Emeritus Attending Physician, Cedars-Sinai Medical Center; Professional Mystery Writer
By David Zierler, Director of the Caltech Heritage Project
March 28, 2023
DAVID ZIERLER: This is David Zierler, Director of the Caltech Heritage Project. It's Tuesday, March 28th, 2023. I'm delighted to be here with Dr. Paula Bernstein. Paula, it's wonderful to be with you. Thank you so much for joining me today.
DR. PAULA BERNSTEIN: Absolutely a pleasure.
ZIERLER: Paula, to start, would you please tell me if you have any current institutional affiliations, and what you call yourself, either professionally or in social settings, as a title?
BERNSTEIN: My institutional affiliation is with Cedars-Sinai Medical Center, where I'm an emeritus attending physician. I've been associated with Cedars since I did my residency there in OB-GYN, and practiced there for my whole professional life. I call myself Dr. Paula Bernstein, since I have a PhD and an MD.
ZIERLER: In Germany, you would be Doctor Doctor!
BERNSTEIN: I think that's really overdoing it.
BERNSTEIN: In social settings or in my writer's community, I don't use "doctor."
ZIERLER: Paula, the emeritus status at Cedars-Sinai, is that an honorific, or does that allow you to maintain an office, to see patients?
BERNSTEIN: It gives me parking and access to Cedars' continuing medical education. I don't maintain an office or see patients anymore, although I have maintained my license so that I can still call in prescriptions.
ZIERLER: Paula, some overall questions to see how you think about connecting your scientific training with your medical career. What do you see as the overlap or the shaded area in that Venn diagram between what you did at Caltech and what you've done as a practicing doctor, a physician?
BERNSTEIN: I would say that Caltech taught me critical scientific thinking, how to approach a problem, how to put all the facts together, how to plan going forward, how to analyze scientific publications, basically a scientific approach to the practice of medicine. I didn't do much research when I was practicing—it was mostly a clinical practice—but I would say that the training I got at Caltech helped form my approach to dealing with my patients' medical issues.
ZIERLER: Now, obviously, you could have gone on to a successful medical career just with the MD. What do you think the PhD made possible that otherwise you wouldn't have been able to do or would've been more difficult?
BERNSTEIN: What it made possible was that I did medical school in two years. The University of Miami School of Medicine recognized that we were in the middle of a recession. The majority of schools had filled their science departments. There was a big rush to hire science professors and train more scientists right after Sputnik. You may be too young to remember Sputnik.
ZIERLER: I know all about it, of course.
BERNSTEIN: In the early 1970s, Ronald Reagan, who was the governor of California, put a tenure hold on the University of California. There were very few academic jobs available, and there were a lot of science PhDs at loose ends. The University of Miami created this special program for people who already had PhDs in the sciences. It made it possible for me, in my early 30s, to make that transition quickly. There were only 28 people in each class, and they were some of the smartest people I've ever met, people from Harvard, Berkeley, and Stanford who, in another economic climate, wouldn't have been seeking a career change.
I had, what we call in physics, the two-body problem. I had a husband with a PhD, who also needed a job. This limited our locations, and being an ex-New Yorker, I had very clear ideas about wanting to be in an urban area, preferably on the East or West Coast. Finding job opportunities for both of us was pretty challenging.
One of the things that my Caltech PhD did for me was to get me into the Miami program. I'm grateful to Miami for having set it up exactly when I needed it. I was in the fourth class.
ZIERLER: Now, Paula, the pivot to medical school, did you have it in your mind early on that a PhD in fundamental sciences, a focus in chemistry, might lead to a medical career, or this was really a real-time decision you made?
BERNSTEIN: No, this was a real-time decision. My fantasy was to get a PhD in chemistry, an academic job in an ivy-covered liberal arts college and then get tenure. I hadn't thought about medicine until I discovered chemistry departments were boys' clubs, and I was the wrong gender. I was asked questions on interviews that would be illegal now. I was asked constantly about my husband's plans, and my pregnancy plans. It was a shock, because I'd gone through my life always getting everything that I wanted by virtue of being smart enough. It never occurred to me that being a woman was going to be a problem, even though, when I got to Caltech, there were no women tenured faculty, no women undergraduates, and just a small handful of women graduate students. I came in 1966. I was one of a group of graduate students who came with Harry Gray when he joined the Caltech faculty. Harry was always very popular with the women graduate students at Columbia, partly because he made no gender distinctions in mentoring his graduate students.
ZIERLER: Paula, a question about the road not traveled. I wonder if you've ever thought, given that you've spent so much of your career translating the science in a clinical setting, had you gone on to that professor's life, do you think you would have stayed purely in a fundamental basic science kind of realm, or would you have done things in a clinical setting from the academic vantage point?
BERNSTEIN: Once I decided that I had to leave that road, I don't think I ever thought hard about the road not traveled or regretted my decision. I loved doing clinical medicine. I found it more interesting than a lot of the research I had been doing. When I fell in love with chemistry, I was falling in love with what I learned about the fundamental nature of matter. This was information that had been put together over a century of research. What I didn't realize about the work going on at the time, was that I was researching a small area, the leaves on a branch of a tree, and I spent my time doing very sophisticated research that only a limited number of people would read and not many would understand.
Clinical medicine allowed me to touch people's lives in a very different way and make life better for patients. I never regretted the road not traveled, but it was a struggle making the transition. I put in time, effort, and energy at Caltech getting a PhD, spent a year doing a postdoc, and another year in a non-tenured research position that was associated with UCLA, where I was clearly going nowhere. It was very frustrating and anger-producing.
Those were the years where the women's movement was getting started. I began to read some of that literature and realized that chemistry departments were a boys' club and I was excluded.
ZIERLER: Paula, in that vein, the sexism that you experienced, the exclusion, did that influence what kind of medicine you wanted to practice, going into OB-GYN?
ZIERLER: I could see that cutting both ways. On the one hand, maybe you thought that this was an area perceived as appropriate for women doctors, or maybe you saw it as empowering that this was a great place for you to make an impact. How did you think about those things?
