Marie Beall (BS '74), Doctor of Obstetrics

As the daughter of a professor of medicine, Marie Beall received a first-hand perspective of a doctor's life. Growing up in Los Angeles, Beall always gravitated toward math and science, and she was excited to enter Caltech's first coed undergraduate class in 1970. In the conversation below, Beall describes her undergraduate experience and her developing interests in pursuing a medical degree.

For all the scientific preparation she received at Caltech, one of Beall's key challenges in medical school was memorization. Whereas her undergraduate education emphasized concepts, the path to a medical degree required the ability to recall terms and medicines. Although her primary focus has been clinical, Beall has taken advantage of basic research opportunities in pediatric genetics over the course of her long affiliation with UCLA.

DAVID ZIERLER: This is David Zierler, Director of the Caltech Heritage Project. It is Monday, October 3rd, 2022. I am delighted to be here with Dr. Marie Helen Beall. Marie, it is great to be with you. Thank you so much for joining me today.

MARIE BEALL: Thank you.

ZIERLER: To start, would you please tell me your current title and institutional affiliation?

BEALL: Right now I don't have an academic title. I was a Clinical Professor of Obstetrics and Gynecology at UCLA for a number of years. I then went out into private practice. UCLA has this complicated way of designating things, because I had the same title but I was no longer compensated by the university, and that's mostly a teaching appointment. A couple of years ago during the pandemic, UCLA informed me that they no longer needed outside teachers. Through the back channels, I heard that they had a—actually I think it's probably still going on—they had a gynecologist who was accused of abusing patients, and they just decided they wanted to have people that they really knew and could control, with their students. I'm also about three-quarters retired at this point. I am affiliated with a practice. I do a lot of the scheduling and that kind of thing, and keeping the younger doctors pointed in the right direction.

ZIERLER: What does 75% retirement look like to you, in a given week? Are you going into the office? Are you taking new patients?

BEALL: We do a consultative practice, so yes, we take new patients. Because it's obstetrics, it changes over all the time. I work on average about one day a week. I cover vacations, so sometimes it's a lot more.

ZIERLER: After your separation from UCLA, did you start a private practice, or did you maintain one throughout your time at UCLA?

BEALL: I did not personally maintain one. I was working at the county hospital at Harbor, which is a UCLA site, and the people who work there are UCLA faculty. We had a department private practice, and there was a point where there was one of those academic upheavals that people who don't work in academics don't understand [laughs]. They deposed the chair. I was at that point the vice chair, and they gave me the side-eye pretty strong. I said, "I'm outta here." At that same time, they decided they didn't want to continue with the department private practice, so one of the hospitals where we had been working called me up and said, "Would you willing to just come yourself?" That's how it started. It was not my practice before, but it was certainly something I was working in and knew about, and it was comfortable. Also, in your fifties is a crazy time to go out on your own. Fortunately, the state of California had a law that said that you could COBRA for two years, because nobody would even give me a quote for health insurance, because of some priors that I was like, "Really? Seriously? I know this isn't really a problem, so what are you talking about?" Eventually we got a couple other people, and then we could have a group health plan. My insurance was still incredibly expensive, but at least they couldn't tell me I couldn't have it. That was the most exciting part about going out on your own. [laughs] I knew I could make money; I just didn't realize I couldn't get insurance.

Clinical and Research Medicine

ZIERLER: Spending so much of your career with an academic affiliation at UCLA, did that influence the kind of medicine you practiced, and did you ever get involved in more fundamental research?

BEALL: Yes and yes. I was at the Westwood campus for several years. This is one of those things that I think is different for medical school, because in a medical school setting, you're expected to see patients because that's what brings in money, but you're also expected to be doing research. The people who were the most successful at getting tenure were the ones who managed to convince the house staff that they didn't know how to take care of patients so they were never bothered. In OB/GYN, if you're a woman, you already are a patient magnet, no matter what you do. So, it was difficult at Westwood to get any time to do anything serious. Once I went down to Harbor—Harbor, weirdly, although it's a County hospital, had a much more extensive lab than Westwood did. There's a long story about that. Part of it is that Harbor was the original UCLA hospital before they built the university hospital in Westwood. I apologize if you're not an L.A. person and you don't follow all this stuff. [laughs] Harbor had this big lab. They had multiple different animals projects going on. For a while, I worked on a project with mice who were aquaporin-deficient. Aquaporins are membrane water channels. The question was whether the aquaporins were responsible for regulating the amount of amniotic fluid. There was a whole project. Unfortunately after about three years of doing this, we weren't getting any significant information, so that kind of petered out. That's what happens in research, sometimes. There is still reason to think that aquaporins are involved, but the model I was using was just not doing it, which I will expand on, if you have any interest in that.

ZIERLER: Please, tell me.

BEALL: The animal model that had been used the most for looking at aquaporins regulating the amount of water in the egg were xenopus ova. Xenopus laevis, I think it's the African clawed toad, but it's an amphibian that lays big fat eggs. I had mice who were aquaporin-deficient, in aquaporin 1. It occurred to me that the mouse embryos are not much bigger than frog eggs, at least big frog eggs. We were taking the embryos out and putting—I had a whole device that I developed, that I built, to put individual embryos in, so I knew which one was from which mother. Then we'd incubate them in whatever fluid we were using and see if we could tell the difference in terms of how much water was absorbed into the embryo. It was a semi-clever idea, and unfortunately after a bunch of fooling around, it didn't really work all that well. That's where we got. [laughs] I couldn't generate enough data to get research support, and it was an expensive thing to do without that, so eventually I kind of gave it up.

In an academic medicine setting, you always do clinical research. We actually had a project at one point where we were trying to figure out how you could—let me back up. When babies are born, they can get stuck halfway out. It tends to get called a shoulder dystocia, in the theory that the shoulder gets stuck behind the pubic bone. It can be life-threatening for the fetus if you can't get it released. There are various maneuvers that are described. But one of the questions was, how good are we at actually deciding what is a shoulder dystocia, and can we objectively define this? Me and a bunch of research nurses stood in the back of the room with many deliveries and timed the events of the delivery. What we found was that two standard deviations from the mean for a normal delivery, between the delivery of the head and delivery of the shoulder, was a minute. So, if it went on for longer than a minute, this was objectively an unusual delivery. This was true whether it was the intern doing the delivery, or the attending, or the midwife. Midwives tend to have a whole different philosophy about how you do this kind of thing; it didn't matter. If things were going as per usual, the baby got delivered in that amount of time. The plan was to start looking at what things actually made a difference in terms of improving the time, if you had a baby that was getting stuck. That may still be going on, but it was a project I worked on for a number of years, and then somebody else took it over.

ZIERLER: What is the decision tree from medical school and residency, the level of specialization for an OB/GYN? How do you make those decisions ultimately leading to the things you're most interested in doing professionally?

BEALL: Well, I went to medical school. Now, my father was a professor of medicine, a very senior person. Internist medicine doctors in an academic sense tend to think that the OB/GYNs are brain-damaged. [laughs] The old joke is that you take the bottom 10% of the medical school class, and those that can bench-press 100 pounds go into orthopedic surgery, and those that can't go into OB/GYN. [laughs]

ZIERLER: [laughs]

BEALL: This was sort of before there were a lot of women in medicine. I won't say that that was my father's actual opinion, but it was just—so, I was at Caltech, and I took the medical school exam, the MCAT, which is the GRE for medical school basically, and did very well on it. The MCAT, at least at that time, was wildly variable. It had a whole section on things like organic chemistry, and then it had a whole section that was sort of general knowledge. It literally asked you questions like, "Which artist is famous for statues of ballerinas?" and "What direction is Rio de Janeiro from Buenos Aires?" I was like, "I know where they are from here." [laughs] This is not the kind of thing they do anymore because it's so culturally biased. I did quite well with the MCAT. My father was really impressed.

At about the same time, the pre-medical advisor at Caltech was a guy named Lee Hood, who had gone to medical school at Johns Hopkins—I don't believe he ever did an internship—and had gone to Johns Hopkins sort of because Caltech wouldn't take him back as a grad student, because at least what I was told was that the Department's position was that, "You've taken most of the courses and met most of the profs here; go learn something else." He was the pre-medical advisor, and his advice was, "Don't do it." So, I didn't really have a lot of thoughts about going to medical school. Then there were two guys that I spent most of my time studying with. One of them was just a little bit better than I was. He got it faster. He wound up at Rockefeller Institute as a PhD. The other one was not smarter than I was, in my opinion, but was willing to work 25 hours a day. He actually wound up going to medical school himself after being a PhD for a little while, and wound up as a pathologist, who is somebody who goes to medical school who doesn't really actually want to see people. [laughs]

I said, "Let me think about medical school." I looked into MD/PhD programs, which was probably more me thinking that PhD was a more legitimate academic degree than anything else, but the bigger MD/PhD programs—there was one at University of Chicago, and I interviewed there, but they didn't take me. There was one at University of Washington, but they didn't accept people from outside of their geographic area, because it was a state school. I applied to UC San Francisco. They didn't take me. I'm not really sure why. I applied to Harvard because everybody applies to Harvard. They weren't interested. Then I applied to UCLA. UCLA took me. A little awkward, because my father was a professor at UCLA, but, oh well.

