Training more optometrists; 2 pioneering female doctors; preventing suicides: Upstate Medical University's HealthLink on Air for Sunday, May 7, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a new optometry training program is designed to increase the number of eye care professionals in Central and Western New York.

Robert Fechtner, MD: ... Rather than taking a pathway into medical school, which is one way to become an eye doctor, you can go directly into optometry school and have a four-year training program, perhaps even with an additional year afterwards, and you come out well trained to take care of many, many eye diseases. ...

Host Amber Smith: And we'll hear about the lives of two of the first women doctors in America, from the author of a biography that was a Pulitzer Prize finalist.

Author Janice Nimura: ... The old line about "doing it, but backwards in heels" very much applied to them. They knew that in order to be taken seriously, they had to be excellent, and they were. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, an encore of our interview with the author of a book about Dr. Elizabeth Blackwell and her sister, which was a finalist for the Pulitzer Prize in biography last year. But first, a look at the profession of optometry and a new training program coming to Syracuse.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Upstate Medical University and the SUNY College of Optometry are joining forces to help increase the number of trained eye doctors in Central and Western New York. This partnership provides an affordable option for aspiring eye care professionals.

Here to tell us more about it is Dr. Robert Fechtner. He's professor and chair of ophthalmology and visual sciences at Upstate.

Welcome to "HealthLink on Air," Dr. Fechtner.

Robert Fechtner, MD: Hi, Amber. I'm glad to be here with you today.

Host Amber Smith: Now, some listeners may not be familiar with the SUNY College of Optometry. It's actually in Manhattan.

What can you tell us about it?

Robert Fechtner, MD: Oh, my gosh. The SUNY College of Optometry in Manhattan has a gorgeous building overlooking one of the parks (Bryant Park) in the center of Manhattan. It is a fabulous location, tremendous training facilities, unless you don't want to be in Manhattan for your education. In that case, there is nowhere else in New York state to get education as an optometrist.

Host Amber Smith: It's been around since the 1970s, is that right?

Robert Fechtner, MD: I believe that's correct.

Host Amber Smith: And it does optometry and master's degree and doctoral degrees as well, right?

Robert Fechtner, MD: We're talking about optometry, and some of our listeners today may get a little confused because we have optometrists and ophthalmologists and just a whole slew of different specialties.

So, the optometrists are people who have had a college education, usually with a science background, and they want to go into health care. So rather than taking a pathway into medical school, which is one way to become an eye doctor, you can go directly into optometry school and have a four-year training program, perhaps even with an additional year afterwards, and you come out well trained to take care of many, many eye diseases.

Host Amber Smith: Is an optometrist the same thing as an optician?

Robert Fechtner, MD: The optician is the person in the eyeglass store who can fit you with lenses and do the glasses. Their background is limited there, and they don't take care of medical conditions. For example, they won't measure you for your glasses, but they ought to get you in a pretty good-looking pair of frames.

Host Amber Smith: But the optometrist would measure you and be able to diagnose some basic medical conditions.

Robert Fechtner, MD: The optometrists certainly are expert with refraction, with glasses, with contact lenses. In addition, they get medical training, so they know how to take care of many of the medical conditions of the eye, and interestingly, as an aside, it varies state by state what optometrists are allowed to do. That is a statewide scope of practice.

So I am at the next, perhaps, pathway, which is ophthalmology. I'm a medical doctor. After college, I went to medical school. I was trained in all different aspects of medicine and chose toward the end of medical school to become an ophthalmologist, which required four additional years of training after medical school.

So we are the doctors who get trained fully in the medical conditions, in surgical care of the eye, and then you can go beyond that for subspecialty training.

Host Amber Smith: How is a patient supposed to decide whether they need to see an ophthalmologist or an optometrist if they have an issue with their eye?

Robert Fechtner, MD: One of the nice things that happens is that despite a little bit of discussions over who should be doing what, the optometrists and ophthalmologists largely cooperate and collaborate. So for example, if you go into an eyeglass store, you're going to be seeing an optometrist. And if the optometrist's examination finds that you have a medical condition beyond their scope of practice, they will have a relationship with an ophthalmologist. They'll get you to the ophthalmologist for that level of care.

On the other hand, here at Upstate, in our department of ophthalmology, we have optometrists who are on the faculty. So if we do an exam and you are well, or if you have diabetes, need your routine annual exam, the optometrists are fully capable, and we will be moving patients to the proper level for the best appropriate care.

Host Amber Smith: Now getting back to the SUNY Upstate campus, here in Syracuse, there's about 1,600 students in medicine, nursing and a variety of health professions. On average, how many of those students go into eye care each year?

Robert Fechtner, MD: The number remains low, and the field is very competitive. For ophthalmology, you have to compete to get a residency slot, and we usually have only a handful of students each year introduced to ophthalmology during their career who want to pursue it.

For optometry, the pathway doesn't need to go through a health care university. You could do undergraduate, perhaps at one of the SUNY schools, take the required science courses, and then you would apply to optometry school, and that is a pathway in. You don't have to go to nursing school or physical therapy or one of these others as a prerequisite.

And I'd like to underline that anybody listening to this who thinks they might enjoy being an eye doctor and doesn't want to go through medical school, you have to look at optometry. It's a great career, it's a great pathway, and here in New York state, we have a fabulous college of optometry, who will soon be joining us here in Syracuse.

Host Amber Smith: Let me ask you: Back in medical school, what was it about ophthalmology that attracted you to the profession?