BERNSTEIN: The latter. There were several decisions that I made as a result of my experience. One was that I wanted to do something with my life where I had control. I did not want to work for anybody. I didn't want to be judged by a department of men. When I graduated residency, I opened my own office, went into private practice, and took in a close friend two years later. She and I practiced together until we both got to be old ladies and retired. I had complete control over my practice. I decided who to hire, how many patients to see in a day, and how much time I could allocate for each patient. When I decided to take Friday afternoons off one summer so I could take my two-year-old to swim lessons, I could do that. I was my own boss.
OB-GYN at that time was really a male doctor's profession because it was surgical, and women were being treated in a paternalistic way. I thought that as a woman OB-GYN, I would have the capacity to treat patients the way I would want to be treated. I wanted to make sure that my patients were fully involved in whatever choices were being made. .
I went into the training thinking ob-gyn was what I wanted, and when I began to do deliveries and become familiar with the surgery, it felt like a great fit. There was so much variety. I was sharing an experience with my patients that was one of the highlights of their lives. I took care of people for a lifetime. I delivered their babies at the beginning of my practice, and then prescribed their hormone replacement therapy when they went into menopause. Later on, many of the babies I delivered got to the age where they needed a gynecologist, and I took care of them. It was a very personal practice. I don't know if that exists anymore. My partner and I used to call it the Marcus Welby Model of Medical Care. Are you old enough to remember Marcus Welby?
ZIERLER: Again, like Sputnik, not personally, but I know very well the name.
BERNSTEIN: We loved it. I would walk into the office every morning, look at my appointment list, and it was like visits with old friends.
ZIERLER: Now, when some of your patients got old enough, talking about carrying them through the duration when they went through menopause, was that your inspiration for entering that practice area when your patients got to that age?
BERNSTEIN: Yes, it was. In 2002 there was a study that scared women to death about being on hormone replacement therapy, so that what used to be a 15-minute conversation became an hour-long consultation. Hormone replacement therapy became a subspecialty for me in my later years.
The thing I loved doing the most was laparoscopic surgery, which was just taking off in the early '80s. I became involved with the resident teaching program. I created a yearly course, and I set up a skills lab.
ZIERLER: Paula, tell me about your interests in patient education. I know this is something that you care deeply about. What were your motivations in focusing on that?
BERNSTEIN: I always felt that every patient should have an understanding of what their disease process was, what the options were for taking care of it, and what the pros and cons were of each option so that they could participate intelligently in a decision about care. This led to what was then my hobby, and has become my retirement joy. I've always loved to write. I did write two patient-oriented paperbacks at the time I was practicing. One was called Woman to Woman: A Gynecologist's Guide to Your Body, and that was published by Bantam. The other was called Carrying a Little Extra: A Guide to Pregnancy for the Plus-Size Woman, published by Penguin. Writing those books, which involved a lot of research, was like writing a term paper. It's not like writing fiction. But it was part of my commitment to patient education. I also loved teaching residents. Maybe that was the part of the road not taken that came into my medical practice. It was going to be teaching undergraduates about chemistry, and it turned out to be teaching residents about surgery or about obstetrical care.
ZIERLER: Paula, tell me about your focus on the issue of obesity and pregnancy, and if there were maybe what we would call socioeconomic issues at play that took you beyond a strictly medical or scientific context.
BERNSTEIN: That's a funny story. I was originally planning to partner with a friend who was a psychiatrist, one of whose specialties was eating disorders. I wanted to do a book on pregnancy and eating disorders because I had recently cared for a number of patients with that issue and had done research on it. I had an agent at the time, we submitted an outline, and she took it to Penguin. They didn't think there was a big enough audience for a book like that, but they wanted a book on obesity in pregnancy. Having struggled with weight my whole life—(where was Ozempic when I was 20?) I was up for doing it. For that, I partnered with two nutritionists at Cedars, and did a lot of research, because there are significant medical issues that come up in women who are very obese.
I did not get into socioeconomic issues, which are really front and center right now. This was the early '80s. I think I published that book in 1984. What was interesting, was that in writing it, I did a lot of research about things like the set point, things that are now being discussed in The New Yorker or in The New York Times. My viewpoint always was, "Your weight is not your fault. It's your genetics and your metabolism. How do we manage it to keep your pregnancy safe?" That was not a typical doctor viewpoint about obesity at that time. It was, "Cut your calories, do more exercise, and have a little willpower." There's nothing more annoying than a thin doctor telling you you're overweight.
I would not bring up weight with my patients. I figured if they wanted to discuss it, they could bring it up with me. One of the things I would say very honestly, was that if I had the answer to not just losing it, but keeping it off, I'd be a size eight. I'm very happy to see the change. I hope that that the medical establishment will start thinking about weight differently, and that people will realize that Ozempic is not a drug for people who are five pounds overweight and want to take it off. It's a lifetime commitment like your blood pressure drugs, for people who are genetically and metabolically programmed to be overweight.
ZIERLER: Paula, on that point, when in the chronology do you embrace fiction writing? Is this something that you had always done, and you decided to go professional, or how did that start?
BERNSTEIN: David, I wrote my first novel when I was 11 years old.
ZIERLER: Oh my goodness.
BERNSTEIN: I was deeply inspired by Gone With the Wind, which my mother was reading at the time. I took it after she'd finished reading it, and smuggled into my fifth-grade classroom, and was caught reading it inside my social studies book. My fifth-grade teacher told my mother that he really thought it was much too mature for a 10-year-old. My mother listened very politely, brought the book home, and said, "Don't take it to school again," as she handed it back to me.
My 50-page handwritten, first novel was called Scarlet, Vermilion, and Lavender Rose, and it was a Civil War romance. I took creative writing in high school. However, like many smart kids growing up in The Bronx, I went to Bronx Science, and that was where I fell in love with chemistry. I was enchanted with the idea of trying to understand matter at its most primal level. Back then it, was atoms, protons, neutrons, and electrons. Had I but known, maybe I could have been a theoretical physicist—or an experimental physicist and gotten down to the quarks and the Higgs Boson.
Writing was always a hobby for me. When I went from Bronx Science to Barnard, I took a lot of literature classes. I worked on the literary magazine. I didn't do much writing when I was at Caltech, but after residency, I would take writing classes at UCLA because they had a wonderful writing program. Often those classes generated writers' groups. By the time I retired, I had a file cabinet with several first drafts of what became my Hannah Kline series.
