Karen Maples

Karen Maples

Partner Emeritus for Kaiser Permanente, Southern California Permanente Medical Group

By David Zierler, Director of the Caltech Heritage Project

October 10, 2022

DAVID ZIERLER: This is David Zierler, Director of the Caltech Heritage Project. It is Monday, October 10th, 2022. I am very happy to be here with Dr. Karen Maples. Karen, it is so nice to be with you. Thank you for joining me today.

KAREN MAPLES: My pleasure.

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

MAPLES: I am currently a Partner Emeritus for the Southern California Permanente Medical Group. I retired from my practice in 2019, having stayed at Kaiser Downey/Bellflower Medical Centers, for my duration of my entire career, so that was 35 years. I am now working part-time as a Partner Emeritus, still in the OB/GYN Department.

ZIERLER: Being Emeritus, does that mean you're basically doing the same things you did, just on a smaller scale? Or are you doing, for example, more research as a result of going Emeritus?

MAPLES: I'm still a clinician: so I see patients in clinic and I round on postpartum patients in the hospital. In my department, retirees transition out of the operating room, so I'm doing outpatient gynecology or clinic-based gynecology and no longer perform surgeries. Fortunately, I no longer have to be on call for labor and delivery, so I don't have to attend any 4:00 a.m. deliveries. Another benefit is that my weekends are now clear. It is a gift that not everyone can participate in or choose to do so, but I've opted to continue my practice.

ZIERLER: For the course of your career, how much of your time has been devoted to obstetrics and how much to gynecology?

MAPLES: I'd say it was a good mix. As a generalist, it was a 50/50 mix. The last part of my career, I had more administrative responsibilities. In 2001, I became assistant chief for the OB/GYN department. In 2006, I became chief of the department. In 2011, I became the assistant area medical director for Downey Medical Center and 50% of my time was spent in administration. In that role, despite the additional administrative responsibilities, I continued to perform GYN surgery, round on patients, do vaginal and cesarean deliveries, take overnight and weekend call.

ZIERLER: What is the relationship between Downey Medical Center and Kaiser Permanente? How does that work?

MAPLES: Good question, and sometimes we even have to inform our associates or folks who are coming to Kaiser, because many people don't understand that it is a triad situation. There are three entities: the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups. In Southern California, we are called the Southern California Permanente Medical Group. In Northern California, it's the Permanente Medical Group. In Washington state, it's—you know, and so on. Basically, we have a special relationship with Kaiser Foundation Health Plan and have agreed that we will take care of their patients within the health plan. We typically also have a relationship with the hospitals, so we manage our patients in the Kaiser hospitals. This arrangement has served our patients and staff very, very well over six decades. There are times when we negotiate what our rates are and how many physicians we need for different specialties based on our access needs, et cetera. It is a very linked working relationship.

ZIERLER: This question is inevitably going to have political overtones to it, but with the relatively recent overturning of Roe v. Wade, what does that mean for your patients, and what does that mean for you?

MAPLES: Since I practice exclusively in California, there's zero change for Californians. We don't even have a Kaiser-based facility, I believe, in any of the states that restrict abortion services—like Kansas or Texas or anything. Actually, Kansas, I think this state adopted a measure that would continue to allow abortion care. Since we are based in California, the Supreme Court decision really has no major effect.

ZIERLER: To the extent that there is concern that the overturning of Roe v. Wade might ultimately lead to a federal ban on abortion, is this something that you are concerned about? Is this something where you see a trajectory possibly going in that direction?

MAPLES: I would think it would be highly unlikely, but boy, I did not know that this overturning of Roe v. Wade would occur, either. I think it would be highly unlikely. I know that the California legislature has tried to codify and put in the Constitution that women's right to choose will be in our Constitution. Unless that federal ban—I think it's unlikely, is what I'm saying, at this point in time.

ZIERLER: To the extent that you are following developments in states where this has changed things, what is problematic, what is troublesome about this change in the law?

MAPLES: The biggest concern other than it's really affecting women who are poor, have no means to travel outside of their states—it also has had some strange impact on physicians not knowing when they can intervene on certain complicated pregnancies. For example, if woman has a pregnancy that was not going to be viable, many obstetricians would have offered the patient a termination of that pregnancy. This is because the risk to the mother continuing a pregnancy that is not going to be able to survive a term delivery, outweighs the risk to the fetus, the unborn child. In a case like that, we would offer the patient the option of termination. In some instances, some of the physicians have felt hesitant, thinking they were going to be sued, or worse be treated as criminals, and possibly going to jail if they intervened on what we would have considered normal, ethical, medical practice. That's really sad to me. Even some doctors were afraid to offer women a medical termination for an ectopic pregnancy, a pregnancy that was developing outside the uterus. This condition is very dangerous, but the medications that you use for that kind of termination are the same medications that women use for elective terminations, and they are afraid that, again, they will be accused of going against the new state laws. I think that there needs to be much more clarity on some of these states' laws, but ultimately I think it's just very sad that they are being so restrictive across the board.

ZIERLER: To what extent do you see these developments in socioeconomic terms? In other words, as you mentioned, these are things that are primarily affecting poorer women. What is the larger story for you?

