Disclosure

Rochelle P. Walensky
JAMA. 2010;303(17):1676-1677 (doi:10.1001/jama.2010.535)
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current as of May 10, 2010. http://jama.ama-assn.org/cgi/content/full/303/17/1676

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 A PIECE OF MY MIND
Disclosure
E
ARLY IN MY CAREER, ONE OF MY PATIENTS WITH HIV
infection, Robin, a recovering heroin addict, had
re-enrolled in school and was newly engaged. Her
fiancé was unaware that she was HIV infected, and
she would not discuss using condoms, let alone her
HIV infection, with him. I encouraged her to confide
her infection to her fiancé—for the integrity of their rela-
tionship and for the value of his health—at each of our
clinical encounters. Finally, she did so. He left her. She
stopped taking her antiretroviral medications and
restarted using heroin. Although the fiancé may have
reduced his risk of infection, the consequences of my
intervention were tragic for my patient. Robin’s case rein-
forced that disclosure is a risky business because the
truth can trigger an unexpected, sometimes devastating
chain of reactions.
Several months after this encounter with Robin, I was
reminded of her when I struggled with revealing personal
information about my own health: I was pregnant.
Although a starkly different disclosure context than that
of HIV infection, the thought of revealing my pregnancy
at work brought on its own set of fears and anxiety. How
would my mentors and colleagues view the potential
impact of pregnancy on my productivity at work? How
would I handle this new feeling of profound fatigue, the
need to slow down, and the diminished academic flexibil-
ity? Whether spoken or unspoken, disclosure of my preg-
nancy, I feared, would evoke mixed reactions. And while
pregnancy should carry comparatively less social stigma
than that associated with HIV infection, from the stand-
point of a young academician, the feelings of concern and
anxiety were very real.
At the time, I had just turned 30 years old. I finally had
a sufficient number of academic achievements such that
time off for motherhood seemed viable. I experienced the
spectrum of emotions felt by so many pregnant women.
On the one hand, there is the unparalleled thrill of carry-
ing a child, and on the other, pangs of panic from a fore-
boding sense of maternal inadequacy. Always there to
bolster me, my husband would offer reassurance with his
usual tongue-in-cheek optimism: “If we can remain calm
and collected while saving patients from bleeding out, we
should be able to build the crib, buy the onesies, change
the diapers, and burp the baby at the appropriate inter-
vals.” But tossed into my emotional stew was the concern
that the credibility I had earned after years of hard work
would be placed in doubt as my waistline expanded. I
was often preoccupied with how I would convince others
1676 JAMA, May 5, 2010—Vol 303, No. 17 (Reprinted)
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(not to mention myself ) that my academic productivity
would be unaffected by having a newborn at home. After
all, having never been a mother before, I was naive about
what daily life as a mother would bring. My secret would
soon be obvious for everyone to see.
During the first 12 weeks of my pregnancy, I was in
the midst of completing my infectious disease clinical fel-
lowship. I would race to the restroom in-between consul-
tations, dine on nausea-relieving saltines, and pray that
my patients were free of treacherous infections that were
especially harmful in utero. Each evening, I was asleep
before my head hit the pillow. By week 14, I felt that it
was time to disclose to my newfound research mentor
that I was pregnant. We had only met twice before, and
in establishing this mentor-mentee relationship, I had
committed to at least two years of research under his
direction.
His assistant showed me in, and I sat down with the
intent to discuss and outline my research project. I feared
that this discussion would prove moot since the preg-
nancy could transform my promising research career into
a nonstarter. I worried that time-sensitive and high-
priority projects once intended for me would simply be
given to someone else. At the close of our research dis-
cussion, I chewed on my lower lip and blurted out, with
little confidence or poise, “There’s one more thing . . . I’m
pregnant.” I will never forget his instantaneous reaction.
He responded without missing a beat, “How exciting!
How are you feeling?” This simple and caring response
was the entryway to a career made possible. There was
not a shred of disappointment or concern that I would
not be able to deliver on the freshly outlined projects. He
understood that for me and for so many like me, research
is critical but family is first. I have since recounted to my
mentor, who is now a close colleague and friend, how
important his reaction was for me at that time. Although
he still fails to recognize why it had such a profound
impact, his kind and unrehearsed response was the
much-needed vote of confidence that I could achieve suc-
cess in both research and motherhood.
Now, as a mentor myself, I have been approached
many times by my mentees to receive word of their great
and life-changing “disclosure.” Indeed, many who are not
my mentees have sought my counsel on how to break the
news to their mentors and navigate the motherhood–
academic career balance. Stressful issues on the minds of
A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.
©2010 American Medical Association. All rights reserved.
 A PIECE OF MY MIND

these young women span the gamut: When should I sub-
mit my grant? Do I have to tell the NIH that I will miss 6
weeks of federally funded work? What if I need more
than 6 weeks of maternity leave? Is it possible to breast-
feed and work? Is there a place at work other than the
restroom where I can pump? Can I afford daycare for my
baby while still on a fellow’s salary? Will I ever get a job
if I interview while I’m pregnant? This avalanche of
uncertainty lies at the forefront of the minds of many
young female academicians. Women will face other well-
documented gender inequities along their professional
path—those of promotion, salary, and grant receipt.
These truths further intensify the need for academic sup-
port during the transition to motherhood.
I am often told that being a successful woman in aca-
demic medicine can be a “struggle,” a “challenge,” if not an
“impossibility.” I disagree. Being a woman in academic medi-
cine is an embarrassment of riches. Because of a consis-
tently supportive environment at work and at home, I en-
joy the blessings of raising children with my husband and
the privilege of working with brilliant colleagues commit-
ted to bettering health care worldwide. And when the in-
evitable scheduling conflicts arise between work life and
home life, I make some difficult decisions, which typically
tip in favor of my family. The pregnancy I described above
has become my 10-year-old son. He now has two younger
brothers.
Rochelle P. Walensky, MD, MPH
Boston, Massachusetts
rwalensky@partners.org
Acknowledgment: The author thanks David R. Bangsberg, MD, MPH, for his in-
sightful comments; Kenneth A. Freedberg, MD, MSc, for his unwavering mentor-
ship, friendship, and commitment to family; and Loren D. Walensky, MD, PhD,
for his partnership in life’s daily juggling act.

Many of the brain’s remaining mysteries need for so-

lution mere wiring diagrams; yet a metaphysical halo
lingers about the mystery of self-consciousness. A com-
puter, after all, of sufficient complexity could handle
the stimuli and responses of living without any com-
ponent that says “I.” But within the human—and, dare
we think, the cetacean and simian?—brain there is a
watcher, who always recedes, and who answers ev-
ery question with another question.

—John Updike (1932-2009)

©2010 American Medical Association. All rights reserved. (Reprinted) JAMA, May 5, 2010—Vol 303, No. 17 1677

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