ZIERLER: Did you ever think about using a pen name, was it important for you to keep those worlds separate, or not? Did you want to embrace any interactions between the two?
BERNSTEIN: I thought about using a pen name while I was practicing medicine. Once I was retired, I didn't see any reason to use a pen name. Sometimes if writers write in different genres, they use pen names.
ZIERLER: Paula, now that we've mentioned the Bronx High School of Science, let's go back now and establish some personal history. For undergraduate, Barnard College, generationally, was that the way for women to get a Columbia degree?
BERNSTEIN: No, they got a Barnard degree. I didn't have a lot of college counseling when I was in high school. My parents were lower middle class immigrants. They had very little money. It was understood that they could not afford to send me out of town to college. But academically, Barnard was excellent, and also a college where women were encouraged to develop professionally. The women in my class at Barnard were amazing. We had lots of doctors and lawyers and college professors. I applied to Barnard early decision. I got four scholarships so that I could afford the tuition, which was $1,100 a year at the time I started. It was more like an extension of high school because I was living at home. I was commuting, as all of the New York students did at that time.
By the time I got to my third and fourth year, I had exhausted the math and chemistry classes at Barnard, and I was taking classes in the graduate school at Columbia. In my senior year, I started doing undergraduate research with Harry Gray. When I decided to apply to graduate school, I applied to Columbia and a number of other places on the East Coast. I got accepted at several excellent schools, but I was really interested in the research project I'd started with Harry Gray, and Harry was such a great advisor, I just accepted the offer from Columbia and stayed on. I figured I would get my PhD and get an academic job somewhere in New York or close by.
ZIERLER: Paula, do you remember what Harry's research was at that point?
BERNSTEIN: Yes, he was doing inorganic chemistry, and he was very into molecular orbital theory. Where was the electron? What was it doing? What were the quantum mechanics of what was happening? He had just become the youngest full professor in the history of Columbia at the age of 29, and was really popular with the undergraduate students. He had a large research group, lots of nice people.
During my first year with Harry Gray's group, he went to Caltech for a sabbatical, and Caltech seduced him, gave him an offer that was just too great to refuse. He came back and had one-on-one talks with all of his graduate students and offered us a choice. He had a couple of students who were within a year of getting their PhDs, and they just stayed at Columbia, and got their Columbia degrees with Harry. Then he had students like me who had just started, who could either switch advisors and switch projects and stay at Columbia, or come to Caltech with him. I had no idea what California was like, I wasn't sure they had supermarkets or anything. I didn't drive. Who in The Bronx owns a car? I decided that I would have this short adventure, move to California, get my PhD, and come right back home to get a job. It didn't turn out that way.
ZIERLER: Here you are.
BERNSTEIN: It was one of these Sliding Door moments that I think we all have in our lives.
ZIERLER: Paula, I'm sure you've heard, in all of my interactions with the women who were in that first class of 1970–1971, Harry comes up repeatedly as one of those heroic professors who was so supportive, who pushed for this, to make Caltech coed. Did you get that from him at Columbia that those were his priorities? Did you see where this was headed?
BERNSTEIN: What I saw was that he treated all of his graduate students equally, and he was so nice to all of us. We really were a team. He would take us out to the West End Bar for beers at the end of a long research day. He would celebrate with his students when they got PhDs. His office door was always open if you had a question or a problem. Harry, are your ears burning? He was the kind of advisor who doesn't come very often, and I think I recognized that. At that point, I was unaware that there was a woman problem in the sciences. I just thought women weren't that interested. I didn't realize the scope of the problem, and it's still here today. We don't have enough women going into STEM fields. I have to say, I'm thrilled to see what has happened at Caltech since I left, the large number of women faculty and undergrads and graduate students, women getting Nobel Prizes, and a level of equality I could not have imagined back in the late 1960s or early '70s.
ZIERLER: Paula, to clarify, had Harry stayed at Columbia, most likely you would've stayed at Columbia?
BERNSTEIN: That's right. In 2018, Uri and I celebrated our 50th wedding anniversary in 2018 at a party at the Athenaeum. Harry and Shirley were there, and I credited him with my marriage. I would never have met my darling husband, whom I've been married to now for 55 years, had I not made the choice to come to California. If Harry hadn't come to California, I would've been in New York.
ZIERLER: Paula, tell me about your early impressions of Caltech when you got your bearings here.
BERNSTEIN: When I got my bearings, I thought the campus was lovely. It was tranquil. I really enjoyed the greenery, the olive trees, the little gardens, the fact that I could ride a bicycle to the chemistry building, and that I had much more office and lab space than I'd ever had at Columbia. I did find that the male students were not nearly as friendly as they had been at Columbia. I was the only woman in the classroom. No one ever said hello or asked me a question. I complained to Uri about it. I said, "These guys never talk to me." He said, "They don't talk much to each other either." I thought I was doing something wrong.
I didn't get the sense of community in the department that I felt at Columbia. Fortunately, I'd come with my own research group, and we were tight. Harry would take the group down to Chinatown for dinner or to the basement of the Athenaeum in the late afternoons. We would have group parties, and Harry would often throw parties. I was sharing an apartment with the only other woman in the group. We did get a woman postdoc, and one of the other Columbia women came out. I didn't even know that there was a graduate house at Caltech for women.
I liked California way more than I thought I would. I had no idea what it was going to be like. There was no great outdoors in The Bronx, and my husband was very into hiking, and backpacking, which was a challenge to a New York couch potato.
ZIERLER: Paula, in what ways did your research or your trajectory change in graduate school, in moving to Caltech, and in what ways might that have been related to how Harry's research might have changed in this new faculty appointment?
BERNSTEIN: I had easier access to X-ray crystallography. I had done my X-ray crystallography at Columbia Presbyterian Hospital with a professor in the medical school, Barbara Lowe. I'm not even sure that the Columbia department had that equipment at the time. The initial project Harry gave me was really interesting, from a spectroscopic, theoretical and structural point of view. I didn't change my project when we moved to Caltech. While I was there, Harry was still doing this same kind of inorganic chemistry. Toward the later part of my time at Caltech, he became more interested in some of the more biological metallic molecules and in photochemistry. I'm not sure about what the trajectory of his research became after I left, because I didn't keep up with chemistry. Once I started medical school, I didn't have any time.