Then in medical school, you rotate through the various clinical subjects, at least in the second half of medical school. You spend a few weeks on medicine, and a few weeks on surgery, and a few weeks on pediatrics, and a few weeks on OB/GYN, and a couple of weeks on neurology, and all these different kinds of things. Many of them were subjects that you've never really thought about. The thing I was most interested in going into was genetics. Most geneticists are pediatricians, but pediatrics is one step from veterinary medicine, because you can't—at least most pediatric patients, you can't really talk to about what's going on with them, so that didn't appeal. I guess it was the summer between the second year and third year of medical school, I did a lab project where one of my jobs was to take blood from the tails of rats. I was extremely popular as a medical student on peds because I was the only one they had ever met who could actually draw blood on a baby! [laughs] It was very similar—they're screaming at you, and they're jerking around all the time. [laughs] I'd start IVs but I couldn't tape them down so the baby couldn't pull them out, so the intern would say to me, "Get it in; I'll tape it down." [laughs] Then I did OB/GYN, not thinking anything. It's such a cliché—woman doctor, going to go into OB, save women. I just—I loved it. When I was in the hospital on another service and nothing was going on, I'd go up and hang around on the OB floor. They thought it was crazy. Just unexpectedly, that was what I really loved. Gynecology is fine, but if you just want to be a gynecologist, you might as well just be a general surgeon; there's more variety.

The thing I really loved was delivering babies. I did my residency at Columbia in New York and the guy who was the residency director was a character, not in the sense that he was inappropriate or anything, but he was just a single guy, about 50 years old, massively overweight, who was one of these people who never told you were doing well. If he didn't say anything, it meant you were doing fine. [laughs] But he was trained as a maternal-fetal medicine specialist, so I got interested in that. Nowadays, maternal-fetal medicine is all about ultrasound, taking baby pictures, but that was right at the beginning of real-time moving picture ultrasound, so that nobody, I think, really knew what that direction was going to go, at the time.

The other thing that the maternal fetal medicine docs did was to basically take care of a lot of the medical complications in pregnant women. Not all, but a lot of internists start running the other way when they find out the patient is pregnant, so, we do a lot of the diabetes and the hypertension and the thyroid disease, and sort of the five biggies, because it's just easier than trying to involve an internist who is trying to escape all the time. So, I decided to do maternal-fetal medicine. The biggest MFM program in the country at that time was at USC. A big city hospital will do about 3,500 deliveries a year. The really biggest ones do maybe 5,000. USC, the biggest year that they had when I was a fellow, did 17,000 deliveries a year.

ZIERLER: Whoa!

BEALL: There were two other hospitals in the country that were anywhere near that size. Now, mind you, there was supposedly a hospital in Caracas that did 50,000, so there were many bigger things. But the deal was, in those days, even in California, people who were not citizens, and certainly people who were not here legally, didn't have access to Medi-Cal, and so they only got treated through the county hospital. There was a huge flux of immigrants, and we had so many people that in fact the county finally started contracting with other hospitals to take the easy patients. So, we had 17,000 deliveries a year, but we also transferred 10,000 out of the emergency room to other places, so it could have been a lot worse. In California at that point, under a Republican governor, they decided that it was cheaper to offer undocumented pregnant women medical coverage than it was to take care of the babies afterwards when they had complications. Babies are all citizens if they're born here. It's still not true in many states in this country, but it's actually a source of some smugness on my part, because it's like, "Oh yeah, we knew we had to do that." There was a certain amount of craziness, because you had people who were only covered when you were pregnant, so you were always trying to slip in somebody's heart surgery while they were pregnant.

Part of the fun of that was that when I've worked in private hospitals, you knew that most times, if the patients went another ten feet down the hall, they could find an equally good doctor to take care of whatever it was that they wanted. The County in those days, we were it. We were on the front lines, and there was nobody standing behind you. [laughs] So, you just did the best you could. This has nothing to do with science; it just had to do with trying to deal with day-to-day stuff.

There is a pregnancy condition called pre-eclampsia, which is high blood pressure that comes with pregnancy. There are certainly forms of that that can be life-threatening, but the things that usually happen are moms whose blood pressure goes so high they have a stroke, or they go into heart failure, or something like that. The first two months that I was at USC, we had three ladies rupture their livers with pre-eclampsia, which I realized after the first one actually is a described complication. But I had not only never seen it before; I had never heard of it before! [laughs] It was just sort of like, "Whoa! What kind of place is this?" But that was what you had. You had people who didn't have any care, who didn't have any ability to get care. They came in, and you kind of had to deal with what was going on. The rate of maternal mortality is about one per 100,000. There are lots of doctors who have never seen one, or have been around when there was one during their careers. I have to say, I was not personally responsible for a lot of these patients, but of course when this kind of thing happened, you all knew about it. We used to get five or six a year. In those days, much of the time it was people who just hadn't had the opportunity to come in early enough. But there were plenty of other things that happened, some of which were inevitable, and some of which shouldn't have happened. There's an old saying that good judgment comes from experience; experience comes from bad judgment. You just hope that it's somebody else's bad judgment. [laughs] Whenever something bad happens, you have to kind of like pay attention and say, "Okay, that's what I'm not going to do." [laughs] I'm sure that there are lots of things about this that horrify people who aren't in medicine, but we were truly and honestly doing the best we could, and we thought we were saving more people than otherwise. Even at USC, they don't have that level of relaxed supervision anymore. In fact, they're only doing about 2,500 deliveries a year, so it's a completely different kind of place than it used to be.

Concentration in Obstetrics

ZIERLER: Did you get involved in the gynecology aspect at all, or you stayed always with obstetrics?

BEALL: As a fellow, I stayed always with obstetrics. In fact, USC was such a big service that at night, there was always one attending on call, but the attending was frequently a fellow. There was one on call for OB and one on call for GYN. The GYN attending took call from home; the OB attendings [laughs] were always there. When I went subsequently to UCLA, there would be one attending on call, and so I would get called in for GYN cases. But they're not cancer cases that happen in the middle of the night; they're usually a ruptured ovarian cyst, bleeding, or something that is fairly straightforward surgically to handle, and that's what we did.

Anyway, back up a little bit from UCLA. I spent two years as a maternal-fetal medicine fellow at USC, and then I was offered the opportunity to do a fellowship in medical genetics, which I kind of jumped at. I did a genetics fellowship—I guess they call it a residency—at Children's Hospital of Los Angeles, which was a USC affiliate. I always have loved the genetics, and this was a way to do genetics without being a pediatrician, so it's all good. But the other people who were fellows at the same time as me were pediatricians. The nurses would try to steer the older patients to me. [laughs] Somebody wanted their birth control, she came to Marie. Somebody would come in, and you're supposed to give them medication for the baby's ear infection—this was before I had kids of my own—I had no clue. They'd just laugh at me. One day, somebody else had a patient who wanted her birth control pills renewed. The other doctor came in and said, "She doesn't know what kind she's on." I said, "Well, are they green? Are they white? Are they pink? Are they yellow? Do they come in a long thin package or a round package?" [laughs] This was what we did all the time, when I was a resident. They all looked at me like, "Oh, she's not brain-damaged; she just has a different skill set." [laughs] That was mine. But after I finished my genetics fellowship, I came back to USC, because I still had a staff appointment at USC, and things got kind of ugly, because my mentor, who was a guy named Larry Platt, wanted to start a prenatal genetics division, but his boss, with whom he was butting heads all the time, said, "Well, Marie is someone who is trained. Maybe Marie should be the head of this." I was like, "I am not getting between those two." [laughs] About this point, UCLA came in to recruit me, so I went over to UCLA.

ZIERLER: Before we go back and establish some personal history, just an overt political question right now: with the overturning of Roe v. Wade, what is your perspective on where we are as a society right now and how this could have happened?