MAPLES: These are often women who don't have access to healthcare. They may also not have access to family planning. It's a double-edged sword. Even if they did have access to family planning, nothing is 100%, so there are failures for women who are on birth control or using IUD or other type of methods. Having the lack of ability to actually have a true voice in planning their family, that to me is a tragedy.

ZIERLER: As you mentioned, as a clinician, you're not centrally involved in research. What have been some of the major research developments in the OB/GYN field that have affected the kind of clinical work that you do?

MAPLES: I think some of the research relating to the management of women who have had previous preterm deliveries is important. There is a lot of research on the use of certain medications or use of proper screening tools so that we can intervene with these patients sooner. That has been very significant. I've been in practice for 35 years, and many years ago, we started doing routine screening for a type of infection that can manifest later in pregnancy. Actually, it is a carrier status for a pregnant woman, but if a woman is a carrier for group B strep—this is the name of the bacteria—then it can affect the newborn baby. We screen for that. When we know they are carriers for this particular bacterium, antibiotics are given to the women when they are in labor. Before, it used to be a risk-based screening, but now we do it universally. I think that has been a big change for us. Every pregnant woman is screened, starting around 36 weeks of pregnancy so we can detect women who are carriers for group B strep, because it could be devastating for a newborn baby.

ZIERLER: Another question that has legislative implications, a little farther back in history—when Obamacare was passed, what did that mean for you and your practice, and most importantly, what did it mean for the patients that you worked with?

MAPLES: It was a boom! [laughs] Kaiser Permanente has been a known entity in California, for many, many years. Some folks might have had Kaiser insurance in the past. Since a lot of it is employer-based, maybe the employers stopped offering it to them. But when the Obama Affordable Care Act came through, it was a major boom for us because many patients returned to us. To take care of so many additional patients, it was necessary hire more physicians, nurses and staff. We had to open more operating rooms and clinics. It was amazing [laughs], to be honest with you. It is always nice to know that it's medical care that many, many folks want. Initially, we were a little bit behind the eight-ball but eventually caught up.

ZIERLER: Was it better for patients in the long run?

MAPLES: Of course I'm going to say yes, because we are a comprehensive medical practice that is based on truly ethical care. My income is not based on how many procedures I perform. I do the best I can for my patients without any profit-driven motive whatsoever. I can easily offer patients options for a surgical treatment, a medical treatment, or even observation as clinically indicated. We have much more I think flexibility. Also, no one is looking over our shoulders, per se. We are a physician-based practice. The medical group sets the standards and policies rather than administrators in the health plan. We make sure that we are doing true evidence-based medicine and practice medicine in an ethical manner.

ZIERLER: For your practice, just a few questions on demographics. Do you work with a range of patients that come from many backgrounds?

MAPLES: Yes, we do, but each Kaiser facility has definitely a different demographic. At Downey, and around the community, most patients have ethnic backgrounds from Mexico or Central America. On the other hand medical centers in South Orange County have a more affluent and white population. But clearly our own physicians get treatment at our facility, so there is a range of many different backgrounds. I see White, Black, Asian and Hispanic women. Yes, it's a diverse population. But I'd say the majority, especially my obstetric population in Downey is mostly represented by Latinas.

ZIERLER: Karen, between the examination room and the operating room, what are some of the most satisfying aspects of your work? What brings you the most meaning?

MAPLES: Well, my mother was an educator, and I frankly thought that was what I was going to be a teacher. The benefit, I believe, at least in my practice, has always been as a teacher. I'm teaching girls who are just going through puberty—because sometimes their pediatrician refers some of the more complicated patients to us, as gynecologists. I see women through their reproductive years and pregnancies. I see them through menopause. I still frankly have some patients who are in their eighties who want to see their gynecologist because they've been used to going to the gynecologist every one to two years. I would say the most important part in the clinic, for sure, has been education.

In the labor and delivery unit, it is always wonderful to bring a new life into this world, as long as everything goes perfectly right. A labor and delivery unit is a place where you want 100% perfection. Obviously that's sometimes not possible, but we certainly try to make sure that things go smoothly without any significant complications. The operating room is wonderful, because we are taking someone who may have some problem that has created issues for months or years, and we can actually alleviate that condition. Whether it's something as serious as significant bleeding from fibroids and we perform hysterectomy, or something such as a pregnancy loss that requires a D&C. We are taking something that we can quote unquote "fix" per se. Most of us don't manage women long-term with medications, other than maybe prescribing hormonal management. Even so, these aren't medications that women usually take for a the rest of their lives. It is good to have the ability to do the education, have a cure. And, of course, being in labor and delivery is always fulfilling.

ZIERLER: Looking over the course of your career, from pharmaceuticals to medical technologies, what have been some of the real game-changing advances that have improved patient experience and outcome?

MAPLES: I definitely say ultrasound. I use it daily now. I remember when I was in my residency, the ultrasound screen was not any bigger than my iPhone screen. Most had horrible resolution. Now, patients can go to the mall and get a 3D image of their growing fetus. Ultrasound technology has really been a major game-changer. Now we are using ultrasounds all the time to not only check for fetal anomalies but making sure the baby is remaining healthy through the pregnancy, whether to make sure the fluid surrounding the fetus is adequate or confirming the position of the placenta—there's a lot of things that can be found on an ultrasound that back in the day we could not. Gynecologists also perform more minimally invasive surgeries via laparoscopy or robotics which enables patient to recover sooner from major surgery. Pharmaceuticals—again, as an OB/GYN, I don't prescribe many different types of medications. Women now have many different birth control options for women, so I guess that is more of a game-changer. Before, we were limited to IUD or pills. Now we have other options for birth control developed in that last ten years and probably there will be more on the horizon there.