ZIERLER: Paula, how far along were you in your graduate education when Caltech became coed for undergraduate women?
BERNSTEIN: I got there in '66. The first class arrived in '70.
ZIERLER: You had already defended at that point?
BERNSTEIN: I finished writing during the summer of 1970, and I defended sometime that fall or winter, got my degree in '71, and started a postdoc at Caltech while I was still in the intense process of trying to find a job. Harry kept me on for a while. I worked with Richard Marsh, a very lovely guy who was an X-ray crystallographer, for about a year, and finally got this UCLA appointment, and also became active in the brand-new Women's Studies program. I put together a course on women in science that was sociologically based – how women are treated in science.
I do remember one of my job hunt experiences in particular. I will not name the school, but they claimed to be looking for someone who could be a faculty member in their chemistry department and also work with their new women's studies department. It wasn't in a place I wanted to live, but I sent in my résumé—Caltech, PhD, postdoc, women's studies program at UCLA—and I did get an interview, but they hired some guy from Indiana.
ZIERLER: What I was going to ask was, as a late-stage graduate student, when Caltech went coed for undergraduates, did that register with you? Were you too cloistered in your graduate world?
BERNSTEIN: That did absolutely register for me, and it was really nice to see more women on campus and to realize that Caltech had finally broken that barrier. Also, they finally hired Jenijoy La Belle, their very first tenure track woman in the English department. Also, they made good on Olga Taussky-Todd, who should have been a full professor in the first place.
ZIERLER: Paula, you mentioned Harry's interest in theory. Was your thesis research theoretical at all, or would you say it was purely experimental?
BERNSTEIN: It was both. I did a lot of spectroscopic studies, electron spin resonance, and X-ray crystallography. I was dealing with an unusual compound called Nickel Diarsine, and I did a quantum mechanical analysis of the electron spin resonance spectrum. Now, I have to confess that when I look at my thesis, it looks like Sanskrit. I cannot remember any of the math. But it was a pretty sophisticated piece of theoretical work. It really touched all the bases.
If I were working in basic research now, I would want to be working in medical basic research because I think that's where all the excitement is. People have been figuring out the biochemical pathways of individual genes, how they impact disease, and what kind of drugs you can develop to target various places in these pathways. The past 10 to 20 years has made such a huge difference in the basic science and clinical treatment in diseases like cancer, ever since we cracked the genetic code.
A lot of that was based on work done at Caltech by people like Leroy Hood who created the instrument for sequencing at the very beginning. I think, for me, basic research might be much more exciting now than it was in the late '60s, early '70s, because there really was no practical use for my thesis. However, I did find an excellent use for that chemical many years later when I used it to poison someone in one of my novels.
ZIERLER: That's great.
BERNSTEIN: I sent the novel to Harry. I think it gave him a big laugh.
ZIERLER: Paula, tell me some of your key conclusions or what you saw as your contributions with your thesis research.
BERNSTEIN: You mean contributions to chemistry ever after?
BERNSTEIN: I don't know that there really were any. Like many papers published at that time, it was a little leaf on a branch of an interesting tree that maybe gave us a better understanding of how electrons worked. It was a nice solution to a problem, but I don't know that it was a giant contribution to advancement in science, I really don't.
ZIERLER: What about the conclusions? What did you learn or what was now known that wasn't known before as a result of this research?
BERNSTEIN: I was looking at a chemical in which nickel was in a state of a 3+ charge. Normally nickel is 2+ because the electrons are all paired. There was this one unpaired electron floating around that should have been completely unstable but wasn't. I was able to figure out from both the structural and the theoretical work that I did that the ligand that was binding the nickel had stabilized this electron by spreading out its orbital among all the carbon atoms in the ligand. That was interesting, and I think that it was one teeny little contribution to molecular orbital theory and how things worked in inorganic chemistry, but it wasn't a major bombshell. I don't know where my research would've gone had I become an academic chemist. I never really had a chance to explore that question.
ZIERLER: In light of your self-assessment, I'll leave it to the larger field if they agree with you, but in your own self-assessment of the significance or lack thereof of the thesis, do you think that influenced your pivot or your decision not to pursue an academic path, or were you more practical about jobs and salaries and things like that?
BERNSTEIN: No, the thing that influenced me was that I couldn't get the kind of job I wanted. I realized that I would have little or no autonomy, and I was angry about the discrimination against women in an academic setting. I became very active in the women's movement in Los Angeles. I was in contact with academic women around the city who were beginning to realize that they weren't being treated fairly in terms of tenure. We were starting to collect data for potential class action suits. Then I got into medical school, and I didn't have time to be an activist anymore.
ZIERLER: Now, do you think if you became angry relatively late in your academic career, to what extent can that be attributed to being in a bubble, so to speak, with Harry Gray, where you didn't have to experience those things?
BERNSTEIN: It was a lovely bubble. Until I started job hunting, it never occurred to me for a moment that I would have trouble. Of course, I didn't plan on the recession. It was a very bad economic time. Had I graduated five years earlier, I might have gotten a job, but I might not have liked it either. I don't know. Harry's group was a place where everybody was treated well. You can tell him I said that.
ZIERLER: When you told Harry that you were going to go to medical school, what was his reaction?
BERNSTEIN: I don't think he was surprised because he'd seen how much I'd struggled to find the kind of job I wanted. I wasn't the only one of hi graduate students who went to Miami. The woman I roomed with in graduate school wound up in my same class. Then a year later, the guy I shared a lab with at Caltech came to Miami. This program was hot.
ZIERLER: Tell me about where you applied for medical school. What options were available to you?
BERNSTEIN: Everywhere. I applied to every medical school in every large city that was a private school, and did not require residency in the state. It wasn't easy because I was an old lady. I was 29 when I applied. I was thrilled to get into Miami because, anywhere else, it would have been four years. My husband, who had a perfectly nice job at the time, took a post doc at the University of Miami to be with me for those two years. Then the two of us ran back to California as fast as we could because we hated the weather, and the roaches were the size of hamsters. We did not like living in Florida.
ZIERLER: Paula, your postdoctoral work first at Caltech and then UCLA, was that sort of a holdover because you knew you were going to med school?
BERNSTEIN: The UCLA one was really a holdover because I knew there was no chance of any advancement or real faculty position, and I was busily applying to medical school that year.
