell people, “I don’t care what you share about me, tell people my history, its perfectly fine, I have no secrets.” And then I find out years later that the person I’d been working with for five years didn’t know. It’s been a fascinating journey that way.
“And, one of the things that I found to be fairly universal about people on their deathbeds is that on their deathbeds they let go of their secrets and their shame.”
DMacA: It’s really interesting to hear that medical colleagues, and medicine being such a conservative profession, were able to deal with that so well…
JR: Yes, but physicians also ask questions. I often think of my most conservative colleague, a Christian conservative gentleman whom I adore. He was fearless in asking me questions. He said “I don’t understand this…” and he would just sit down with me and say, “Tell me about your life and how you came to this…” and we ended up, because he was just so curious, we ended up being dear friends. Of all my colleagues, I remember just one pushing back. She was a very liberal psychiatrist friend that I had known for a long time. And she heard the story and her response was, “Well you’ve just ruined your children’s lives…” That was her response.
DMacA: You talked about the curiosity of your colleague and one of the questions that troubles a lot of doctors at the moment, and you described it very nicely when you were 14, is how to deal with teenagers when they come to their doctors. From your experience, and also as an expert patient, what is your advice to those doctors?
JR: I think this is a terribly difficult circumstance, I really do, and all of my other physician friends who are transgender, who’ve gone through their transitions, we all share this concern. Teenage- ship, adolescence, is meant to be a time of exploration and to push boundaries. That’s what it’s for in our in our life cycle, and I do worry about teenagers making decisions that could be permanent. Counselling is great. I don’t know the science right now of hormone blockers but, I think we need to walk with care, respect them, listen to them, let them explore those boundaries, but maybe not make decisions that are irreversible. That said, I have a friend who has a child who at age three was clearly transgender. It wasn’t even subtle and that child is now probably about eight or nine, born female, absolutely masculine in every way, and to withhold treatment for that child… I don’t know, I mean there’s such a spectrum. It takes great therapists and physicians to pick apart which child is exploring and which child really is born this way. No question, it’s tough.
“This whole idea of being a transsexual was just scandalous and the thought of having that kind of notoriety was just terrifying to me, and being pushed to the margins of society. I wanted to fit in like we all do. I think we all hold secrets. I think that’s a universal thing.”
DMacA: Let’s change tack a little. Very often people will say, I’ve had some trauma in my life that held me back in my career, that I didn’t fulfil my potential. But, you’ve had an immensely successful career. Was there anything, did they relate, did they interreact, how did it affect your professional career?
JR: That’s a great question. In so many ways it opened up my life and I think it’s because, like I said earlier, my focus before I transitioned was on Me, Me, Me. Me holding my secret. And after I transitioned I opened up and my world was about ‘We”. I was able to look way outside myself. We all suffer trauma and I went through a phase of victimhood like many of us do, when I was younger, probably in my 30s. Poor me. Poor me. I attempted suicide one time and failed, and that was really a milestone in my journey because that’s when the doctors re-diagnosed me. Victimhood just seemed to go away and I became so much more interested in other people than myself. I will say there’s one thing, and I have talked about it with friends, about being a physician leader as a woman versus a man, and having been socialized as a man but now living as a woman, is recognizing how powerful receptive leadership can be. I think my friends who are women, and who were born women, struggle with that socialization, of being receptive, and often see leadership as more masculine – a command control kind of leadership- and my experience has been that if I use the same skills as I do in palliative care and just keep my mouth closed and ask questions and use silence, I can get a whole lot more done by people than if I try to tell them what to do. In many ways I found that a feminine way of leading is a much more powerful way of leading. And, at the same time, we have to recognize that sometimes the command and control people win out. They do. That’s life. It’s not always fair.
“When people ask me what does a successful leader look like, I say a successful leader is ‘perseverance’ and never gives up. I guess that would be a summation of my life, whether it’s my personal life or my professional life, it’s just never give up and keep going and, at the same time, appreciate each day as it’s given to you.”
DMacA: As we were chatting, you talked about your career in palliative care. You’ve had to face illness yourself. How has that been?
JR: I would say that the best two years of my life have been since I was diagnosed two years ago last month with myodysplastic syndrome. I had been six months into retirement and had a routine blood count and when it came back… I’m an internist, I knew pretty much what it was going to be, and it was confirmed pretty quickly. I opted not to undergo a bone marrow transplant. I told my haematologist, who is my age, which I think is really important because he’s not afraid of death. I told him the first day, “I want you to hear this: My goal is quality not quantity, so good life is more important than long life.” And he heard that, and I’ve undergone what used to be standard chemotherapy. It is very tolerable. I mean it just barely has any side effects. For physicians, it’s an HMA inhibitor that I get every day for a week each month. I’ve done well. My counts have held up and I’ve lived every day with such gratitude that it’s hard to describe.
When I was working I used to wake up every day and have instant anxiety- “My God what is going on, what do I have to do today?” –These days when I wake up, I am at such peace. When I wake up, I meditate. I only do the things that give me joy, which is connecting with friends, biking, hiking, reading, writing, doing some coaching with young physician leaders, especially young women physician leaders. That is my life and it’s terribly full and overwhelmingly joyful.
DMacA: When we come towards the end of one of these conversations I generally ask what you would say to other people about the particular aspect of a career that we have discussed. But you have so much to talk about. I’m sure you’ve thought about it. What is your message?
JR: When people ask me what does a successful leader look like, I say that being a successful leader is “perseverance” and “never give up.” I guess that would be a summation of my life, whether it’s my personal life or my professional life, it’s just never give up and keep going and, at the same time, appreciate each day as it’s given to you.
DMacA: Joanne, it’s been an incredible privilege to talk to you. Thank you.