BEALL: My perspective is that I think a lot of the people are thinking about this in very simplistic ways. It's like, "Okay, it's a bad thing to kill a fetus, so therefore we should make that illegal." I've done a number of terminations, many of them later ones, because I get the genetic disease ones. What do you do with a fetus that has a lethan anomaly? I had a fetus that had nothing recognizable above the upper lip. There's a blob. Maybe there was some brain tissue in there, but there were no eyes, no nose. This is never going to be a person. The story with this lady was that she was from Arizona. Her doctor had scanned her when she was 16 weeks. At that time, roughly the limit for termination many places was about 24 weeks. Anyway, her doctor scans her at 16 weeks, refers her to the maternal-fetal guy, because the doctor is not really supposed to be calling this kind of stuff. The maternal-fetal appointment takes a little while to happen, and then the maternal fetal guy scans her and says, "[Panicked sound]!" and sends back immediately a note to the doctor saying, "This is terrible. This is not a survivable condition." The doctor that day filled out the forms, talked to the patient—she wanted to terminate—filled out the forms to the insurance company to get this authorized. At the insurance company, somehow, the forms just got put aside. I don't know whether this was somebody who didn't want to approve an abortion, or whether it was just somebody who lost track of what was going on, or what. At the point where this finally came around, the lady went in to look for a termination and they said, "Well, you're more than 24 weeks. We can't do it." Because that was the law in Arizona. The law in California says that if the doctor can make a good-faith determination that the fetus is not going to survive, is not viable—but it doesn't mean not alive now; not going to be able to survive after delivery—that you can do the termination anytime it comes up. They wound up referring her over to us at Harbor because no private doc wanted to get their hands in this. You could say, "Well, she's already like 26 weeks. What difference does it make? Just let her go to term and deliver." But I sat down and talked to this lady, and she said, "I don't go out anymore." Because when you're pregnant—I by that time had kids—people come up to you, strangers come up to you on the street and pat you on the stomach and say, "Oh, is it a boy or a girl? Have you chosen a name yet?" And you've got a monster inside and one that you know is not going to survive. She was not able to deal with this anymore. So, she came in, and we arranged for her termination. Not because I hated this baby, but just because she needed help. I have a whole list of babies who were just horribly gone wrong. Pregnant women who were 14 years old. I don't know if that counts as a woman, but anyway. These are not simple decisions. Just saying, "We're going to draw a line and say it's 15 weeks, and beyond that you can't do anything" is not realistic. There are plenty of people, especially a few years ago, when they got infertility treatments, would get pregnant with four or five babies. The chances, being pregnant with four or five, of actually getting healthy kids out of this is pretty small. I've not done this myself, but there are people who will go in and basically abort some of these kids, basically stop the heart of a few of the fetuses so that the others have a better chance at survival. It's not because mom doesn't want to have kids; it's just because the chances of going even close to term with five is miniscule.

Again, how do you process that in the light of all this other stuff? Don't tell me that God will provide. That's what people always tell me when they don't want to believe that there's something wrong with the baby. I've had women after the baby is born look at me and say, "Why didn't you tell me it was so bad?" And you're like—[laughs]. The other thing is that as I've gotten older, I've realized that doing ultrasound, a lot of it is just like being the person at Sears who takes baby pictures. It's patient entertainment, and you look at a few things. The chance in an unselected baby that you're going to find something serious is very small. That's fun. Then every once in a while, there's a problem. I don't wish for anybody to have a problem, but when there is one, it's like the most interesting puzzle in the world trying to figure out what it is, and where it is, and what else might go along with that. That's what keeps me doing this. That's not science in any real sense, but that is kind of how I got here. As far as pregnancy terminations, there's two sides to that coin, and I don't know how much you favor one over the other.

ZIERLER: It's regressive, though, at the end of the day.

BEALL: I am quite sure that it is regressive. There are a certain number of people—or there at least used to be a certain number of people—who were using abortion as their means of birth control. In this country at least, that is unfortunate, because we have better, safer ways to do this. But most people who are getting a termination are not getting a termination because they had a fight with their boyfriend. They're getting a termination because something terrible is going on.

ZIERLER: And that's not going to go away by forcing them to bring the baby to term?

BEALL: No, no. Even the ones that are—years and years ago, I had a lady who—she was not really my patient, but I met her in a clinic that I was working in. Looking at her chart, she was—do you know what skin popping is?

ZIERLER: No.

BEALL: It's just injecting cocaine—I think it was cocaine—but just right under the skin, not into a vessel. She was skin popping in her breasts. She had multiple abortions. I'm pretty sure that part of the reason was that the skin popping is better during pregnancy because the breasts get more vascular. Then she'd go to about 12 weeks and then she'd have an abortion. I mean, really disgusting reason to get pregnant and have an abortion. On the other hand, you're going to punish her by making her have a baby? It's like, there's no good right answer to this.

UCLA Faculty Brat

ZIERLER: Let's go back in happier times. Let's go back to high school. Did you grow up in the Los Angeles area?

BEALL: Yes, I did. I went to high school at Palos Verdes High School, which is public school.

ZIERLER: Did your father involve you in his career? Did you have an idea of what academic medicine looked like?

BEALL: I knew what the lab looked like. We had all been to the lab from when I was a little kid. We used to go down there on the weekends with him sometimes. When you're a little kid, the most exciting things were the chairs on wheels and that stuff that they put over the top of test tubes that you can stretch out more and more. The contest was to see how much you could stretch it out. We all knew what a lab looked like. I didn't know about academic medicine in the sense of the peculiar things that go with academics, just like you don't know how a big company really works until you go work for one.

I grew up in West L.A. and then down in Palos Verdes. We had the advantage that my father took a sabbatical when I was about 13, and we lived for a year in London, which was an amazing experience. When it came time for me to go to college, I was applying for various places. I wanted to apply to Stanford, and my brother, who is a year and a half younger than I am, pitched a fit because he wanted to go to Stanford, and he didn't want—that was his school; he didn't want me to take it. Mind you, neither one of us went to Stanford! [laughs] It was like, "Okay, what other good place in California?" I got a letter from Caltech saying, "By the way, we're now accepting women." I got recruiting letters from crazy places. I got several from Michigan State, to which my father said, "Oh, fullback or halfback?" I got interested in Caltech. Then I applied, but it was one of 20 applications you send out. My dad went to a meeting that he went to every year, that was at Asilomar. It must have been an immunology meeting. I don't even really remember what that meeting was about. But he met Ray Owen, who I think he had met before, and Ray Owen walks up to him and says, "Your daughter is applying to Caltech" and he says, "Uh, yeah?" [laughs] First time my dad was ever approached by a scientist to say, "Oh, we're interested in your kid." Ray said, "Send her out to see me." So, I went out to take the tour at Caltech, and he talked to me for a while, and he arranged for one of his students to take me around and show me the place. As compared to I went to UC Santa Cruz, and I attended the lecture of some guy talking about how to build a compost heap, which just struck me as maybe kind of far from what I was really interested in.

I'm trying to remember where else I actually got to interview. You didn't travel as much in those days as you do now. Our kids were all like, "Oh, we're going as far away as possible." They all wanted to go out to places on the East Coast. We did, for both of them, the great college tour everywhere. I decided, "Okay, yeah, I'll go to Caltech. It'll be fun." Then you got there, and after a couple of months, you realized, "I didn't know there were so many people in the world like me." My younger daughter went to art school, and she had the same reaction after a while. She was like, "Wait, there are all these people; they think the same things are important." [laughs] That was when I decided that I was really in the right place. There were always a few people—there was one guy in my freshman class who left to go to Stanford because he wasn't popular enough with the girls at Caltech. He thought of himself as a real catch, and everybody else was like, "Yeah, right." [laughs]

ZIERLER: Growing up, were you always more on the science and math side? Was that where your academic strengths and interests were?

BEALL: Oh, yeah. You were talking about high school guidance counselors. In those days, and I don't think my high school was so far out of the mainstream, the high school guidance counselor—they call you all in when you're getting ready to apply to colleges—and he says, "You have really good grades. You should apply to USC." I'm a UCLA faculty brat, and I'm like—[laughs]. At the end of the senior year, they give out prizes for various pieces of nonsense; I got the math prize. I was the first girl who had ever gotten the math prize at PV High. It was just girls got the English prize, and boys got the math prize. I'm not sure that that was exactly that way, but it seemed like it. The reason I got the math prize was because—this is a long story.

ZIERLER: Please.

BEALL: We went and spent a year in London. When I came back from London, I was a freshman in high school. They put me in algebra class, because that was where they thought my math needed to go. It was like the slowest class ever. I was going crazy. After a couple weeks, I went to the guidance counselor, and I said, "This is crazy. Can I get into a smarter-kid math class?" They looked at me funny and they said, "Well, all of the smart kids took algebra in the last school, in middle school, and that's not where you are." They finally made a deal with me that, "Okay, here's the book. Study it on your own. Let us know how you do." I was new in town, I didn't have many friends, and I was a little ticked off, so I took out a calendar and I listed the number of pages I had to do every week. Halfway through the school year, I came up and I said, "I'm done now. What do you want me to do?" And they said, "Uhhhhhhhhh, okay, the next class is geometry. Here's a geometry book. Go." By that time I had some friends, so I only did half of the geometry book. I said, "Okay, what am I going to do?" The way they did summer school was clearly not for you to get ahead, because they did the first half of geometry in the morning and the second half of geometry in the afternoon, so it was intended for kids who had flunked one half of geometry or the other. But this was great for me because I took the second half of geometry in summer school. They handed around these cards, and this teacher said, "I want you to write on the card what you got in your first semester of geometry and what you got in your second semester." I took the card up and I said, "I didn't have the second semester grade." She says, "Oh. You're the one." [laughs]

In those days, not everybody took calculus who was intending to go to college, so I never got to calculus. The guys who had done calculus were really ticked off about me getting the math prize. [laughs] Math was never hard. I have to say, though, I have a bone to pick with the calculus people. The number of people who use calculus in their daily lives is—some engineers; physicists maybe—and they don't require statistics. You look at the newspaper articles, and they say the most idiotic things about statistics, and nobody challenges it because nobody understands what they're talking about. It just seems to me like what regular people need is not calculus; they need statistics. There you go!