ZIERLER: The program at the University of Miami, was it custom-made for you to be a PhD to MD type program?
BERNSTEIN: Yes, it was a two-year program. Everyone in the class had a PhD in one kind of science or another. A lot of them were people who had assistant professorships but whose universities, because of the economics, were not going to be giving tenure. They were a brilliant group of people, many of whom became my lifelong friends. The program was designed to cram two years of basic sciences into one year.
What was very interesting to me was the way that things were taught in medical school was very different from the way they are taught at places like Caltech. At Caltech, I learned to memorize the smallest amount I needed from which I could derive everything else. Whereas in medical school, they wanted you to memorize in enormous detail. Not surprisingly, unless you used the information on a daily basis, you forgot it after the exam. It was not a learning paradigm I was fond of. But I got through it.
During my second year, I did the regular medical rotations through all the standard subjects, and then three months of electives; The regular medical students got a whole year of electives. The summer between my first and second year, I applied for residencies.
ZIERLER: Now, the frustrations that you felt on the job market, coming out of Caltech, what about applying for residencies? Was it similar, or you had good options?
BERNSTEIN: That PhD gave me some very nice options. I remember interviewing the head of one residency program, who said to me, "With that Caltech PhD, you can have any residency you want." I matched with my first choice, which was Cedars-Sinai. Because my husband had a really good job in LA and had taken a two-year leave of absence for me, I applied to all the programs in LA plus one in San Diego, where his company had a second office. I didn't have any trouble matching with my first-choice program. I was the second woman in OB-GYN residency there. Almost all of my colleagues were guys, and that began to change about a year or two after I got there. The majority of OB-GYNs now are women. Our department head is finally a woman. Now, women are running many academic departments in OB-GYN, and other medical fields as well, and women are now 50% or more of medical school classes. Of course, medicine is less lucrative now than it used to be. Maybe the men are all going into hedge fund management.
ZIERLER: Paula, to clarify, when you apply for residency programs, you have your specialty in mind, which is to say that it was in medical school at Miami that you decided on OB-GYN?
BERNSTEIN: Yes. I think I had it in mind when I started, but the minute I delivered my first baby, I knew that was it. I applied only to OB-GYN residencies. The residency application process works as a match. You rank residency programs by your preferences, and the departments rank their candidates by their preferences. I've been on the other end of that, interviewing residency applicants for Cedars, so I know how it works. Then the big computer matches you, and you are obligated to go where you're matched.
ZIERLER: Let the record show that you didn't have to worry about grocery stores or drivability or any of that stuff coming back to Los Angeles.
BERNSTEIN: No, I was very happy to come back to Los Angeles, and I was very happy to match at Cedars. I've always loved being there. It's a hospital that has an exceptionally high level of medical care, and I didn't realize how high until I started consulting on medical legal cases. I discovered there were hospitals where the standards were much lower. I was happy to be a Cedars resident, I learned a lot, got to do great surgery, and never left.
ZIERLER: You're saying Cedars because it was before the merger. It was not Cedars-Sinai at that point?
BERNSTEIN: No, it was Cedars-Sinai. My residency class was the first class in the new hospital. They were still doing construction up on the eighth floor.
ZIERLER: Did you have any opportunity beyond the purely clinical setting to think about science or research during your residency?
BERNSTEIN: I did publish a couple of research papers in the area of laparoscopic surgery because I got into that on the ground floor. In fact, my partner and I bought some of the equipment before Cedars even had laparoscopic surgery instrumentation. They had the laparoscopes, but they didn't have the instruments you needed to operate. I did one paper looking at the results of laparoscopic hysterectomy done at Cedars during a period of a year. I did the first laparoscopic hysterectomy at Cedars-Sinai. I also devised an instrument for uterine manipulation which was manufactured. I wrote a paper about that. But I was running a busy clinical practice, and I didn't have much time for research or money. When you're a private practitioner, you don't often apply for research grants. Some of the private practitioners get involved in clinical trials, but I didn't.
ZIERLER: Now, laparoscopic procedures, was this cutting-edge technology when you were a resident?
BERNSTEIN: Absolutely. When I trained as a resident, we used the laparoscope as a diagnostic tool. You'd look in. Is something going on bad enough to require surgery? Yes. Take the laparoscope out. Make an incision. The one thing that we did do was laparoscopic sterilization. Then pioneers at the American Association of Gynecologic Laparoscopy (AAGL) realized that with the right instruments, you could operate through tiny holes, and save your patient a big incision and a long recovery. I had joined the AAGL, and started going to all of their conferences, and I was really excited when I saw some of these procedures being done. For example, taking out ovarian cysts, removing ovaries, or removing tubal pregnancies, and I wanted to try it. I bought the few tools that were essential, and my partner and I began to do some of these cases. We gave our patients full disclosure, telling them that "If this cannot be done laparoscopically, you will have a laparotomy. If I'm successful in doing this laparoscopically, you'll have a much faster recovery." Most of them would opt for it.
I kept going to the AAGL, and familiarizing myself with all the new instruments. Eventually, Cedars-Sinai bought all the necessary equipment, the general surgeons started using it for gallbladders, and laparoscopy became a tool for general surgical procedures. We were some of the early adopters to this technology, and it was very exciting and fun to do. You had to be very careful and meticulous, and keep in mind that the most important thing was your patient's safety.
ZIERLER: Paula, I'm not sure what the chronology is here, but what was the impact of Roe v Wade and the rise of Planned Parenthood for you?
BERNSTEIN: I have to tell you that I had friends who went to Mexico or Cuba to get abortions, or had illegal abortions in the United States, which were scary. By the time I opened my practice, Roe v Wade had happened, abortions were legal, and I learned to do them in my office with a local anesthetic block, some Valium and a little pain medication. I did that for 30 years. Patients would have counseling and support for their decisions. A lot of us were doing in-office abortions during that time period. If there was some medical problem or the pregnancy was a little bit too advanced for me to feel comfortable in the office, I would take my patient to the outpatient surgery center.
ZIERLER: I wonder if you saw those decisions or the way that you approached these things through the lens of women's rights and your activism earlier in your career.
