BONUS: The Resignation

Bonus Episode: The Resignation

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KATIE HAFNER: Hi, Scott.

SCOTT BAIRD: Hi, Katie. Are you still putting together episodes?

KATIE HAFNER: Yeah, we’re putting together a bonus episode. 

We’re calling it “The Resignation.”

SCOTT BAIRD: [laughter]

KATIE HAFNER: I’m Katie Hafner, and this is Lost Women of Science, a podcast in which we unearth stories of scientists who didn’t receive the recognition they deserved in their lifetime. 

This is a bonus episode for our first season, “The Pathologist in the Basement,” which is all about Dorothy Andersen, the doctor who first identified cystic fibrosis in 1938. 

This time, we’re going to look at a curious incident that happened at Babies Hospital eleven years later, in 1949.

SCOTT BAIRD: Many on the Babies Hospital faculty understood the situation to be a simple power struggle over Dorothy Anderson.

KATIE HAFNER : Did, did somebody want Dorothy out?

KATIE HAFNER: But first, a quick refresher on who Dorothy Andersen was. 

Practicing at a time when many people refused to see female doctors, she pursued the less front-facing profession of pathology. 

Performing autopsies of young children in the basement of Babies Hospital, Dr. Andersen began seeing a pattern of organs that had grown fibrous and tough.  From there, she defined the workings of cystic fibrosis, a multi-system disease that attacks the pancreas, lungs, and a host of other organs.

In the 1940s, cystic fibrosis was so new that Dr. Andersen became a rare expert on the disease, and did what many pathologists—and women—did not do: she worked directly with patients, mostly young children. 

All their gratitude and affection for Dorothy Andersen was obvious to us as we put together our first season. But we found less evidence that Andersen was fully appreciated by the medical community at large. In particular, we wondered: what about her colleagues and supervisors at Babies Hospital, where she worked for practically her entire career? Did they value her? 

As I thought about this, I kept returning to a story that Scott Baird told me the first time we talked. (You probably remember Scott from earlier episodes—he’s the Columbia critical care doctor and Dorothy Andersen fanboy who just published a biography about her.) 

We didn’t have room to tell this story in the original episodes for the season. And that’s left me feeling…not quite finished. I wasn’t ready to close the door on Dr. Andersen’s life without getting into it. So here is that story: “The Resignation,” our final chapter of “The Pathologist in the Basement.”

SCOTT BAIRD: It was two years ago in the winter that I became interested in the topic of trying to put together a life of Dorothy Anderson and started to put together some materials.

KATIE HAFNER: A lot of the research for Scott’s book came from Columbia’s archives.

SCOTT BAIRD: When I first came here, they were only partially open. That is, there was some construction... 

KATIE HAFNER: ...which meant he couldn’t get to Dorothy Andersen’s folders right away. 

SCOTT BAIRD: And in the interim, I had decided to look at any other material that was available. One of the boxes that was available was Rustin McIntosh's box. And he was, of course, the chairman of the department of pediatrics and the chief physician at Babies Hospital during the time when Dorothy was at Babies Hospital.

KATIE HAFNER: Here’s what you need to know about Rustin McIntosh—one of the main characters of this story. 

In the early 20th century, McIntosh was a rising star at Columbia. And in 1931, he became chair of pediatrics at Babies Hospital. He was just 37 years old, which was very young to run a major department, both then and now. 

According to some, he was warm and approachable. His staff called him “Rusty.”  

McIntosh defied statistics in an era when only four out of every hundred physicians were women. In his department at Babies Hospital, he worked with several women. 

One of them was Dorothy Andersen. 

But, Andersen and McIntosh could not have been more different. He was straight-laced and traditional, and she was... neither of those things, to put it mildly. She had built her own cabin in the woods of New Jersey and constructed DIY lab equipment—she was crunchier than most of her academic cohort.

Since McIntosh presided over Babies Hospital for nearly all of Dorothy Andersen’s time there, Scott went digging through the McIntosh files, hoping that in the details of his life, he would find traces of hers.

SCOTT BAIRD: And I opened up this first box, it's this box here.

I started looking through some of these files thinking to myself, well, I'm going to have to just read through reams and reams of material to find anything interesting.