ZIERLER: Were you aware, even as a high school junior, that Caltech had admitted women? Did that register with you at all?

BEALL: I don't think so. It was a time when a lot of schools were admitting women for the first time. A friend of mine, his older sister was one of the first women at Yale. You knew that that kind of stuff was being possible. I'm not sure I even knew about Caltech, very well. Story of my life; I just fell into it, really, more than anything else.

ZIERLER: When you got there, did it feel—? Obviously you would have had nothing to compare it to, but the year before, this was brand-new. Did it feel like the adjustment had been made at that point, that Caltech was a place that had women and things felt normal?

BEALL: No. I lived in Ruddock House. It has got some other name now. Debbie Dison—she's now Debbie Hall, but she was Debbie Dison at the time—was sort of the den mother. There were six women in this house with about 90 guys. I remember [laughs] somebody had decided to make a women's nook by hanging curtains in the hallway so that our rooms were separated. This never worked. The stupid curtains were a bad idea. There was one women's room, which was obviously made just by somebody writing "W-O" before the "MEN," because it still had urinals in it. It took us about half a year to figure out why it always smelled so terrible in there, and it's because nobody ever flushed the urinals. Because why would we? We used them to hang up our bathing suits that were wet after a swim. [laughs] We discovered that we had to go in about once a week and flush the urinals, and this terrible smell went away.

I don't know if you've heard these stories, but there was sort of a tradition about grabbing people and throwing them into a shower in their clothes, or if they were really obnoxious, carrying them all the way down, and throwing them in one of the ponds. There are now girls, and there are a lot of guys who are not sure how they can get to touch a girl, and so girls tended to have that happen to them maybe more than others. I don't think I ever really felt like I got felt up or any of that, but it just sort of—but, yes, there were some ways that you really felt like you fit in better than you had in high school, and other ways you'd sort of get pulled up short and realize that, okay, yeah, this is still—weird. One time, Debbie and her roommate Marian decided to have a slumber party. There were all of six of us, and you would have thought there was nothing going on in the universe except that a bunch of girls are sitting in this one room gossiping. The guys were like sitting outside the door with glasses up to the door, shotgun mics through the window. And it's like, "We are not talkin' about you." [laughs] But it was really funny.

A lot of these guys were not very well socialized. Typically during the day and the evening when you were doing homework and stuff, your door would be open. We had guys who would come in and sit in our room, and then when you decided to go to bed, wouldn't leave. You'd finally kind of roll your eyes and go to bed, and let him sit there, in the dark. But these were the ones who were never going to be very well socialized. They were just the guys who got A's in computer science and D's in everything else. [laughs] Actually, it was not computer science. I don't think there were that many computer science nerds in those days. But yeah, they were only interested in one thing, and that was all that really mattered.

Life Sciences at Caltech

ZIERLER: Was it always life sciences for you, that you were most interested in?

BEALL: Yeah. I had no experience in physics. It was really funny; high school physics and calculus were supposed to be prerequisites for getting into Caltech. As it turned out, I had neither. For some reason, the whole math thing just kind of went right by me. But physics, I knew I was in trouble, so I sat down with the high school physics book and went through that over the summer before college. It turned out that made absolutely no difference whatsoever, because high school physics is taught with really no math at all. The problem was when the professor came in the first day and wrote a differential equation on the board, I had absolutely no idea what he was talking about! [laughs] The thing that saved me the first year was it was all pass/fail, and I managed to squeak out passes. I would not have gotten very good grades a lot of that first year. But by the beginning of the second year, I had kind of caught up. It was that sort of Caltech thing where the really smart guys had done math, too. It was like, listen, I was lucky to get pass/fail. [laughs] Guilty with an excuse. But that was kind of the way it worked.

ZIERLER: Was there intelligence shared among the women undergraduates, particularly with the older class, about professors who were considered allies, to a degree?

BEALL: I don't remember very much talk about professors. There were certain grad students that you kind of knew you wanted to avoid. The thing I remember was when I was a sophomore or junior, we had a new set of freshmen, and there were still like 15 guys for every girl, and some guy was trailing around after this girl and we said, "You don't have to take this. You can just tell him to go away. The other guys will make him go away if you tell them that he's bothering you." And they just couldn't imagine turning down a guy. You're like, "You'll learn." [laughs] One of the most fun things about Caltech was that being interested in math, being interested in physics, was not a turnoff for a lot of the guys. It was like, "Finally, somebody I can talk to!" [laughs] Because in high school, you constantly had to kind of censor yourself so that you didn't sound like you were too studious or too—but Caltech, for a lot of the guys at least, it was not that way. It was like, "This is the only thing I really know anything about. Go!" [laughs]

The other thing I remember about the first year at Caltech—I took the regular English class, which was some kind of survey, but a lot of it was books about young men coming of age, which I think had been picked out in a previous iteration of Caltech. One day we were tasked to read Portrait of the Artist as a Young Man, which I read cover to cover and hated it. It was because here's a guy whose constant complaint is that women are mysterious and unknowable and are jerkin' him around and aren't interested in him, and he was such a weenie. So, we all go in there the first day we're supposed to discuss the book, and unknown to me, the professor was a Joyce scholar. The first day, we go in there, and he said, "Well, what did everybody think?" And I said, "I think Stephen Dedalus is a toad!"

ZIERLER: [laughs]

BEALL: Which was—of the many things that he thought might come up, that was not one of them! [laughs] He kind of [stuttering sound] and he said, "Uh, class dismissed." All my classmates were like, "Yay, do that next time!" [laughs] I had read the damn book, but the problem was it was just not speaking to me, at all. I think they finally got that idea, but for a while, it was sort of like every book you were reading was about somebody else, somebody who specifically had trouble with you, and you're like, "I don't like you." It was a lot of just getting people to put bathrooms in, and not teach to the 20-year-old male paradigm that they had in their heads.

Now, when I started medical school—sorry, this is not a Caltech issue, but—there were twice as many women in my medical school class as had ever been in any UCLA class before. It used to be, at least from what you read, fairly common in all kinds of medical schools, for the professors to slip pinup pictures into their slide set. That happened once, and there was such an outcry that it never happened again. But there was finally enough women in the class that there was sort of that critical mass. People weren't going to take this kind of bullshit anymore. Of course, my experience at medical school was like, "I haven't seen so many women around in a long time!" [laughs] That was not everybody's experience.

ZIERLER: What about politically on campus? Of course Caltech is a very different place than Berkeley or Columbia, but the women's rights movement, civil rights, the Vietnam War, were these issues that you remember as an undergraduate?

BEALL: I remember the Vietnam War. One thing was, it always seemed like the professors were more politically aware than the students were, and more liberal than some of the students were, which was not necessarily the way things worked other places. There was a big poster that went up on the side of the library that said, "Impeach Nixon." I think I know some of the guys who had to do with putting that up. [laughs] I remember working in the lab and it was during the Nixon—the whole Watergate thing—and they had this whole blackboard—there's the White House, CREEP, others—and they had all these names of people and arrows to say who had implicated who in what [laughs] on the blackboard in the lab. There was a lot of quiet glee about all the stuff going on to politicians. I'm not sure it wouldn't have been similar if it had been more liberal politicians. But that was kind of the limit of it, as I recall. The other thing was that my class was the last one to get draft numbers. Do you know about this?

ZIERLER: Yeah.

BEALL: As it turned out, nobody from my class was actually drafted, I don't think, but they were the last ones to actually get the numbers to show what order you were in. They were very smart about this. They would say, "We don't plan on taking more than up to number 60." Then once they distributed the numbers, everybody who had a number higher than 60 would lose interest in it. But yeah, Vietnam was there. It was all the time. You all knew people who had been drafted. You knew people who had done semi-weird things to avoid getting drafted. It was like the war in Afghanistan became; it didn't seem like we were accomplishing anything other than burning money and people.