BERNSTEIN: Absolutely. I was outraged by the Dobbs decision. My husband and I recently set up a fund at the University of Miami School of Medicine, in conjunction with the OB-GYN department, to support residents and medical students who want to do their abortion training out of state. Legislation has just passed in Florida forbidding abortion after six week, and that's going to destroy the abortion training program in the OB-GYN department. The department was doing most of the surgical abortions in Florida for women with high-risk medical problems or who needed to be terminated in the second trimester because of major congenital defects. We're in the middle of a fundraising campaign at present. Hopefully, with the next incoming class, we will be able to send both students and residents out of state. It was the one concrete thing I felt that I could do that might make a small difference.
ZIERLER: Paula, I wonder if you can explain, you mentioned your determination to open your own practice, and the freedom that this would afford you, but you also retained an affiliation ever since with Cedars-Sinai. How did that work? What was the nature of the affiliation?
BERNSTEIN: I was an attending physician on staff. I admitted all of my obstetrical patients there, and delivered them there. I did all my surgeries there. You can't practice OB-GYN without a hospital affiliation. I was the clinical chief of gynecology for a few years. I was very active there, both in terms of resident teaching and being on the medical executive committee that involves physicians in hospital policy. It was my place.
ZIERLER: But were you self-employed? Were you an employee?
BERNSTEIN: I was self-employed.
ZIERLER: How does that work?
BERNSTEIN: Some hospitals buy medical practices and employ physicians. The Cedars-Sinai Medical Group is owned by the hospital. I had an independent practice. I made my own money. I billed for my services through the patient's insurance. My billing was separate from Cedars-Sinai. I took my patients there for whatever medical care they needed. For the hospital portion of their care, Cedars would do the billing. I was not a Cedars employee, I was a Cedars attending, and that was the private practice model. When I finished my residency in 1980, there weren't any giant hospital-owned groups like the Cedars-Sinai Medical Group. Everyone was either in private practice or on the hospital's academic staff.
ZIERLER: Now, when you became an assistant clinical professor, did that involve teaching or mentorship?
BERNSTEIN: Resident teaching, yes. Cedars and UCLA were affiliated. Although the appointment was through UCLA, all the activity was at Cedars.
ZIERLER: Now, when you were clinical chief in 2008–2009, did that have administrative responsibilities?
BERNSTEIN: Yes, it did. I wasn't sure that I was going to be good at administration or like it, but I discovered that I was able to juggle a lot of balls at the same time, and I learned who needed to be at the table to accomplish the things that I wanted to accomplish. As clinical chief I focused on our operating rooms; scheduling, and improving turnover. I took a science-based approach.
When the schedule wasn't on time the anesthesiologists blamed the surgeons, the surgeons blamed the nurses, and the nurses blamed housekeeping. I collected data. I assigned someone to go into the operating rooms and measure the time that it took for each part of the process. We discovered that there were things being done sequentially that could be done simultaneously, and were able to make changes that got our 7:30am cases going on time. If 7:30 is late, every surgery that follows is late.
We also collected data on when surgeons showed up for their cases, and surgeons who were consistently late were not given early times. It was a data-driven approach to making operational changes. I didn't mind administrative work, but after my term as clinical chief, I retired from my practice.
ZIERLER: Paula, you mentioned when you started in OB-GYN in your residency, you were really one of the first or the few women in the field.
BERNSTEIN: There was only one other woman OB-GYN at Cedars, and she was couple of years ahead of me.
ZIERLER: I assume at some point, those numbers balanced out and even, at some point, the women became the majority. When did that happen? Was it a slow transition? Do you remember any pivotal years?
BERNSTEIN: It was a fairly slow transition. There were one or two women behind me in each residency class, then it started to become more and more female, and often there would be just one man. We had six residents in each class, and sometimes five out of the six were women. When I started my residency, I remember listening to a lot of sports talk in the operating room.
BERNSTEIN: I was usually the only woman surgeon at the table. "Lakers, who are the Lakers?"
ZIERLER: Girl from New York.
BERNSTEIN: Right. I began to notice, during the years of my practice, we'd often have an all-woman team. The anesthesiologist, nurses, and all the surgeons would be women, and then we could talk about girl stuff.
ZIERLER: Paula, I don't mean for this to be an overly provocative question, but going on the assumption that women are generally more comfortable with female doctors for OB-GYN, do you think that that makes women better OB-GYN doctors in the way that they can better serve their patients?
BERNSTEIN: I have to say that I've known quite a few wonderful male OB-GYN doctors. I think anyone can be warm and supportive, and recognize that the patient is part of the decision-making process. Anyone who can do that can be good OB-GYN. A lot of women now do prefer women physicians. However, I'm not a fan of sex discrimination in any direction. When I supervised a clinic, and a patient did not want to see the male resident who walked in, and demanded a woman, I would stick up for my resident. You don't get to discriminate on the basis of sex any more than you can say, "I don't want a Black doctor seeing me. Send me a white one." I think discrimination in any direction is wrong. We should judge people as individuals.
ZIERLER: Now, when you took on becoming a resident supervisor in the outpatient Cedars gynecology clinic, and then as a menopause consultant, were these sort of post-retirement roles, or when did you start to wind down your practice?
BERNSTEIN: I stopped practicing and gave up my office at the end of 2009, but it's really hard for doctors to retire. It took me a year to make that decision. " If I'm not Dr. Bernstein, who am I?" Until you can let go of that, because your self-esteem and identity is engaged with being a Dr., you can't retire. Having made the decision to stop, it was still hard to give up medicine because I enjoyed it so much. I looked for opportunities to continue on a voluntary basis. I spoke to my department chair, and said, "I love teaching residents. Can you use me?" We had a high-risk gynecology clinic that was open once a week. It was very close to Cedars. I supervised there, twice a month. I discovered all the new electronic toys that the residents used that I didn't know about.
They have a piece of software called UpToDate on their phones, which tells them how to treat any bizarre disease they've never heard of. It's a lot easier. On the other hand, they have to deal with all of this electronic medical record software, which is not physician-friendly.
I retired at the perfect time. I turned 65. My lease was up. Insurance companies were paying even less despite inflation, and despite the fact that doctors' overheads were going up. Cedars-Sinai was about to launch its electronic medical record system. I thought, "Yes, the stars are aligned. It's time for me to stop." I also contacted Planned Parenthood, and offered to train residents to do abortions because they did have residents doing rotations through there from several of the local residency programs.