And then I saw some material from 1919 when he was in the first world war. And I said, no, not there. And I pulled out this one. It's the eighth file. And it says 1949 on it. So I opened it up. 

[paper rustling]

But I, I was unprepared for this. The first page on the first file that I opened up is a letter to President Dwight D. Eisenhower. And it says, “Dear Mr. President, I submit herewith my resignation as Carpentier Professor of Pediatrics and Executive Officer of the Department of Pediatrics to take effect at the close of the current academic year.”

KATIE HAFNER: Yeah, I know what you’re thinking, because I was thinking the same thing: The White House is pretty far for a New York pediatrician to be going with a letter of resignation. 

But before Dwight D. Eisenhower became President of the United States, he spent five years as president of Columbia University.

In his letter,  McIntosh went on: “This action implies, and as a matter of course includes, my resignation as Director of the Pediatric Service of Babies Hospital.” 

SCOTT BAIRD: And no one I had known, had ever mentioned anything like this. And I kind of went, what, what happened here?

What happened was that the board of trustees decided that they were going to move the pediatric pathology offices and suite from Babies Hospital to another location in the medical center, several blocks away.

KATIE HAFNER: So here’s what you have to know: The hospital wanted to add a new orthopedic unit to Babies Hospital, and to make that possible, the board of trustees was playing tetris with existing space. Moving the pediatric pathology labs, which, at the time, were housed on the 8th floor, seemed like an obvious solution. After all, in the medical hierarchy, orthopedic surgery is sexy and lucrative. Pathology is, well, not that. 

ERNEST CUTZ: We are working there in the background. Nobody talks much about us. 

KATIE HANFER: That’s Dr. Ernest Cutz. He’s retired now, but he used to work as a pediatric pathologist at the Hospital for Sick Children in Toronto. Remember, pathologists study the nature and cause of disease. They spend the bulk of their time performing autopsies and reviewing biopsy specimens. 

ERNEST CUTZ: The clinicians are recognized by patients, so that's kind of a visible part of medicine, but there's also this invisible part, which are people working in labs, working in autopsy rooms, et cetera, who generate knowledge influencing the clinical care.

KATIE HAFNER: Pathologists don’t work directly with patients…but they do work with doctors who work directly with patients.

JIM WRIGHT: Pediatricians and pediatric surgeons, before they go and talk to the parents of patients, they oftentimes want to come to the pathology laboratory and have the pathologists show them the microscopic slides related to the care of their patient.

KATIE HAFNER: And that’s Dr. Jim Wright, a  professor of pathology and laboratory medicine, and a professor of pediatrics at the University of Calgary. 

JIM WRIGHT: And so you can well imagine if pediatric pathologist were removed from the hospital and sent somewhere across town, those kinds of interactions can't happen.

KATIE HAFNER: One of the jobs of a department chair is to defend their people, and that often means defending the physical space those people need to do their work. Rusty McIntosh, who in 1949 had reached the pinnacle of his profession, was apparently so serious about that part of his job that he was willing to quit over it. 

Here’s how he put it in an impassioned, five-page single-spaced document he wrote at the time: 

SCOTT BAIRD: The pathologist is forever puzzling over the nature of disease.

 KATIE HAFNER: That’s Scott reading from the McIntosh manifesto. 

SCOTT BAIRD: So does the clinician, but his angle of approach is different.

When the two get together, the chances of progress are enhanced. New ideas, fresh attacks are as apt to be generated in a casual chat as in a scheduled consultation. In fact, probably more so. 

KATIE HAFNER: McIntosh continued that surgeons sometimes asked pathologists to accompany them in the O.R., especially when removing a tumor, so the pathologist could weigh in on how radical the excision needed to be.

For clinicians like McIntosh, the bottom line was this: in-person consultations with pathologists, even a quick conversation at the nurses’ station, was as important as listening to a patient’s heart and lungs.

But, practically speaking, how much of a disruption in the work flow would this move actually create? McIntosh was very specific on this point..

SCOTT BAIRD: And he noted that a round  trip walking from Babies Hospital to the proposed newer site of the pediatric pathology labs and offices would take at least 12 minutes.