I don't remember there being a lot of verbiage about either women's rights or civil rights. I'm trying to think if I knew more than one Black guy at Caltech, and I'm not sure that I did. Two. There was one guy who was famous for being clumsy in the chemistry lab. All I really know about him was that every time you'd hear a crash of glass, he'd say, "It's just me! I'm fine!" [laughs] I'm not even sure it was always him. [laughs] It was sort of like somebody way over there you couldn't really see. That was organic lab. The freshman chem labs when I was a freshman were farmed out, because the Gates, the Chemistry building, was closed, because of the earthquake. So, there were like three or four of us in somebody's chemistry lab where they kind of kept us corralled over in a certain spot so we couldn't wreck anything real. [laughs]

ZIERLER: Were there any faculty members who were really useful to you as either mentors or in focusing your academic interests?

BEALL: Probably the two that were the most useful to me in an academic sense were Bill Wood and Lee Hood. I worked in Bill Wood's lab for a while. It's not that I ever talked to him about this, but he had a famous father, so it was sort of the same kind of thing. What do you do about all this stuff? Lee Hood was—the two of them were writing the biochemistry textbook. The first year I took biochemistry, what we had was sort of copied pages or preprints or something, of the book. We would mark it up and say, "Uhh—" They were people that I was around a lot, I worked with, admired.

Max Delbrück was a very senior professor. He was famous in the Biology Department because he would have parties. It was a great thing to be invited to Max Delbrück's house for a party, because for one thing, it's the only place I have ever actually had my hands on a Nobel Prize, because he would get them out. [laughs] The other thing is that crazy things would happen. Like one time but they had a puppet theatre left over from some children's birthday party, and he said, "We're going to put on a play, a puppet play." I have no idea how much of this was a put-on by Max or what, because they got this whole thing, and there's an evil professor who is going to give the students a question that can't be answered and then like fail them all. Then there's some servant or chef or something who finks to the students. There was an advanced biology class that I hadn't taken yet, because I was a junior student, but they had a couple of the students playing the students. They had the neuroanatomy professor playing something; the professor, I think, but I'm not sure. They get to the crucial point of the show, and the servant explains to the students what is going on, and one of the students says, "[Gasp] That's even worse than neuroanatomy!" At which point the performance was called because the professor couldn't go on! [laughs] That may have been a put-up from the students and Max to sort of let this professor know that things were a little bit too intense in his class! [laughs] I think it was his first year teaching. That was the kind of thing. Ruddock House was known as being the house that had the most glee club members, so when we went out Christmas caroling, it was a big deal. We would arrange our Christmas caroling route so that we wound up at Max's, because if you told him when you were coming, he'd invite everybody in! [laughs] he was fun. He was not somebody that I ever worked with in a scientific sense, but he was extremely approachable. If you got him going, he'd start talking about when he was a student in Heidelberg back in the old days, when people would duel, to get interesting-looking scars that impressed the girls. [laughs] Again, I'm not sure how much of that was really true. I'm sure at some point that was true in Heidelberg! [laughs]

ZIERLER: Did you stay on campus during the summers? Did you do lab work, or did you go back home?

BEALL: I did do lab work for at least two of the summers. I did not stay on campus. When I was there, the dorms weren't open in the summertime. We stayed in this house—I don't remember how we found it the first year—but there was this little house that was down Orange Grove, or down California all the way past Orange Grove. There was a little old lady who liked to go for the summer and visit her relatives on the East Coast. She was looking for girls because they were less destructive than boys. It was the most amazing house. She had apparently been married to a minister for a long time. He had died, and she was going around visiting family. But it was this little, tiny house under a leaning tree. One day, we had invited our professors over for dinner, and we were looking around in the kitchen for serving dishes and things like that, and up on the upper shelf, there's a violin case. We were like, "Huh?" It was a Stradivarius! [laughs] The only reason I know that's what it was, was because there was a newspaper clipping about it, in the violin case. We were like, "We're putting this away and forgetting we ever saw it!" [laughs] It was that kind of place. You stumbled over big silver tea services when you started looking around for things. It was a lot of fun. It was four of us, two bedrooms. The first year, it was me and Frances Janssen and then a woman who was a grad student, and another woman who was not a Caltecher but had been on the Caltech cheerleader squad. Sort of a different version of life. The grad student was very important because we had the use of this lady's car but you had to be a certain age to—you had to be more than 25, I think, to fall under her insurance, so only the grad student did. It was this enormous Cadillac. The grad student was a little woman, and she'd sit there like this trying to drive, because she could barely see out the windshield. We used to use it like once a week to go down for grocery shopping. We tended to take about three other people as well, because they were like, "Hey! Transportation to the grocery store? Yeah, I'll do that!" We'd have a big event once a week and drive the car and go down to the grocery store. I haven't thought about that place in a long time!

ZIERLER: [laughs] When did you settle on medical school for your next move? Were there any professors who were encouraging you to think not medical school but a PhD in biology?

BEALL: Like I said, Lee Hood used to say, "Don't go to medical school" to everybody. I don't remember anybody saying to me, "Yeah, go to medical school." That was my dad. I think it was more just—second-year biochemistry, one of the things at the end was you had to submit a research proposal. The grades were "accepted," "accepted but not funded," and "not accepted." [laughs] I'm not sure quite what all of their thinking was with this, but it made you understand that just having a good idea was not going to get it. I wasn't quite ready to go out there and start tooth-and-nailing it to be getting money. You realized when you started looking around at PhD programs that they weren't asking you to come in and have a great idea; they were asking you to come in and work on their idea. So, it wasn't really as exciting as it would have been to be going out there and curing the world. This was one of those things that you learn as you get older, especially in academics. Students are all the time coming in and saying, "I want to study this disease." You look at them and you say, "Well, there's about 13 people in Los Angeles who have that disease. In any kind of reasonable timeframe, there is no way that we're going to be able to get anything done. We have to either look at something that looks like that disease, or we have to think of another topic." That's a big part of the problem with any scientific endeavor. People wind up doing weird things with toad eggs, and it's not because anybody really cares about toad eggs; it's because you're sitting there trying to figure out how you can get to the question you really want to answer in a way that you can actually do. But when you're a student applying for the next level of studies, toad eggs just does not sound like the greatest [laughs] thing in the world.

From Caltech to UCLA

ZIERLER: Did you want to stay local? Was it Los Angeles that you were specifically focused on for medical school?

BEALL: No, that was happenstance. I actually got accepted at other places, but not anyplace any better than UCLA, and I had a certain amount of pressure from home that, "Yeah, UCLA is a good place." So, "Okay." I did my residency in New York, about as far away as it was really possible to get. You have to leave home sometime! [laughs] I got married my third year of medical school, the end of my third year. My husband had finished law school, which is only three years, and he had accepted a job in New York, so I was only applying for training in New York. As a student, I arranged to do some rotations at hospitals in New York, which is actually one of the things you do anyway when you're looking for internships, is to try to impress them with how great you are. The funny part about this was I went for a month and then I came back. I was staying with my parents, because why should we have another apartment in L.A.? My mother said her friends came up to her and said, "Did something happen?" [laughs] We used to say we knew lots of people who lived together before they got married, but we were the only people that we knew who didn't live together after they got married! [laughs] Because that first year, I was sort of back and forth, which really—to me, the hardest part about marriage was always what I called roommate issues. What do you do with the wet towels? My husband always put his wire hangers in with the clothes in the laundry basket, which drove me crazy. Since we would be together for a month and then not together for a month and then back together for a month, we went through all those roommate issues about four times [laughs] before we finally sort of settled on a consistent thing. We're still married, so I guess it's not that bad! He is also a Caltech grad, so we're like the atypical Caltech grads. He was a law school professor.

ZIERLER: Oh, wow.

BEALL: It's really funny, because he has never practiced law. Law schools are a little different; they don't strongly encourage the faculty to go out there and do trials or whatever. He lives to write. One of the nice things about the law is that although he may take a dataset and do some statistics on it, he doesn't go out there and generate new numbers on anything. A lot of it is opinion. And you know the story is with lawyers that they'll argue about anything! [laughs] He has been retired from any full-time faculty position for ten years, and he still puts out a couple papers a year. He has got an emeritus position and that's good enough for the law reviews. He does it because he loves it. Not what I would choose to spend my time on, if I didn't have any—but nobody really cares what I want to write. [laughs]

ZIERLER: Coming in with a Caltech degree, how well prepared were you for medical school at least in the classroom?

BEALL: The thing that was hardest about medical school was all the memorization, because Caltech was totally not about memorization. There was one time that they expected that we would have memorized all the steps in the Krebs cycle, which I can't even tell you. I was like, "Really? Come on. Everybody can look that up!" [laughs] Once you get out on the wards, there's the expectation that you're going to know, if they tell you somebody's potassium is six, is that normal or not. Anything that you do several times a day, you start to learn, but it still strikes me as like, why would you do that? Why wouldn't you just have the report in front of you and it says what's normal? Because every once in a while they change the reagents or something, and the normal becomes different anyway. In medicine, that was always a big deal, was that you were supposed to be able to know what was normal.