In addition to the clinic and Planned Parenthood, I had developed this very detailed menopause consult process. My cardiologist, who was also a good friend and referring physician, asked me if I would work with his practice, and do menopause consults for their patients. I did that, and the clinic for eight years after I retired.
ZIERLER: Paula, I'm curious, you wound down right at the time Obamacare was coming into force. Had you stayed active or in talking with colleagues who remained active, what changed?
BERNSTEIN: With Obamacare?
ZIERLER: Yeah, or had you stayed in practice, would things have been different for you at all, for better or worse?
BERNSTEIN: I think had I stayed in practice, financially, things would've just continued getting worse and worse and worse. It has become almost untenable, especially in expensive areas like Los Angeles, for small individual practices to survive. Once the insurance companies invented the PPO, they had control over what physicians got paid. Before PPO's when malpractice insurance went up, physicians would just raise their OB fees to compensate. But, once most patients were in PPOs, the insurance company would pay the same amount regardless of what malpractice cost, and they wouldn't give you raises for inflation or anything else. By the time I retired, I would have to do 25 deliveries in a year just to pay my malpractice premium.
ZIERLER: Now, when you embraced retirement or at least the soft landing, is that—
BERNSTEIN: The soft landing.
ZIERLER: —is that when your writing career really took off?
BERNSTEIN: Yes. That was when I decided to go to my file cabinet, take out some of my first drafts, and find an editor. I was very fortunate. I connected with a wonderful woman named Linda Schreyer. She'd been a screenwriter for many years, and then when she got exhausted with Hollywood, she started doing editing and freelance teaching. I signed up for one of her classes, which became my writing group, and she and I started working together to edit some of my first drafts. Those became the first three novels in my Hannah Kline series. The writing group has continued this whole time.
BERNSTEIN: My editor suggested to me that I join Sisters in Crime, an organization that supports and mentors women crime writers. It was started 35 years ago by Sara Paretsky. I joined the LA chapter, started meeting terrific women writers and, somehow or other, I became the President. I get termed out at the end of this year. I've been busy not only writing but running this chapter, and putting together the Southern California Crime Writers Conference, which is happening in June. Being President is like a full-time job.
My writing has really taken over. I am not going to be able to retire on my royalties, but I have so much fun doing it. After I self-published the first six novels, I found a publisher, Third Street Press. Their business model is to look for series that need better marketing and could be selling more if they were well marketed. I hate doing marketing, and I don't do very much of it. I'm a Luddite, so I'm not on social media. My publisher reissued all of my books. We got a fabulous cover designer. The publisher reformatted everything, and has been doing all the PR, and so I have been selling more books. I don't care at this point in my life about making money, I care about people reading my books. Writing is my hobby or, as my husband calls it, our tax deduction.
ZIERLER: Paula, just to bring our conversation right up to the present, are you involved at all in science or medicine, or is that really all in the rear view mirror for you at this point?
BERNSTEIN: Most of it at this point is in the rear view mirror, except as I adapt it in my novels. My novels are all medically based and have some medical or scientific theme going through them. This gives me a chance to do the research, talk to my colleagues, and get information about fields that are not my expertise. My heroine is an OB-GYN, so there's always something there in the background about her medical life. The novel in which I poisoned a Nobel Prizewinning astronomy professor with the chemical from my thesis is all about the search for extrasolar planets. That's something that my reader learns about in the course of figuring out who'd done it.
I wrote one recently in which the villain is the owner of a start-up company doing research in immunological drugs for cancer, and it features a psychiatrist who's the best friend of my OB-GYN, so I had to learn about how to do therapy from all my therapist friends.
Every single one of my novels has something medical in it. The one I'm working on now, Murder is Paralyzing, involves a victim of a murder attempt who winds up as a quadriplegic. I'm educating my readers about what it really means to be completely paralyzed from the neck down. In that sense, I've never left medicine and science behind; I'm just using it in a different way.
Then I have a little private practice of all my friends who use me as their first touchstone. "Should I call my doctor? Do I need to go to the emergency room? I'm out of my medication and I can't reach my doctor. I've called 93 times. Could you call me in a prescription for a few days to hold me?" I give a lot of careful advice to friends, with the caveat that "This is not my area of expertise. Your neck pain is not my end of the body, but I would suggest you talk to your doctor about doing the following." Once a doctor and scientist, always a doctor and scientist.
ZIERLER: That's right. Paula, now that we've worked right up to the present, for the last part of our talk, I'd like to ask a few retrospective questions about your career, and then we can end looking to the future. First, to go back to Harry Gray, and maybe this is a bit of a philosophical question, but I can see a duality to how you might think of him. On the one hand, his promotion of women, his forward thinking, that might have made him very revolutionary in his time, relative to his peers. But maybe it's just as simple as he was a decent human being, and it's irrelevant what time period you're talking about, because decency is decency. I wonder if you ever thought about that in historical context.
BERNSTEIN: I never thought of Harry as revolutionary in being equal and fair to the women in his group. I just thought that was normal. Harry is a very decent, nice, funny human being. He's got such a great sense of humor. I never thought about it at the time. I just assumed that this is how you were supposed to be. He was a great role model for how I wish all academic advisors were. Unfortunately, I eventually learned that wasn't the case. I never thought of Harry as revolutionary, and I didn't realize that he had been one of the people who had been pushing for admitting women undergraduates. That was something I learned from you at that nice luncheon we had at Kathy Faber's, so I sent him an email saying, "Are your ears are burning?"
ZIERLER: Paula, in thinking about the road not taken, you already explained to me you never regretted it. You've never looked back. But, on the other hand, at the time, you were very upset. I wonder if all of the meaning that you've derived, all of your accomplishments in medicine, that's really the answer for why you've never looked back. That's why you've made peace with how upset you were at the time.
BERNSTEIN: I think that's true. If I hadn't been lucky enough to get into the Miami program, if I hadn't been able to make the transition to medicine, and if I hadn't loved it as much as I did, I could have been bitter and angry for a long time. I don't know where that would've taken me, but I'm glad I didn't have to find out.
ZIERLER: Of all of the satisfaction that you've derived in your medical career, what stands out? What's been most meaningful to you in terms of the research, in terms of helping people, in terms of the emotional support?