And it is…it's very easy for me to envision him timing that several times to see. He was an extraordinarily careful and meticulous man.

KATIE HAFNER: And for even more good measure, after submitting his letter of resignation...

SCOTT BAIRD: Rusty called a meeting of his senior staff at which he outlined the facts.He concluded with something of a bombshell.

KATIE HAFNER: That moving the pathology labs...

SCOTT BAIRD: …was tantamount to asking for his resignation. There was a quaver in his voice, which defined the depth of his emotion. After a stunned silence, someone announced that he would follow Rusty with his own resignation. And he was followed by a virtually unanimous declaration of the same intent.

KATIE HAFNER: The board wasn’t just dealing with the resignation of Rusty McIntosh. Now, the entire senior staff of the department of pediatrics at Babies Hospital was threatening to quit in solidarity.

SCOTT BAIRD: All of which sounds sort of like a, a movie. You can envision the scene with Jimmy Stewart and, I don't know, somebody else like that. 

And when I went further into this, it turned out, this was basically about Dorothy Anderson. 

KATIE HAFNER: Coming up, we’ll look into the role Dorothy Andersen played in this fiasco. I’m Katie Hafner and this is Lost Women of Science.

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[AD BREAK]

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KATIE HAFNER: So, according to Scott, Rusty’s resignation really came down to…Dorothy Andersen. 

SCOTT BAIRD:T his seems paradoxical in a…for a pediatric pathologist to be that important, but it clearly was.

KATIE HAFNER: Okay, that’s confusing. Why wouldn’t a pathologist be considered important? 

It turns out that there are hierarchies in departments—mostly related to money, power and reputation. In a department like pediatrics 70 years ago, the superstars would likely be the cardiologists or the cancer specialists. So going to bat for a pathologist is a bit surprising.

But it’s also important to take a deeper look at the role pathologists play within a hospital’s ecosystem. And with it, the role of space. There’s a saying in academic medicine, “Space, The Final Frontier,” since battles over space are so common and so often contentious.

I happen to have a front row seat to these space wars. My husband chairs a large department at an academic medical center, and during COVID, while we’ve both been working about 20 feet from each other, I’ve heard a lot of debate over space. Somebody needed some, somebody else wasn’t using theirs optimally, et cetera. I’ve never heard him raise his voice, much less threaten to resign, but it’s clear that these fights are common and unpleasant. And victory often goes to whoever has the most clout. Pathologists wouldn’t be high on that list. Again, Jim Wright, the professor of pathology:

JIM WRIGHT: Unfortunately, administrators often view labs as they would the hospital laundry service or any other hospital service. They don't see it as involved in medical care per se. They think it could be done anywhere by anybody.

KATIE HAFNER: But in many cases, it can’t. And moving the pathologists out of the building risks those crucial informal collaborations with the front-line clinicians. But it’s not just about patient care; it’s also about power. Adds Ernest Cutz, the retired pathologist:

ERNEST CUTZ: We don't seem to have, kind of, a voice, so we have to kind of fight to be heard.

KATIE HAFNER: Even now, pathologists spend a lot of time defending their space.

JIM WRIGHT: I’ve seen this happen again and again...

ERNEST CUTZ: We had a similar episode about 10, 15 years ago…

JIM WRIGHT: …where there are little battles related to a space or cost.

ERNEST CUTZ: There was an attempt to move the pathology department with the adult pathology. And we fought really hard.

KATIE HAFNER: In other words, dustups like this are common. But this was 1949, when pediatric pathology was still in its infancy. 

JIM WRIGHT: prior to the 1940s, 1950s, you know most children's hospitals did not have pediatric pathologists.

KATIE HAFNER: Babies Hospital, where Dorothy Andersen worked, was well ahead of its time. In fact, as Dr. Wright, who’s a historian of the field, pointed out, Babies Hospital was “ground zero” for pediatric pathology in North America. Martha Wollstein, a doctor who worked at Babies Hospital, was the first pediatric pathologist in the U.S. decades before all this happened. She started in the 1890’s, but she was an outlier. 

So since pediatric pathology was such a new specialty, there wasn’t much precedent for the particular fight in which  Rusty McIntosh found himself embroiled.