ZIERLER: To flip that question around, what is most frustrating to you, as a clinician, in terms of your limitations? The medications that don't yet exist, the technologies that don't go far enough to give you the tools to provide the best possible care?

MAPLES: That's hard. I'll have to think about that. I don't have anything right off the bat that I can truly think of.

ZIERLER: That's a good sign, then, that you have the tools that you need.

MAPLES: Yes. I could always—like more ultrasounds in the department, better resolution.

ZIERLER: Administratively, the reporting structure, before you went Emeritus, did you lead a team? Were there people who reported to you?

MAPLES: Yes. When I was chief of the department, I managed the frontline physicians in OB//GYN. When I became an assistant area medical director, I had oversight over other departments. These included OB/GYN, Pediatrics, and Radiology. I had other assignments such as being the Area Physician Marketing Lead charged with engaging with employer groups to also let them know about Kaiser Permanente and SCPMG, what our role is with their employees, and what we can do better assist their employees who are Kaiser members.

ZIERLER: Let's go back in history. Even before Caltech, first, where did you grow up?

MAPLES: In Berkeley, California.

ZIERLER: Are your parents from Berkeley?

MAPLES: No, not at all. My mother was born in New Orleans. Her family came to the Bay Area with the migration around World War II. My grandfather got a job at Naval Supply in Oakland and when my mother completed high school she also came to California and with her siblings. My dad was actually born in El Centro, California. It is way, way south by the Mexican border. He's a native Californian. He ended up going to Cal Berkeley. That's where he met my mother and where they both graduated from college.

ZIERLER: Growing up, did you always gravitate more toward math and science in school?

MAPLES: I did. Especially I would say in high school, I was definitely on that track, big-time. In tenth grade, I spent a year abroad and returned in the eleventh grade. Because it was kind of self-paced in that foreign school, I was allowed to self-pace in math at Berkeley High School. I was kind of ahead of the game in that sense, so I was able accelerate math and science classes. I also tutored high school students in math.

ZIERLER: Perhaps you were a bit young, but just being in Berkeley in the late 1960s and early 1970s, the antiwar movement, the women's rights movement, civil rights—what was that like for you?

MAPLES: The assassination of Kennedy, that was my first exposure to a national tragedy. That was in 1963. I guess I was in third or fourth grade, so that was really a blow. My mother was very much involved in Berkeley politics. She was a precinct leader, so I would help her distribute literature and flyers when she was doing some of her canvassing. We were always involved in the politics, not only locally in Berkeley but also national. I was actually at one of the precinct parties when I saw Robert Kennedy being assassinated on live TV. As you know, this occurred just months after the assassination of Dr. Martin Luther King. Those tragedies really sent a chill down my spine.

In ninth grade, the National Guard was deployed to quell the unrest at Cal Berkeley. They took over our ninth grade gym for two weeks and we said, "Woohoo! No gym for two weeks." That was fine for ninth graders, but it was a little scary seeing the protests at Cal. I think by then my dad was working up there, so I was a little worried by him. Yes, we were surrounded by this all the time, but Berkeley was a very safe place in the sense that the schools were really integrated. I remember my third-grade class, it was incredibly ethnically balanced with Japanese, Black students and white students. Not as many Hispanics. I thought the world got along, until—it didn't. Especially viewing things like the Watts riots, I frankly was afraid. I wondered "Are they going to just start shooting every Black person on the streets" But Berkeley to me was a very safe place, as a Black person, to grow up, because there was a lot of interaction, and I didn't feel—other than the war protests, I didn't see anything overtly racist.

ZIERLER: Growing up, were your neighborhoods mostly integrated?

MAPLES: Where we lived, yes, we were integrated, but there are different parts of Berkeley. South Berkeley at the time was mostly Black. The Hills of Berkeley are mostly white. We lived in the north Berkeley flatlands, so my neighbors were white, Black and Asian. I was in a very integrated neighborhood growing up.

ZIERLER: In high school, when it came time to think about college, how did you learn that Caltech was newly available to women undergraduate applicants? Who gave you that information?

MAPLES: I had no clue about accepting women applicants. I honestly had no clue about Caltech. There was a gentleman, Lee Browne who came to my high school recruiting minorities. He was looking for students, who were science-minded, math-oriented, who obviously scored well on some of the standardized tests. He came to Berkeley High on a recruiting trip and told me about Caltech. I had no idea Caltech even existed. I had never heard of Caltech, so I had no idea whether women were accepted or not. I had no notion of it whatsoever.

ZIERLER: What was attractive to being recruited? What was exciting after not knowing anything about Caltech?

MAPLES: Again, my mother, as a teacher—and I thought this would be a good opportunity for me. Like I said, math and science was my jam, at the time. I was getting acceptance letters from schools I hadn't even applied to. At that time, it was very assertive recruitment for African American students who had done well in math, science and I guess, many colleges took note of scores on standardized tests; that's all I could think of. Frankly what it came down to was you opened your acceptance letters and also looked at the financial aid package, and that drove me towards Caltech more than anything.