The other thing is that in medicine, more than most of the scientific stuff that I learned, there's just so much that we don't really know. Like this whole COVID response where everybody was like, "Oh, they were lying to us"—they just didn't know. That's what medicine is like. Is it the right thing to do a cardiac bypass on somebody? Who the heck knows? They say about surgeons that if your only tool is a hammer, everything starts to look like a nail. Surgeons will operate on things just because they can. You have to catch up with them afterwards and say, "No, that really isn't the best thing to do about that." You can't do a really good control trial. There's too many variables. You just have to do the best you can. Medicine slowly, slowly has gotten into this—the ideal is what they call evidence-based medicine, that you're supposed to be looking at what the studies tell you. Unfortunately, anything that is more than about 15 years old is based on standards of study that we wouldn't accept nowadays, so you're still sort of going around and around.

When I was a medical student, I had this very bad habit of spending more time writing down the jokes than the actual stuff that they were saying in the lecture. There was a guest professor who—I think he claimed that this was a response that he had heard from a professor—but anyway, somebody asked what he thought was an impertinent question, and he said, "Young man, there are so many things in medicine for which there is no good explanation that you might as well just stop thinking and start memorizing right now." [laughs] My husband keeps saying about various medical issues "Well, that's not logical." And it's like, "It doesn't have to be logical." [laughs] It's logical according to some system that we haven't figured out yet. He tested positive for COVID a couple of weeks ago—"Why do I keep testing positive?" "Well, because there's stuff lingering around." "Well, that doesn't make sense. Why am I not still infectious?" It's like—it's not a "why" question. [laughs] You have to have a lot more tolerance for uncertainty. [laughs]

ZIERLER: When did you develop the interest in obstetrics? Was that before your residency?

BEALL: Oh, yeah. Well, you have to decide what you want to do your residency in. It's funny; you finish the second year of medical school, and you get into the clinical clerkships; that means you go out on the wards, basically. At the beginning of that time, there are a few people who have ideas about what they want to do, and a lot of people who just don't know. You do your first rotation in surgery, and a lot of people get done with that, and they're like, "Well, that's something I'm never doing again." Eventually, most of us got to something where you're like, "Yeah, that's it. That's what I want to do." Some people are, "Yeah, I want to become a professor, and the best way to do that is to do medicine and then do a fellowship in this or that." Then there are those who get to the end of the third year of medical school and say, "I hated everything." Then you have to think about, why did you hate it? "I didn't like the hierarchical structure." Well, that's really not going to be there when you're in practice. "I don't like dealing with people." Okay, pathology; that would be a good one for you, or anesthesiology. Have you ever heard of a book called The House of God?

ZIERLER: No.

BEALL: There is a book called The House of God, "the house of god" being the translation of "Beth Israel." It's about one of the big Harvard hospitals in Boston. It's about somebody's internship at the House of God. When you have done an internship—I was an intern at Columbia, which is a very similar kind of setting—it's sort of painfully real. They have all these aphorisms. Some of them are things like "Age plus BUN equals Lasix dose, which is only funny if you're a doctor. [laughs] Then there are things like "Gomers go to ground," which means just that people who are—not old and useless, but old and non-functional, and why are we working so hard to keep this person alive, when they don't value life and can't contribute to it—"go to ground" means they fall down if you're not watching them. At some point, one of the interns commits suicide. The author's mentor is the senior resident who he calls The Fat Man. It turns out most of these apparently are real people. The Fat Man was rumored to be a gastroenterologist in Beverly Hills. In the book he always says he's going to go into gastroenterology and do the bowel run of the stars. Eventually, he sits the interns down about what speciality they want: "Well, if you don't want to deal with gomers, how can you not deal with gomers? You can become a pathologist. You can become an anesthesiology, because they're all asleep anyway, and you're not going to have to talk to them." Then they say, "You can become a psychiatrist." This is because the guy who wrote the book is a psychiatrist. Those of us who aren't psychiatrists, think, "Oh no, biggest gomers in the world!" [laughs] Crazy people; oh, no. Part of it is that the patients that are involved in the specialty that you want are not annoying. Patients who have things that you don't think are interesting or you don't know what to do with tend to be more annoying. People you can't cure tend to be more annoying. That's kind of what the whole House of God thing is. Like I said, it's borderline horrifying for anybody who is not in medicine, but it's really a lot closer to the truth than is really comfortable. [laughs] When I was in training, I used to know people who claimed that they knew these people, or some of them. I started my residency in 1979; it was probably written in the early 1970s.

ZIERLER: What was it like managing the two-body problem when you were choosing a residency program?

BEALL: Again, he had already had a job in New York, and there are lots of training programs in New York, so I basically confined my search to training programs in New York. I guess I applied to Yale, which is not too far from New York. The funny part about that was you'd go to every interview—you know how dyed-in-the-wool New Yorkers are, like nothing exists west of the Hudson? They'd have these group interviews, and there would be like ten people there, and there would be me; there would be one person from Harvard, Yale, Brown, someplace like that; and then the other eight would be from New York Medical College, which is not an especially highly-regarded medical school and is also full of dyed-in-the-wool New Yorkers, so they can't imagine going anyplace else. They're all sitting there going [gasping sound]. The other two of us are like, "Eh, them again." [laughs] I didn't feel a lot of anxiety about not being able to get a place in New York.

One of the funny things was that the chair of the department of OB/GYN at UCLA where I had been a student had been at Columbia. Apparently, a lot of the faculty there hated his guts, but it didn't matter, because he was still a force in the world. Even though I had met him like twice, he wrote me like about a two-and-a-half page letter. And I know, because everybody who interviewed me sat there and said, "Oh, you have a letter from J.G. Moore" and would sit there and read the whole thing in front of me. [laughs] I'm quite sure that's what got me my residency. But it was so funny, because students have a tendency to say, "Well, the person who knows me the best is that attending I really liked in pediatrics." That's not who you want to get to write your letter. The department chairs know that, but I think the students, a lot of times they're not—at least when I was in training—nobody really pushes that at them. If that attending in pediatrics is any good, he'll say, "I would be happy to write you a letter, but you really need to get one from—from somebody who makes a difference!" [laughs]

ZIERLER: What kind of medicine did you want to practice as a result of the residency? How did that focus your options?

BEALL: My image of medicine was always academic medicine. I was at Harbor. My dad was also at Harbor. We crossed paths at official banquets and that kind of stuff, occasionally. Somebody I know, not a physician, was at an event and met my mother. This was at a time when I was the vice chair of the OB Department. My friend said to my mother, "Oh, you must be so proud of Marie. She's doing so well." And my mother said, "Well, she's not doing very much research." [laughs] So, you know, it's—I am proud of a lot of the things I've done in medicine, but I always have this feeling that it wasn't really a successful career, because I didn't do research and write earthshaking papers and stuff. But that's what you get. I've enjoyed myself a lot of the time.

ZIERLER: Following residency, what came next? What were you considering?

BEALL: Most residencies don't really prepare you for an academic career, because there is no research component in a residency. Most accredited fellowships will have a research component. So, I always knew I was going to do a fellowship. I did my fellowship in maternal-fetal medicine because that's what I liked. I did research in fellowship. Because of the place where I was a fellow, it was more what they call clinical research, based on clinical datasets rather than going to the lab and doing stuff.

ZIERLER: Did you want to return to Los Angeles? Was that part of the calculation?

BEALL: It wasn't a big deal. It was really more that the premier fellowship positions were at USC, probably at Yale, and those were the biggies in those days.

ZIERLER: Why USC? Why in that area? Do you know the history there?

BEALL: Part of it was just that they had so many deliveries. Of those 13 people with that disease in L.A., ten of them were going to USC. [laughs] That was really the biggest issue. I knew people who could get me in there. It was a well-regarded program. Most of the people in that field had spent some time at USC in those days, so that just seemed like a good fit. The residencies now are done according to what they call "the match," which means that the candidates apply, they rank their programs from one to whatever, and they can discard programs that they don't want to match with. The programs rank their candidates, and then it goes into a huge computer and mixes it all up, so there's very little ability to game the program. You can't get anybody to commit to you early, because you don't have any way of enforcing that. Even if they say, "Oh, yes, yes, I'll mark you first," they can tell ten people that, and you can't tell the difference. The fellowships now are done the same way. But when I was a fellow, I interviewed at USC and the guy offered me a job at the end of the day. Since that was a place that was at least in my top two, I said, "Okay, yeah, I'll do that." [laughs] I also applied at San Francisco because they had an MFM/genetics track, but that wasn't available by the time I actually got there for an interview. They were like, "Well, we'll think about it." Then the next day, the other guy offered me a job, and I was like, "Yeah, I'm taking what I got."

ZIERLER: Being in that environment, was it less clinical than it otherwise might have been? Were you spending more time in the laboratory, more time doing research?