In his lengthy treatise, McIntosh made a case for this emerging field of medicine. He asserted that clinical work benefits from having labs close at hand. But his argument gestured toward one pathologist in particular...

SCOTT BAIRD: Many on the Babies Hospital faculty understood the situation to be a simple power struggle over Dorothy Anderson.

KATIE HAFNER : Did, did somebody want Dorothy out?

SCOTT BAIRD: Well, it sounds as if there was indeed a push to bring Dorothy and her resources to another site on campus. The other site was the rest of the department of pathology.

Why? She was an enormously important asset, not just in research, but in education and in patient care.

KATIE HAFNER: Okay, we already know Dorothy Andersen had identified cystic fibrosis 11 years earlier. But she’d done so much more than that. She had developed the first CF diagnostic test and the first effective treatments. She helped run the CF clinic within the hospital, which, by the way, in 1949, had diagnosed and treated more than 100 patients. 

And she branched out, too. For instance, she became an early expert on congenital heart disorders. And she even described an extremely rare disease: type IV glycogen storage disease AKA Andersen’s disease.

In his five-page manifesto, McIntosh devoted the better part of a page to a discussion of Dorothy Andersen. He stressed that Andersen’s research brought in tens of thousands of dollars in grant money—which is the equivalent of hundreds of thousands of dollars today. And her recent awards had brought a lot of prestige to the hospital. 

McIntosh even pointed out a time when Dr. Andersen treated a boy with cystic fibrosis who happened to be the grandson of a wealthy donor. The donor was so impressed with the quality of Dr. Andersen’s care, he promised heaps of money for her next research project. 

And why was Dr. Andersen able to do all of this? It was at least in part because she was present—literally—at the intersection of research and clinical care. 

Later in her life, Dr. Andersen wrote: Pathology “enables the physician to keep one foot in the wards, where medical problems exist, and the other in the laboratory, where facilities for solving the problems are available."

Here’s Scott again.

SCOTT BAIRD: Dorothy was essentially saying that pathology was a great profession because it allowed you both to locate problems and then to take them into your lab and solve them.

When she first came to Babies Hospital, she was a pathologist without significant pediatric experience. But within a very short period of time, she developed enough pediatric clinical expertise that she became essentially a pediatrician.

Well, that's all well and good, and it worked out for Dorothy. It doesn't really work out that way for many people, I think, pursuing a career in pathology. And I think Dorothy was special in that regard. She was able to make it all work.

KATIE HAFNER: And with McIntosh having submitted his resignation, and members of his staff threatening to do the same, with everything on the line...

SCOTT BAIRD: Apparently everyone backed down. So within a week and a half, the board of trustees was no longer going to pursue the removal of pediatric pathology from Babies Hospital. McIntosh was no longer going to pursue his resignation and everything sort of got patched over.

KATIE HAFNER: We don’t know if Eisenhower responded to McIntosh’s resignation. It isn’t clear that he paid much attention at all to this whole kerfuffle among a bunch of disgruntled doctors. And it’s unclear what Dorothy Andersen thought about the McIntosh resignation threat, since so few of her letters and personal papers have been saved. 

What is clear is that a flurry of meetings and letters ensued, including a few barbs back and forth between McIntosh and his dean. 

Then, when the board abandoned its plans for the move, McIntosh withdrew his resignation.

There was only one concession: The pathology offices and labs would move from the 8th floor to the hospital’s basement. It was a compromise, but in the big battle, Rusty won.

And so they carried on with their operations under the same roof as before. And so did Dorothy Andersen.

SCOTT BAIRD: She had a half-a-dozen clinical research projects all going on at that time, and leaving Babies Hospital would have made that much more difficult.

KATIE HAFNER: I called Scott one morning just as we were finishing up this episode to clear up a few things. I was especially curious (and a little confused) about McIntosh’s relationship with Andersen.

SCOTT BAIRD: Andersen and McIntosh were not any great friends. And in fact, it appears as if they didn't share much of a friendship at all, but they had respect for each other.

KATIE HAFNER: It appears that although McIntosh didn’t much like Dorothy Andersen, he still fought like hell to keep her at Babies Hospital.