BERNSTEIN: The relationship with my patients, and knowing that I was really able, for many of them, to make a significant difference in their life. Helping them achieve fertility, taking away their pain, ending a pregnancy that would've been a disaster for their life, whatever it was, I was able to make a difference, and that gives me a profound sense of satisfaction. To me, it's the human relationships that have made such a difference. David, I'm going to remind you that we started talking about doing this interview because I asked you if you'd ever found out about the Caltech Childcare Center.
ZIERLER: That was the last thing that I wanted to talk about.
BERNSTEIN: That was your last question?
ZIERLER: Yeah, I wanted to save that for the end, so let's go there. When did that start to get discussed?
BERNSTEIN: It was toward the last two years of my graduate school time. I had been active with the National Organization for Women. I'd read a lot of books from the feminist literature of that period, starting with Betty Friedan. One thing that was really clear was that a major obstacle for women achieving in any academic, or really any other field was adequate childcare. Even though there were few women faculty or graduate students with children at the time, there were a lot of graduate student families with children, where the wives were in graduate school in other fields. I became friends with Peggy Wilson, the wife of a Caltech postdoc in the biology department. Peggy was in graduate school. I also became friends with Diane, the wife of one of the Caltech faculty, who was an architecture student with two children.
The three of us started talking and came up with the idea of talking Caltech into starting a childcare center for faculty and graduate students. The first thing we did was to poll the graduate student body to see if there was a need. If Caltech had childcare, would they use it? We couldn't email everybody, because there was no email. We printed surveys, and sent them out through the Caltech mail system. It turned out a lot of people were really interested. Eventually, we put a committee together. Caltech owned many houses in the immediate neighborhood that were rented to faculty and graduate students. We thought it would be nice if Caltech provided a house for a childcare center. Then we explored how to obtain teaching staff.. Pacific Oaks had a graduate program for people who wanted to teach nursery school. We got in touch with them to see if we could collaborate.
Our architecture student designed and built a beautiful model of a playground. We made an appointment with one of the Caltech administrators. We came in with this architectural model, and we advocated. To my surprise, they agreed to give us a house. I remember we spent several weekends fixing up the house. All the parents who were interested in using the childcare center came together. We built the playground, painted the inside, and we got the house ready to be used. Shortly after that, I left Caltech, and lost track of what happened. As far as I know, the Caltech Childcare Center, is alive and well, and is still a part of the Caltech community. I'm sure it's being used by faculty and graduate students. In fact, I'd love an update. One of these days, I should go visit. That may have been one of my Caltech legacies.
ZIERLER: Paula, who were some of the administrators, the people that really made this possible?
BERNSTEIN: I can't remember. We're talking 1970. I'm sorry.
ZIERLER: Now, this obviously is before the current language of emphasizing diversity, inclusivity, and equity.
ZIERLER: But in making the case for a childcare center, if not those specific words, was the spirit of what those words represented really a motivating factor?
BERNSTEIN: The spirit of equal treatment for women was certainly a part of it because it's really hard to be an active woman faculty member, and have a family, and not have good care for your child. I really felt that universities and corporations having on-site childcare was critical to empowering women to be able to do the things they wanted to do. Caltech was accepting women undergraduates—it was post Jenijoy La Belle—so I think they were beginning to see the handwriting on the wall, and this was a small expense for them to make a statement that they were open to women. I don't know what their motivations were. I don't know what the conversations were behind the scene. I just know that we got our house. I didn't have a child at the time, and wasn't even thinking much about having a child. But I did know that once I had one, childcare was going to be critical, and it certainly was.
ZIERLER: That must be very meaningful for you to know what you made possible just by having a place for Caltech people to send their kids during the day.
BERNSTEIN: I was very happy that it happened. Where is it now, David?
ZIERLER: I don't know. But this is a fun research project.
BERNSTEIN: Let's find out and go visit.
ZIERLER: Let's find out and go visit, and let's get some stories about what's been possible as a result of this. I want to learn more.
BERNSTEIN: I would love that.
ZIERLER: Paula, as an alumnus, have you been engaged with Caltech activities over the years?
BERNSTEIN: I have. I've always loved seminar day. When it was in person, Uri and I went. The pandemic really made a mess of that. I'm part of a women's lunch group that originally was in person, and now it's on Zoom. It's mostly alumnae of the first class, plus Kathy and me. I was put in touch with it because I went to a luncheon during seminar day at the Athenaeum for women alumnae. You've met all those women. Everyone who was at lunch at Kathy's house is part of our group.
I love going back to Caltech. Uri and I have so many nice memories of it, and we still have close friends from that era. I have very warm feelings for Caltech, and I've also maintained a friendship with Harry over the years.
ZIERLER: That's so nice.
ZIERLER: Yeah. Paula, on that note, let me ask one final question. Looking to the future, what's left for you to accomplish, both on the writing side, both on the science and medicine or mentoring side? What's so important to you as you look ahead?
BERNSTEIN: I just acquired my very first grandchild.
BERNSTEIN: Uri and I got started a little late.
BERNSTEIN: We were married eighteen years before we had our child. Dani is 37 now, and they had their first child, a little boy. What I'm looking forward to is being a grandma. They live in Portland, so it's going to be a number of plane flights. I'm looking forward to getting to know my grandson, to teaching him about science, buying him his first doctor kit. That's one thing.
I'm in the middle of a book, which will be number nine in my series. Then I think I'd like to either start a new series or maybe try another genre. My other favorite genre is science fiction, which I'd never read until I came to Caltech. When Uri was courting me, he always came to my apartment with a science fiction book from the lounge at Marks house, and ice cream, so how could I not marry him? I'm going to keep writing because it's something I can do and something I love.
We have always traveled. Every single year, we've gone someplace, except the pandemic years, so I hope to keep doing more of that. For me at this point, more of it is visiting people I love rather than exploring new places, because I've done a lot of exploring over time. We're going back to London this year, finally getting out of the country for the first time since COVID. That's what I have to look forward to. Not stopping.
ZIERLER: Paula, this has been a wonderful conversation. I'm so glad we were able to do this. I'd like to thank you so much.
BERNSTEIN: I loved it, David. You're a great interviewer.
ZIERLER: Oh, thank you!