ZIERLER: Did you graduate at or near the top of your class?

MAPLES: At Berkeley? Yes.

ZIERLER: Tell me about your first memories of Caltech, when you arrived on campus.

MAPLES: Lee Browne had a four-week or six-week session prior to starting the regular semester at Caltech. It was a core group of students that he had brought on campus. My uncle drove me down to Caltech. This was absolutely the first time I had ever stepped foot on campus. I don't think back in the day they did parental campus tours and this sort of thing; at least I wasn't aware of it. None of the schools I had applied to, I had ever physically gone to see, other than Cal Berkeley. My uncle basically dropped me off. I think we went out for a hamburger for dinner, and then he said, "All right, see you later," and I was plunked down at Caltech.

Caltech now is vibrant, gorgeous, full of vegetation and plants. When I arrived, Caltech was a dusty, concrete, asphalt campus. Within a week, I was gagging because the smog was just horrible at the time. You could not even see the San Gabriel Mountains. It was really, really bad. But it was a nice experience to be with this group of folks before everyone else arrived. I finally found out that there would not be that many women, because there were only three of us women and 20 or so guys with our group. That was an eye-opener. Certainly when the rest of the freshmen came on in, and even upperclassmen, then it was obvious that, "Ah, this is different, because we are having the new women here."

ZIERLER: With classes before you of women coming into Caltech, did it feel like by the time you arrived that campus had adapted to having women undergraduates, or did it still feel ad hoc to some degree?

MAPLES: At one point, I believe they had one or two dedicated alleys for women. By the time I had arrived, they got rid of that, totally, so women were distributed among all of the seven houses, and you didn't have to be restricted. Women could be on any alley they wanted to live. In my house, there was just four freshman women, so you match up two and two. It was kind of limiting in that sense.

ZIERLER: Did you feel at home at Caltech initially? Did it feel like a very different environment to you?

MAPLES: It did, but gosh, it has been 50 years since I arrived on campus. [laughs] It's kind of hard to say what I was feeling. I kind of had this mentality that "Full speed ahead, charge, I'll get through this." In that sense, it felt normal. The only thing that wasn't normal is taking those first quizzes at Caltech where 20 out of 100 would be passing, that sort of thing. Coming from a background where you're acing exams, knowing that, "Oh my, okay, this is way different," and you're kind of on your own. Knowing that one of your TAs was actually younger than you were—that means he had already graduated from college that was an eye-opener. [laughs] Things like that were different, for sure.

ZIERLER: Was it always life sciences that you were interested in? Was that what you wanted to focus on, at Caltech?

MAPLES: Oh, no! Everybody comes in the mindset for only math and physics. I thought my major would be math. But you get to the point where you start taking some of the advanced math classes that are so theoretical, and you're just like, "Where is this going?" Once I took biology, I knew that it was much more appealing to me, and it became my major.

ZIERLER: Among the faculty, who sticks out in your memory that might have been especially supportive, as an African American woman, somebody that you remember as being particularly welcoming or wanted you to feel welcomed at Caltech?

MAPLES: Lee Browne was still around; he was not exactly faculty but was always helpful. But in terms of support in my major, it was Dr. Ray Owens. He was a wonderful biology professor. I don't know whether he saw me as African American or a woman or whatever, but he was just very, very supportive. He was truly my mentor through Caltech.

ZIERLER: What kind of biology were you most interested in, and when did you start thinking about medicine as a place to apply this knowledge?

MAPLES: It wasn't towards the biochemistry. I would say it was more biology that you could use, in the sense of physiology. We all had labs, but I didn't want to be in the rat lab forever, or dealing with mice forever. That's when I started to look for different options. I was actually able to go to Huntington Hospital. They actually had a little research lab, and I was able to do some research there. That piqued my interest in doing something that was more practical, from my point of view, rather than just doing things that were more theoretical.

ZIERLER: On the social side of things, because women were such a small minority on campus, did all of the women band together? Were the social groups gendered in that way?

MAPLES: No, it was more house-oriented. We at Dabney kind of came together, that way. We would do things with other houses as well. I ended up being president of the Caltech Y. That's another social outlet. I was a head usher for Beckman and Ramo Auditoriums, so I recruited not only folks from Dabney but other houses who wanted to do things like that. So, it wasn't gendered, that I saw. The only thing I saw gendered was in my last year, I think the second half of the year, I ended up living in a house called Lara House; there were only women in that house at Caltech. It was off-campus housing, and seven or eight of us lived in that particular house. But no, I didn't see it as gendered, that way. The affiliation was with your house.

ZIERLER: Did you stay in Pasadena for the summers? Did you go back home?

MAPLES: The first summer, I did go back home. The second and third summers, I stayed in Pasadena because I had an internship at JPL. The last summer, I had been admitted UCLA medical school and because I did not have English credits [laughs], I had to go to PCC—Pasadena City College—to pass English to complete my admission requirement.

ZIERLER: Tell me about the internship at JPL. What did you do?

MAPLES: People ask me this, and honestly I don't even remember! I'm so embarrassed. But I did it! Two summers in a row! I don't recall [laughs] what the exact project was.

ZIERLER: Was it fun? Did you enjoy yourself?