SCOTT BAIRD: There was no way he could let Dorothy go to another building. It just, it would have been, it would have been in some ways catastrophic.

KATIE HAFNER: Catastrophic…..that might be a bit of a stretch. But who knows. Some of the work that Andersen would go on to do, including revelations about how CF affects the sweat glands—those things might never have happened if she’d left Babies Hospital. 

In any case, this entire unfortunate incident says a lot about how much Dorothy Andersen meant to the hospital. 

And that takes us back to our original question: is being an asset the same thing as being valued?

Dr. Andersen continued to bring in donations and prestige, but her climb up the hospital hierarchy was painstakingly slow.

SCOTT BAIRD: She didn't become an assistant professor until sometime in the mid-forties.

KATIE HAFNER: In the 1940’s, Dorothy Andersen was already in her forties.

And she didn't become an associate professor at Columbia University until the early fifties. And she didn't become a full professor until the, I think it was ‘56 or ‘57. It took her 25 years, I believe, to become a full professor at Columbia.

KATIE HAFNER: Okay, timeout, this would not have happened to a man.

SCOTT BAIRD: It's an interesting question. Hattie Alexander, who was a world famous microbiologist, she didn't make it for 25 years just like Dorothy. And, um, I think that was relatively common for women back then. 

KATIE HAFNER: Martha Wollstein is another example. She was the first doctor to specialize in pediatric pathology in North America, and she was hired by McIntosh’s predecessor in the 1890s. Because she was a woman, they could pay her less. Wollstein’s career at Babies Hospital lasted more than 40 years. And yet…

SCOTT BAIRD: She remained an associate professor.

JIM WRIGHT: I think that would be, you know, probably an unassailable fact that there was discrimination and that being promoted would have been much slower and more difficult than you know, for a male counterpart who might even have been less talented.

KATIE HAFNER: Compare these stories to the meteoric rise of Rustin McIntosh. He was given a professorship at Columbia within a decade. Two years later, he was appointed chair of pediatrics.

SCOTT BAIRD: He was in his mid thirties and he was designated a full professor. He certainly seemed to have great promise, but he had made none of the scientific contributions that Martha Wollstein had made for the previous two to three decades. 

KATIE HAFNER: Being of value to an institution is one thing. Being valued, as a professional, is another. These women’s contributions to Babies Hospital were impossible to deny. McIntosh was willing to lose his job over Dorothy Andersen. But, at the same time, he wasn’t in a rush to promote her. And by Scott’s account, he rarely praised her in public. 

The larger message of this incident is a sad one: Even if men in power make a cause celebre out of the work a woman is doing—even if that entails a personal or professional sacrifice—material support like a raise, or a promotion, still might not reach her. Her accomplishments are not forgotten, but perhaps, in the fullness of time, she is.  

[CREDITS]

This has been Lost Women of Science. Thanks to everyone who made this initiative happen, including my co-executive producer Amy Scharf, producer Sophie McNulty, senior editor Nora Mathison, composer Elizabeth Younan, associate producer Ashraya Gupta, and the engineers at Studio D Podcast Production. 

We’re grateful to Mike Fung, Scott Baird, Bob Wachter, Cathie Bennett Warner, Maria Klawe, Susan Kare, Jeannie Stivers, Jane Grogan, and our interns, Leeza Kopaeva, Giuliana Russo, and Kylie Tangonan.Thanks also to Paula Goodwin, Nicole Schilling and the rest of the legal team at Perkins Coie, and to Barnard College, a leader in empowering young women to pursue their passion in STEM as well as the arts, for support during the Barnard Year of Science. 

Thanks also to Jack Kertzman and Sam Fickinger at Hyde Street Studios in San Francisco, where this podcast was recorded.

Lost Women of Science is funded in part by the Gordon and Betty Moore Foundation, Schmidt Futures and the John Templeton Foundation, which catalyzes conversations about living purposeful and meaningful lives. 

Lost Women of Science is distributed by PRX and published in partnership with Scientific American.

You can learn more about our initiative at lostwomenofscience.org or follow us on Twitter and Instagram. We’re @lostwomenofsci.

Keep an eye out for season two: Coming in early 2022.

Thanks so much for listening. I’m Katie Hafner.