BEALL: There, in those days, it was kind of back and forth all the time. Nowadays, for that kind of fellowship, you would be required to spend 50% of the time in research, which means no more than one clinic a week. There's a good deal more active expectation of research. You have to produce a thesis by the end of your fellowship, which is part of getting board-certified. That was true even when I was a fellow. Actually, one of the more common reasons for not getting board-certified is that somebody can't come up with an adequate thesis, either because they didn't do any research, or because they don't know how to defend the thesis that they've got, which means they didn't do as much of it as they thought they did.

ZIERLER: It's almost like a PhD within an MD world.

BEALL: Yeah, I would say so. I've never done a PhD defense, but I have to think this is sort of like a baby PhD defense. They ask you things like, "This paper that you cited, was that a randomized trial, or was that just a cohort trial? How many patients were in it?" I had heard about this, so I read all that stuff up before I went in for my boards, and it was fine, but I can imagine somebody getting completely messed up. To become board-certified in OB/GYN both after the residency and then again after the fellowship, you have to take an oral exam, and oral exams, on the face of them, are just threatening, because you just feel like people are going to laugh at you if you say something stupid. And, there are people who give the orals who don't necessarily laugh but they will be very harsh, such that they sort of terrorize people. Some of that is more legend than true, but I've had at least one of them give me one of the board exams. [laughs] "So you gave this patient ten units of insulin which you think is the right dose." It's like—[laughs]—nobody's going to die from ten units of insulin! [laughs] Anyway.

Thesis on Medical Genetics

ZIERLER: What did you focus on for your thesis?

BEALL: I did a study on treatment of premature labor with—it was a comparison of a couple of different drugs. Nowadays they would do this trial with a placebo arm, but in those days, our human subjects committee wouldn't allow us to put in a placebo arm, because they thought that it was unethical not to treat this. It turns out that none of the drugs are good enough that you can actually separate them from water clearly, so that it makes sense to do a placebo arm. That was a defect in the study, but it wasn't anything that we could cure. One of the things that was interesting about it was that one of the drugs that was most commonly used, you had so many side effects that it was less effective, because people couldn't tolerate the dose.

ZIERLER: When you decided at the Children's Hospital of Los Angeles to focus on medical genetics, you were talking about how this gets you close to the pediatricians. Were you following all of the advances, to go back to Lee Hood, in protein sequencing and DNA sequencing? Were these technologies that were becoming relevant in a clinical setting at that point?

BEALL: Really, no. DNA sequencing now; yes, absolutely. One of the things that is the most exciting is that now, you can take a pregnant woman's blood, get the baby's DNA out of their blood, and then sequence it. We're not quite there yet, but the technology to sequence the baby's DNA is there. They do that on amniocentesis, where we know it's baby, and we'll get there with the cell-free DNA in the mom. With the mom's blood, they can test for like Down syndrome, for a whole extra chromosome. It's not quite as good as doing the amniocentesis, but it's close, and much less discomfort and risk than sticking a needle into the mom's stomach. What they call a perinatal microarray, they can look for all—the trouble is that you test for a whole bunch of things, or you test for—they're not quite down to gene level, so they're looking at larger segments. If they find something that is maybe helpful, if they don't find anything but you've still got a baby whose stomach is on the wrong side or something, you don't know what's going on here. You just did the best test you could, and you don't know.

This is an OB version of medical dumb science; the screening for Down syndrome in pregnancy for a long time was a blood test where they looked at analytes, which are a bunch of different proteins and hormones and blah-blah-blah. The way they did this was that they took a bunch of moms who were pregnant with normal babies and a bunch of moms who were pregnant with babies with Down syndrome, and tested their bloods for everything they knew how to test for, basically, and found six things that were different. The problem is that there is no overarching theory about why this should be true; it's just that's what they got. So, like I said, it's stupid science. It's like when I tell the mom that it's a boy, I just look between the legs at the ultrasound. It's not science; it's just observation. The DNA stuff is more scientific in the sense that there's actually a theory behind what you're doing and everything, but it has taken us quite a while to get there.

ZIERLER: The 1980s, at the height of the AIDS crisis, was this something that you got involved in, with expectant mothers?

BEALL: Oh, yeah. AIDS hit New York about the time I started my residency. It was not so prevalent in pregnant women, because the majority of the people who had it were gay men. But as time went on, it became more common in drug users in New York. It's funny, because it's a cultural difference between the coasts. In California, people would bring their own syringe and needle or whatever. They might use it over and over, but it was for themselves. They'd get their drug and they'd inject. In New York, they'd go to what they'd call a shooting gallery, and the guy would give you the loaded-up syringe, you'd shoot yourself up, and then he'd take back the syringe and use it on the next guy. So, there was much more HIV going through the drug users in the East Coast than there was on the West, always.

Yeah, for a while, it was crazy. I can remember one patient—we would not do this now, but somebody did an amniocentesis on a pregnant woman who we knew was HIV-positive, and the lab refused to receive the specimen. It would have been nice if we had known about that beforehand! [laughs] But it was just everybody was terrified and didn't know how this was coming, or why, or what you needed to do to protect yourself. It was just crazy. I always thought The Village Voice wasn't doing—this was in New York—wasn't doing anybody any favors by saying that this was uniquely—they actually put out an editorial—this was uniquely a tragedy for the gay community, because their culture was so based on—they didn't say it this way, but basically indiscriminate sex. [laughs] Like, I don't think that's going to win you too many friends!

My dad, as it turned out, his specialty was allergy and immunology. In most places, HIV goes under infectious disease, but in his hospital, the infectious disease experts had no interest whatsoever in taking this on, so he took it on. He used to tell all these stories about—for the first three years or so, everybody died. Everybody died within a year of diagnosis. Because they just really didn't know how to diagnose it until you were already sick, and they didn't know what to do about it once you were. My dad hates funerals anyway, but he went to more funerals than you want to think about. He and my mom would go to the Gay Pride Ball and be the only mixed couple on the dance floor. Then when he finally retired at age 70, he started volunteering with Doctors Without Borders. The first place was he spent a year in Thailand, teaching the doctors there how to use the AIDS drugs. Thailand, as it turns out—quite an enlightened country—they provide AIDS drugs for anybody who needs them. Now, it's not every drug in the world, but they have a formulary of AIDS drugs that they will provide to anybody who needs them. Then another thing he did was China. In China, they wanted every drug that was available to the Americans, even if only one out of 50 people could actually get them. So, it was a different philosophy.

He is now 95, and he is not going anywhere, but he has been all over the world doing AIDS work. Not Doctors Without Borders refugee camp kind of stuff, but in settings where they are maybe not used to the drugs or used to what tests you can do. Since my dad is older, he knows how to do things without MRI machines and necessarily having the third-level testing and everything.

ZIERLER: Tell me about your decision to move over to UCLA.

BEALL: Like I said, my mentor and his boss were getting into kind of an ugly fight about something my mentor wanted to do, which his boss was trying to inject me into the middle of. I was a little ticked off at USC because I had had a baby and they basically wound up taking all of my vacation time away without telling me they were going to do it. [laughs] Then UCLA came calling, and so I was amenable to going over and talking to them. USC was kind of too big and too political. It would not have been the most comfortable place to stay, for me. UCLA Westwood was uncomfortable the other way; they were so focused on everybody having NIH grants, which wasn't going to happen for me, that it was just like, you know, I'm going to become the lowly water carrier here. So, I moved down to Harbor.

The nice thing about Harbor was nobody cared if you were on the clinical track or not. Just to sort of understand why this is important, at UCLA, if you're on the tenure track, you have an item, which means that the university pays the first part of your salary. On the clinical track, at least in the medical school, you don't have an item, so you're paying your own salary from your patient billings, from the first dollar. You're paying it after the dean takes whatever it is he thinks he needs, which sometimes they don't tell you until after the year is over. [laughs] It's a little confusing to figure out even how much money you're making. It is weird. I went out in private practice, and I didn't think of myself as poorly compensated when I was at the county, but I went in private practice and by the second year was making double the amount of money. The patients I was seeing were still mostly MediCal patients. It wasn't like I was seeing a lot of expensive Mrs. Gotrocks. It was just that I wasn't carrying all of the administrative stuff that I had previously been paying for.

ZIERLER: How did your medical career change as a result of moving over?

BEALL: Like I said, I stopped doing research immediately. I was doing some resident teaching, and student teaching, which I really enjoyed, for a while, but at some point during the pandemic, that also fell off, for a variety of reasons. In 2016, I broke my hip, and I have never really gotten back to full-time ever since then, partly because for a while I wasn't really physically able, and after that, I was like, "I don't need to do this full-time. I'm getting too old to be working 12-hour days, five days a week." I backed off quite a bit at that point. You know what they say: "Growing old is not for the faint of heart." Over the past 15 years, no insurance company has made any money off of me. [laughs]

ZIERLER: For the last part of our talk, I'd like to ask a few retrospective questions, and then we'll end looking to the future. Have you been an engaged alumnus of Caltech over the years? Have you followed what has been happening on campus since you graduated?