MAPLES: Yeah! Because I went back for the second year, so it must have been fun. You caught a shuttle that took us from Caltech to JPL. It was good.

ZIERLER: Tell me about the decision to pursue medical school. How did that come about for you?

MAPLES: After doing the Huntington Hospital research and also knowing that I did not want to do research in a lab necessarily, I decided to consider medicine. There wasn't a pre-med major at Caltech at that time. Frankly, a few professors were rather discouraging. They thought medicine was kind of a waste, because they really believed in "true science" as it were, rather than medical science. Again, you were pretty much on your own. I learned how to study for the MCAT, took the MCAT on my own, went on about my business in trying to apply. I didn't really have much guidance. I applied to med schools and got in and decided that UCLA was the best option. It was fairly close to home.

ZIERLER: With either Professor Owen or anybody else on the faculty at Caltech, were you encouraged to go to medical school? Was anybody hoping that you would, in that Caltech way, continue with fundamental research?

MAPLES: It wasn't encouragement, but at least Dr. Owen didn't discourage me, per se. No one jumped on the bandwagon and said, "Hey, go to med school." I didn't have that sense at all.

ZIERLER: With UCLA, were you specifically looking to stay in California, maybe even also Southern California?

MAPLES: Yeah, I think definitely that was my choice, to stay in California.

ZIERLER: Tell me about UCLA Medical School. What were your experiences there?

MAPLES: It was very different then, compared to now. Back then, the first two years were very much didactic. You sat in the classroom receiving lectures or you were in your anatomy lab. Multiple-choice tests were the norm, and I hadn't seen a multiple-choice in years at Caltech. Or closed-book tests, for that matter. Everything was closed-book there; Caltech was open-book. I had to go back to my high school days, where you would study just for that particular exam, and you learned every muscle and nerve in the hand and promptly forgot it the next week when you moved on to the forearm, et cetera. That's the kind of learning it was at that particular time. Things have really, really changed.

I really came into my own in terms of medicine, I would think, when it was time to do actual rotations in the hospital wards. Because Caltech supports critical thinking, you do more integration, kind of putting the whole picture together and I had that advantage over other medical students. I would do these history and physicals—actually hand-written physicals, and they would be like 20 pages long, because I had like 20 different differentials, and I would talk about research, this and that and everything. I really enjoyed my time on these preceptorships. Some were six weeks; some were twelve weeks. That's where I think I really shined in medical school, was starting to get in the hospitals and actually interviewing the patients, looking at the labs, looking at their imaging studies, and putting the entire picture together.

ZIERLER: Do you think there was anything particularly useful that you drew on from your Caltech undergraduate education for medical school, for succeeding as you were becoming a doctor?

MAPLES: The thought process. Like I say, just putting pieces together. When you're on the ward, it's not about memorization. You don't have A, B, and C multiple choice answers. You have to take all these pieces of information to come up with a diagnosis or a treatment plan. That's what the benefit of Caltech was, for sure, was being able to have a really more comprehensive thought process to understand what is going on with the patient.

ZIERLER: Was it during those rotations that you became interested in pursuing OB/GYN practice?

MAPLES: Absolutely. My first rotation was pediatrics. It was pretty hilarious, because I was a third-year medical student, and there was an intern that apparently looked like me, because nurses would come to me or other doctors would say, "Do this, x, y, and z," thinking I was her. I felt so bad for that poor intern, because I was clueless to what was going on, but I tried to do my best at it. I also knew that pediatrics was not for me, because these babies couldn't tell me what was wrong with them. I mean, I need somebody who is going to communicate with me so I can figure out how to treat them. So, that was out.

My second rotation was OB/GYN. Despite the fact that I was a third-year medical student and had never delivered a baby or done pelvic exams or anything, patients were just incredibly happy to see me, because back in the day, there were very, very few female gynecologists, OBs. I guess all surgical specialties were mostly male-dominated at that time. You would see women in pediatrics, maybe women anesthesiologists, but you would not see many women in OB/GYN. That was incredibly rewarding, when you're knocking on an [laughs] exam room and the patient just beams when they see you, and when you're having a conversation, even though you're, like I say, a lowly third-year medical student. That certainly drove me to consider OB/GYN. And the fact that they were very, very interested—especially the OB patients—in the teaching process and trying to do whatever is best for their unborn child, so you felt like you could really guide patients' decisions on their best care, at that time. It was very, very rewarding, for a third-year medical student.

My next rotation, I believe, was internal medicine. The patients I encountered were very complicated because my rotations were at the VA hospital and county hospitals. I loved it, because they were so complex. Some of my professors in internal medicine were disappointed that I did not choose to go into internal medicine. Their point of view was that the best and the brightest were internists, and not surgeons or OB/GYN. But I still decided to go ahead, follow my passion and go with OB/GYN.

ZIERLER: How do you do that in terms of choosing a residency? What are the mechanics of aligning your interests with the best possible place to be a resident?