BEALL: Pretty much. Do you know what the Gnome Club is?

ZIERLER: No.

BEALL: The Gnome Club, I think it used to be one of the original—they weren't really houses, but there were dining groups or whatever. But when they built the new houses, the Gnomes became an alumni honor society, kind of. The Gnome Club Founders Night is March 9th. They always have a dinner, usually in the Athenaeum. My husband and I are both members. It doesn't take a lot to be a member. So we go, frequently. There was a point in time when I was the president of the Gnome Club. That was a long time ago. My kids are now in their thirties; it was when one of them was a baby. [laughs] At one point, I used to sit on the Alumni Association committee that organized Seminar Day. This was one of these things where the Alumni Society staff would have everything organized, and they would say, "Okay, you two guys are in charge of Biology. Go talk to the chair of Biology and he'll tell you which two people are going to give the talks for this year." "Okay, I can do that." Then you'd stand up and introduce Professor So-and-so, who is giving his talk.

But then one year, I was the president of the committee. The president's job is to help to pick the person who gives the big talk in Beckman, and also to introduce that person. This was when Dr. Baltimore was the president. I said, "We should talk about gene sequencing." I forget what it was. Maybe it was stem cells. Anyway, everybody else wanted—they always want to talk about whatever landed on whichever planet or moon most recently. Which is fine, except that after a while, and you've done it three years in a row, it's like, it's time to talk about something else. Everybody else on the committee was like, "Oh, no, this is too weird and esoteric." Then California passed a law or a resolution saying that because the government wasn't going to fund this stuff, that California was going to fund stem cell research. Then everybody was like, "Oh, maybe this isn't such a bad idea." Then Dr. Baltimore wanted to give the talk. I don't know if you've ever heard him give a talk, like at Seminar Day. I can sit there, and I'm supposed to know this stuff, and I have a hard time following what's going on! [laughs] But they decided—it was actually hilarious. I wish I could remember the guy's name. A guy from Stanford who was a friend of Baltimore's came down, and Baltimore interviewed him—that was the presentation—about stem cell research and what this meant, and duh-duh-duh. Then they passed up questions from the audience. One of the questions from the audience was—this was when George W. Bush was the president, and they were outlawing stem cell research and all this stuff—and they said, "Considering our current government, do you think the United States risks falling behind countries with smarter leaders?"

ZIERLER: [laughs]

BEALL: It's like, you can't make this stuff up. Actually, for me, the best part of this was that they have a luncheon afterwards at the president's house—I'm sure they probably do this every year—for the plenary speaker and the—what do they call the alums that win the prize?

ZIERLER: Distinguished Alumnus Award.

BEALL: Distinguished alums, yeah. One of the distinguished alums was this Japanese-American guy. His story was that his education was not wonderful. I think he got sent away to the camps during World War II. Then he came back and was working in Pasadena as a gardener, but he got injured or something, and he couldn't work for a while, so he wanted to come and sit in on classes at Caltech. He goes in to talks to Max Delbrück about sitting in on his course, and Max says, "Tell me your story." The guy tells him his story. Delbrück talked the rest of the faculty in the Department of Biology into accepting him as a student. [laughs] So, he went through Caltech as a student. He became, again, a professor at Stanford. Unfortunately, by the time I met him, his memory was going, but it was still such a great storyand it was so Caltech. It was so—"You don't need to have test scores, we know that you know what you're doing, just be a student and we'll figure it out." That to me was really the difference between Caltech and a lot of the other more prestigious universities, was that so much of what got you a space at Harvard had nothing really to do with how you wanted to study or what you wanted to study. It was, did your grandfather go here? Did you do impressive things like build houses for poor people? Not that that's a bad thing to do, but just it's all about how you present yourself, and not about what you really want to do. At Caltech, it was all kind of like, "Yeah, if you're right, we'll figure it out." [laughs]

ZIERLER: There is such an obvious connection between your medical education and your medical career. But what about your education at Caltech? Has there been an approach to the science, a way of looking at the data, an approach with your academic colleagues, that stayed with you throughout your career?

BEALL: I think the biggest thing is to actually look at things and say, "Is there evidence?" Yeah, in medicine, you've got to all the time do stuff where you don't have good evidence for what the right thing is to do, but at least to acknowledge that that is what is going on. Because you have to kind of keep yourself ready to change everything you do when the evidence comes in the other way. The guy I have worked with for the past well over 20 years now, who was the chairman of the Department at the time when I mentioned that there was some upheaval in the Department, for not obvious reasons, is actually a graduate of MIT. [laughs] Although he says, "Oh, all that quantitative stuff; I hated MIT." But I think as compared with a lot of people, I have always been more interested in looking at the numbers, looking at "How many people do you actually have? How well do you know this? Do you even know it?" I think those are the kind of things that have stayed with me from Caltech.

A lot of people, even a lot of doctors, they spent so much time studying humanities that—have you ever heard these people complain about, "Scientists, you haven't read the great books, you haven't done the cultural things." And you look at them and you're going like, "You can't balance your checkbook! Why is that not a disabling problem?" [laughs] If you think about the great thinkers of the past, Leonardo and Newton have much more in common with each other than not, in that they were interested in how things worked, and it didn't really matter what educational wrapping you put around that. That's what I think we've lost a lot, is that we've decided that there's a science box and there's a humanities box and there's an art box, and they're all different boxes. And they're not; they all bleed into each other.

ZIERLER: Last question, looking to the future. Whenever you feel the time is right to transfer from 75% retirement to full-time retirement, what will that look like, and what opportunities might you have to be active in different ways?

BEALL: I've really been trying to retire. My business partner is not ready to let me go, because he doesn't have anybody else who can do some of the things I do. But there are a couple of things. I now have four grandchildren who live in San Francisco. I'd really like to be able to spend more time with them, maybe even move up there at some point, although I haven't really thought about that. At the moment we decide to do that, at least one of them will decide to move someplace else. But I have a grandson who is so funny. He is four years old. He can tell you about every dinosaur in the world. We took him to one of these airplane mausoleums where they have old airplanes from various military sources and he is going around telling the docents about the different airplanes! He just has so many enthusiasms, and he's so excited about everything, and he's so good about remembering things and wanting to learn more about things. He's just hilarious. I also have a lot of hobbies that I'd like to get back to, more.

I know that I'm not doing a great deal work-related anymore, but every year it just gets harder. It's harder to get up and—I can't work overnight and then the whole next day the way I used to be able to do. I now have trouble working the next day if I spend 12 hours on the first day, so it's time to slow down a little bit. Being a doctor is one of those—it becomes life-defining. I will always be a doctor. But what I do now is not so incredibly irreplaceable that I would feel guilty about stopping doing it. I don't have any great desire to like write the great novel, or try to right the wrongs of the universe. I feel like I should have more of those feelings, but I don't. I'd like to spend more time with family. I'd like to spend more time just trying to finish up the 14 unfinished projects that I have lying around! [laughs] I have a baby blanket that I've been working on for about five years, and I've got to get it done before the last one of my nieces has her last kid! [laughs]

ZIERLER: That's great.

BEALL: You talked to Debbie. We have a Caltech Women's Group that meets by Zoom every month. I think they're finally back to meeting in real life, which would be a lot of fun. One of the things about up until now is that we don't make a lot of friends outside of the work environment. It would be nice to have some friends that are different.

ZIERLER: It sounds like in retirement, you're going to be one of those people who is way busier than you are even now.

BEALL: Maybe. But it's also just that I find about half the mornings, I wake up and I'm not ready for anything. [laughs] I don't have any trouble with my hip anymore, but my knees are starting to give me trouble. I had an aunt who I think had two knees and one hip replaced, and I think I'm going there, so we'll see. That was one of those being-a-doctor things; I actually got to diagnose my own hip fracture. That actually was kind of fun. It was like, "Oh!" It's not subtle. My husband and I, both of our mothers are gone. Our fathers are both well into their nineties. We're hitting 70 pretty soon, and it's just you start to feel it. All those people who say 70 is the new 40 are fooling themselves. It's not. Maybe 70 is the new 50, or—but people used to retire and die within five years, and that is not happening anymore.

ZIERLER: Maybe the best thing is, your partner really needs to find somebody who can replace you, because you've got some things to do!

BEALL: The answer to that is, it's not going to happen, and at some point, I'm going to have some other health ill, and I'm just going to say, "No, I gotta go."

ZIERLER: Or you could be proactive and just do it beforehand.

BEALL: I could be. Yeah. It's—but that's kind of where we're going. It's funny; he has now a granddaughter who's about 18 months. But they're so much more fun when they can talk to you.

ZIERLER: Sure, sure. All right, so maybe in a couple months, when this kid starts speaking, he'll understand more.

BEALL: Maybe, yeah. That would be nice.

ZIERLER: Marie, this has been such a lovely conversation. I'm so glad we were able to do this. I'd like to thank you so much.

BEALL: Thank you.

[END]