MAPLES: You choose the specialty first. From there, you definitely look at residency programs, and at this point, you do try to see whether you can get an interview. When you interview at the residency programs, you have a chance to also see the facility and talk to the residents that are there, so you very much get a sense of what the culture of the institution is. This is so Karen, I must say—I went to a Kaiser facility in Los Angeles and I talked to the residents, and I said, "They seem way too happy. They obviously are not learning anything, so I'm not going there. I'm going to the county, where they beat the residents down. Because I want the most amazing teaching experience." This was my mentality, in that those residents are much too happy and relaxed, so they must not be learning—that's my own craziness coming out. [laughs]

ZIERLER: Tell me about your residency. What was that like for you?

MAPLES: My first two years were at what we call big County or Women's Hospital, affiliation with USC. There were 17,000 deliveries a year at that institution. One in every five babies in California I believe were born at that place. Another thing that you can do in your fourth year in medical school is that you can do what is called externship. You could actually go there and just be a practice intern, as it were. I did that for a month and singlehandedly, I think I did on my own 100 deliveries, as a fourth-year medical student. I thought it was incredible. That's why I ended up choosing USC as well, because I knew I would have the volume. In an OB practice or even a surgical practice, volume is really important. You want to see as much as you can, with the guidance of faculty present, so when you go out on your own, you feel much more confident. That was why I chose USC. But the culture of that institution was very toxic, so I ended up transferring to another county facility, Harbor-UCLA, for my third and fourth years. That was wonderful, because I actually got to go to Kaiser Bellflower to do a rotation there. I could see the differences but also the benefits of practicing in that particular environment. I was very grateful that I was able to transfer, and it was fortuitous that I was able to get a position at Harbor-UCLA and then go to Kaiser, ultimately.

ZIERLER: As you mentioned, the culture at USC was toxic. In what ways? Do you mean that in racial ways?

MAPLES: No, it was a lot of infighting among the residents. Even I think sometimes the faculty seemed to want to pit different residents against each other, or they would be very demeaning to the residents during grand rounds, not as supportive as some could be. I think it was just their way of toughening you up or just making you think on your feet more, but it got to the point where even the residents were fighting among themselves, to the detriment of the whole program, I thought.

ZIERLER: I wonder if you can explain how the residency offers opportunity to figure out what kind of environment you want to practice medicine. How does that work in terms of giving you a sense of where you could pursue a career?

MAPLES: You get your first taste of that during your third- and fourth-year rotations. At UCLA, we definitely had the benefit in the med school—I was able to see a county hospital. I was able to see a private hospital. You could see a VA hospital. So, you kind of could see what's a little bit different in those type of environments. I was at a county residency, but they did rotations at Kaiser. I did not go to a private hospital. Some doctors, a few years later, at the residency that I completed, they were doing some rotations at private hospitals. So, you do get some exposure. It just depends on the program, whether you are just stuck in your own facility the whole four years, or do you have opportunity to as a resident get exposed to a private hospital or a Kaiser hospital. Not every residency program offers all three different flavors of practice necessarily.

ZIERLER: What was most compelling to you as you surveyed these options?

MAPLES: I liked the fact that I did not feel alone in a practice at Kaiser, because at my facility, there were many physicians around me. I wasn't just in a private practice office, solo practice, or just with a handful of folks. At any given time, I could consult with several of my colleagues, or in the operating room lounge with multiple specialties. It was very much more collegial, a lot more camaraderie. Again, I felt we were not bound by how many procedures we did, in terms of our salary, our income, or anything like that. It was just about what the patient truly needed or required, rather than, "I have to bill." Also, I don't have insurance pre-approving any procedure. If I saw someone who needed a biopsy that I saw right there in my exam room, I could perform the biopsy without going out—"Excuse me, I've got to call your insurance"—to see if I could get authorization to do this. I could just take care of the patient right then and there, so it was better for the patient, more timely diagnosis, and obviously from the diagnosis to treatment, it's faster as well. That was very, very attractive to me.

ZIERLER: Tell me about your first job. How long did you stay at it?

MAPLES: At Kaiser Permanente?

ZIERLER: Yes.

MAPLES: The duration—35 years.

ZIERLER: Ever since! You were always there.

MAPLES: I was always there.

ZIERLER: What does that tell us about Kaiser Permanente? What has made you feel so at home there to make such a long career there?

MAPLES: When you are hired, the thought is that you are going to stay. Because you are not an employee; you're an associate for the first—it was two years for me; now, it's three years. Then you become a partner if you fulfill all the requirements and you've gotten along with your peers and there have not been any red flags in terms of problems with patient care, et cetera. When you're hired, the thought is that you are join the partnership, and with that partnership, you're there for the duration. You are no longer an employee. This is your medical group. These are your patients. These are your colleagues. We all worked together to ensure the best outcomes for our patients. We set the standards for our own department because all Permanente Medical Groups are all physician-led.

ZIERLER: It sounds like you are saying that Kaiser Permanente offers the best of both worlds to doctors, where you have the freedom and latitude that you would in private practice, but the resources of just being part of a large medical group.

MAPLES: Correct. That's exactly how I feel. And, you have the mentoring. Since there are physicians who have been there—like me, as well—25, 30, 35 years—when it came to do surgery, we were always matched up with one of the more experienced physicians. Again, you're not just out there on your own, so you can learn from your colleagues. It was a wonderful experience, definitely. As I went through and had my growth, then I became the mentor to the newer associates. We still continue to have the residents rotate in my department; they also keep you on your toes as well. In my department we are teaching the OB/GYN residents that are coming from the county facility, Harbor-UCLA.

ZIERLER: I wonder, when you're a doctor, a full doctor, do you ever run up against being an African American woman, people mistake you for not being a doctor? Do you have to deal with those kinds of things, or that's really not an issue?

MAPLES: If it is, it is not very much of an issue. We're around wearing white coats [laughs] and a lot of nurses are not necessarily wearing the white coats. Nowadays, most folks are wearing more scrubs these days. But I've been pretty much identified as a physician. I mean, I've had patients who want to address me by my first name, and I don't know whether that's just trying to be familial, or is it a little bit of disrespect because I'm female or African American or whatnot. All I do is I correct and say, "I'm addressing you with your name"—I don't call them Sharon or Gladys; I talk to them as Mrs. Smith or "Dr." if they're a physician, and I expect them to address me with my title as well.

ZIERLER: That is great to hear that that has not been a major issue in your career. That is certainly heartwarming.

MAPLES: Unless I'm just oblivious. [laughs]

ZIERLER: Maybe that's just as well if you were.

MAPLES: Yeah.

ZIERLER: At what point in your career did you start becoming a mentor to younger either medical students or doctors?

MAPLES: You become a mentor pretty quickly. You start, honestly, in residency. When you're a senior resident, chief resident, you are definitely teaching, I would say, more than mentoring. You're actually teaching the interns and teaching the medical students. When you become a partner physician, you're also trying to mentor the associates, because you want them to also be partners. The mentoring continues. Also we are fortunate to have midwives on our staff, and sometimes we mentor them, as well. Sometimes they have more complicated patients, and even in clinic, I mentor them almost on a daily basis, because if they have any questions about a patient, I can assist them. I'm mentoring them, always. Just like you're a lifelong learner, I think you become a lifelong mentor in this particular profession, especially if you're surrounded, and if the culture of the department is to have that mentoring mentality.

ZIERLER: Over 35 years, how has Kaiser Permanente changed as an organization?

MAPLES: Ooh! [laughs] Wow. I think it has really gotten better. We are certainly getting the best and the brightest. The physicians that are coming into Kaiser Permanente are truly top-notch candidates. We are definitely making sure that we have as much of the latest technology on board in our facility. We also have a wonderful relationship with the medical school that is now part of our Kaiser family. Our medical students in the last couple years have started rotating to our Kaiser facilities. That is wonderful, that we've been involved in actual teaching of medical students. Just so much has changed. Like I say, the quality of the applicants is getting better and better. We're teaching the next generation what we think is evidence-based medicine. Definitely we are making sure that we are engaging our physicians but also understanding that physician wellness is very important, because more and more physicians are experiencing burnout. We actually have physician wellness champions in each medical center. That is definitely new. None of this just "suck it up" mentality; that's no longer the case. That definitely has changed.

ZIERLER: What about the demographics of those who enter the medical profession? The doctors at Kaiser Permanente, has it become more diverse over the years? Did you feel at the beginning of your career that you were a bit of a pioneer and maybe that's less the case today?

MAPLES: I would say especially as a woman—I mean, probably more than 50% of medical students are female now. That's a big change. I went to one of our med school reunions—I guess I was out like ten years—and I was like, "Where are all the women?" Someone had to remind me, "Karen, that's all the women there were in our class. You don't remember?" Because in OB/GYN we were getting more and more women, so I was exposed to more women, but when I went to a med school reunion, I was shocked to see that there weren't that many women. I think that demographic has definitely changed.

ZIERLER: What about minorities? Are you seeing more non-white people become doctors?

MAPLES: I believe the medical profession has grown more diverse. However, there seems to be less African American male doctors. But yes, there is definitely more diversity than there used to be.

ZIERLER: As you advanced in your career, did you ever think about administrative options that would pull you away from medicine?

MAPLES: Not really, no. I really like to be with the patients. I was asked to apply to an administrative role after retirement, but again, it would have taken too much time away, because I still wanted to do the clinical work. And I did want to have a bit of a reduced schedule in my old age, so I opted not to do pure administrative work.

ZIERLER: With the time freed up, when you became Emeritus, what kinds of other things do you do now in your free time?

MAPLES: I have become a grandmother, for the first time! My wonderful granddaughter was born in 2020, right at the—

ZIERLER: A pandemic baby.

MAPLES: Exactly. So, that's what I do. I exercise and do my yoga, and I just have more time for my granddaughter, for sure.

ZIERLER: What about your connections to Caltech? Have you been an active alumnus or at least do you follow what is happening on campus?

MAPLES: The most connection I have is with our Caltech women's group. It started with the first five classes of women, and we started meeting quarterly for lunches. The pandemic hit, and now we're kind of having our monthly Zoom chats. During different parts of time, and I don't have the timeframe, I used to reach out to applicants, to talk up Caltech and let them know about Caltech and what it was like, and what it meant to me. I'm trying to get a little bit more involved with the African American community at Caltech, but again, as long as it doesn't interfere with Grandma time.

ZIERLER: When did the lunch group start? How far back does that go?

MAPLES: Hmm. I think it was before the pandemic, which has been three years. I would say a good five years? Because I'm thinking they graduated in 1974, right? Yeah, I think about five years ago, we started the quarterly meetings.

ZIERLER: What has been meaningful about connecting with your fellow alumni, thinking about Caltech as an undergrad?

MAPLES: It is neat to see what directions folks have had in their career, who is retired, who is not, who is opting to work post-retirement, who is just doing their travels. Just staying in touch, it's kind of cool.

ZIERLER: Have you followed some of the developments at Caltech in terms of promoting diversity? Have you followed those trendlines at all?

MAPLES: I have seen, and I'm really encouraged by—but sometimes Caltech goes on these cycles. I mean, there was a large increase in diversity, and then it just fell off, like—terrible. Now it's kind of trending back up. That's very gratifying, and it looks like it's heading more in the right direction. Certainly I never could imagine that the women would make up such a large proportion of the Caltech undergraduates. That's amazing.

ZIERLER: When you were an undergraduate, would that have seemed inconceivable to you, that women are now almost 50%?

MAPLES: Inconceivable. We were one woman for every seven or eight guys. Yes. That's crazy.

ZIERLER: What do you think accounts for that? That is obviously a bigger question than Caltech. As you said, more than 50% of the medical class now are women. What do you think accounts for these demographic changes?

MAPLES: I think it's just the change in societal expectations. And I think it's just that finally women said, "We can do it." One of the things that, as I'm growing up, I started to have my voice in high school. I applied to a summer internship at an oil company between my junior and senior years and they were only going to interview male students. I said, "That's unacceptable." I went to my chemistry teacher. I said, "I want to have an interview. This is not fair. I'm a good student. I should be offered this opportunity." She and my mom helped me, and I got an interview. I didn't get the job, but—so I think that there has been a lot of societal change as well, that has pushed forward that women are capable in the sciences.

ZIERLER: In your career, have you ever taken an active role in promoting these ideas, or has your approach been more leading by example?

MAPLES: Other than in high school, when I really had the time and inclination to really try to get more girls involved in science, it's more leading by example. Although, like I say, when a recruitment comes, I try to make sure that I talk to any woman who is interested in medicine or the sciences. I make myself available, for sure.

ZIERLER: For the last part of our talk, I'd like to ask a few retrospective questions about your career, and then we'll end looking to the future. Over the course of your career as a doctor, what are some of your proudest moments?

MAPLES: Well, were you aware that I delivered the octuplets?

ZIERLER: I heard about that! I knew that there was a delivery; I did not know that it was you, though!

MAPLES: That was me.

ZIERLER: Wow!

MAPLES: That was pretty—that was a highlight. That was my 15 minutes of fame, no doubt.

ZIERLER: Did you know that there were eight babies?

MAPLES: We thought there were seven, and at the end of the delivery, it was like, "Oh, there's one more." The successful outcome was definitely a team effort, no doubt. I happened to be chief of the department, so this patient became mine during her hospitalization. With the expertise of our wonderful nursing director, we made sure our team was optimally prepared. We made sure that we had enough operating or delivery rooms and personnel available, because we knew the babies were going to be premature. Everything went perfectly well. We did some rehearsals. It was just seamless. And they are still, as far as I know, the only surviving octuplets in the world, so this is quite a feat. My other highlights, I would just say being assistant area medical director or chief of the department, just trying to manage a very, very complicated diverse group, and trying to make sure that we keep our patients—our true north is our patient care—together. That's very important. And also to make sure that we take care of ourselves. That's another highlight, I would say, for me.

ZIERLER: To go back to the octuplets, was it a C-section?

MAPLES: [laughs] Yes. [laughs] This is not a litter. Yes, they were delivered by Cesarean section. I had two physician surgical assistants. We had two anesthesiologists. We had at that time seven neonatologists; these were specialists with newborn babies. Seven respiratory therapists. When the eighth was born, our team was able to manage two babies at once. I cannot give enough praise to our outstanding nursing staff. Ultimately, 52 people were involved in the delivery and neonatal intensive care.

ZIERLER: What was it like during all of the media attention? How did you handle that?

MAPLES: Well, we have a media relations department, so we knew by hour four, even though we were supposed to keep this under wraps, that there was going to be media attention. Yes, by hour three, there were already news trucks in our parking lot. The media relations said, "These are the questions that you're likely to be asked, however you have to be very cautious, because the patient is protected from our disclosure of anything about her or her babies without her knowledge." So, I had to limit my comments very much, and I was able to give proper interviews without getting into too much trouble. I even went on Larry King Live—it's archival—and that was interesting, to say the least. It was amazing. I was getting newspapers from around the world. I mean, it was an event. It was definitely an event.

ZIERLER: Finally, last question, looking to the future. Where are some of the big questions headed in the field of OB/GYN? For the next upcoming generation of doctors, what are the kinds of new developments in the field that they might be focused on that you might not have at the beginning of your career?

MAPLES: It is critically important that we reduce maternal morbidity and mortality for black women's pregnancies. Strides should also be made to reduce preterm deliveries. I would love to see new developments as both issues have significant societal and economic impacts. We are making significant inroads for treatment for hypertensive emergencies in obstetrics, as well as hemorrhage, but we can do better. I think that the next generation of physicians will also address new surgical techniques.

ZIERLER: I want to thank you so much for spending this time with me. It is really wonderful to hear all of your memories and to capture them for history. I'd like to thank you so much.

MAPLES: You're welcome!

[END]