Robert Fechtner, MD: You might describe me as somebody who's a little bit OCD (someone who has obsessive-compulsive disorder). I love fine detail. Ophthalmology is a fabulous equipment practice. We have tremendous diagnostics. And it seems sometimes that the specialty picks the person.

Either you want to be in there with blood and guts, or perhaps you're a little fussy like me, and working on a tiny, tiny organ like the eye suits you. So, tremendous complexity, it's a beautiful sensory organ, and there's just so, so great a need for everybody to maintain their best vision.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with professor and chair of ophthalmology Dr. Robert Fechtner about a new optometry program at Upstate.

Now I understand the first class for the Doctor of Optometry program at Upstate is likely to be fall 2025. What can you tell us about the program?

Robert Fechtner, MD: Amber, we're very excited to get this program launched.

As you know, the College of Optometry is based in Manhattan. One of the things we learned from COVID, that perhaps was a good thing to learn, is we can teach remotely. You don't have to be sitting in a classroom to learn. The first two years of optometric training are largely classroom and then simulation laboratory: You learn how to examine an eye.

So if we can launch in 2025, we'll be doing tele-teaching, having our students here working and learning alongside the students in Manhattan, and we will be building a facility here for training. By the time we get to the third year of the program, the optometry students are in a clinic working with actual patients under the direct supervision of an optometrist.

So starting in 2025 means two years later, we are hoping we will have a new eye institute here on the campus of SUNY Upstate.

Host Amber Smith: Do you know yet how many students you might enroll in Syracuse?

Robert Fechtner, MD: It's not certain, and I will make one distinction. These will not be SUNY Upstate students. These will be SUNY Optometry students, but the SUNY Optometry plan is to start small, perhaps with an initial class of eight. We're going to ramp up. We will make sure we get everything right. The students' education here has to be absolutely as good as going to Manhattan; personally, I think it could be better. And once we get that class, we'll bring the next class in, and then in year three, we will have the facility for these students to be doing the clinical portion of their education.

Hopefully, we will be up to about 30 students a year when we're fully up and running, and that's just about the right number for us to meet the needs in Central New York.

Host Amber Smith: So let's go over the prerequisites. Do you need to have a college degree to apply to this program, or what type of degree does it need to be?

Robert Fechtner, MD: There may be some exceptions, but generally everybody has gone to four-year college. If you go on the web and you look for SUNY Optometry, on their website, they have a list of the required classes and some additional recommended classes. It's a science background. It's going to be biology and physiology, chemistry, many of the courses that you might take if you were going into medical school. It is a competitive field, so not everybody who applies gets in. The last numbers I saw were for a class of nearly a hundred. There were over 500 applications.

Host Amber Smith: So what type of student will you be looking for? What would help someone stand out in this field?

What type of person would be good to become an optometrist?

Robert Fechtner, MD: What sort of person should be an optometrist? It should be a caring person, just like any other type of doctor or nurse or physical therapist. You have to want to be able to help people, so if you find in yourself that desire to be with people to do something meaningful, that's great.

If you have an inclination to be more of a science person, that's fabulous. You don't have to be a bench scientist. You just need to be able to understand how the body works and be able to learn about disease. So I think it's a very broad group of people who might enjoy being an optometrist.

And I'll tell you one other thing. I have young adult children, and we're concerned about what can you do where you have a secure career. If you are in a health care profession, you have a secure career. This is not a job that's going to be done offshore or over the internet. It is face-to-face, real people, and for me, that's one of the most rewarding things.

Every day I come in, I get to help someone.

Host Amber Smith: Well, let's talk about the type of salary and lifestyle a person who's a doctor of optometry might have. It's pretty much working weekdays, right?

Robert Fechtner, MD: This is a very manageable lifestyle. And I noticed when I looked at the Optometry website, very heavily weighted toward women.

And to me that implies that you can have a full life and have this career. Perhaps that's a little old-fashioned of me; I have gray hair. It is very much a weekday job. You can define your hours. You can be employed by a large corporation, or you can be in a one- or two-person office. So, tremendous range of what you could do.

There are very few optometrists who are doing night and weekend emergencies, so the quality of life can be fabulous. The income: Typically, you can be in six figures as an optometrist, and I have not met any unhappy optometrists.

Host Amber Smith: Well, that's good to know. Now, people somewhere along the way have probably heard that they need to have their eyes examined once a year.

Why is that so important?

Robert Fechtner, MD: We do make the recommendation that you need to get your eyes examined. When you're young, you have to have your eyes examined once before your teen years. When you're young, and if you're seeing well, perhaps it doesn't need to be every year, but by the time you're age 40, you ought to be getting your eyes examined every year or two.

Certain people need them examined every year, such as if you have diabetes, and the reason is, we can see problems as they're starting, before they affect the vision, and we can take care of them before there are any permanent effects of vision. Once you reach age 60, annual eye exam's a great idea. We can detect things like diabetes, we can detect glaucoma, we can detect macular degeneration.

And only your ophthalmologist or optometrist can look in your eyes and know what may be a future threat and address it before you have any loss of vision.

Host Amber Smith: I have not thought about diabetes showing up in the eyes. What happens to your eyes?

Robert Fechtner, MD: Diabetes is a disease that affects every part of the body, and it affects nerves and blood vessels.

The eye is basically nerves and blood vessels. So what we see in diabetes is often some changes in the blood vessels; they become weak, they become leaky, perhaps new blood vessels start growing that shouldn't be there. And if we see it early, we can treat it, perhaps with laser, perhaps with some medications, and slow down or even stop the diabetic eye disease.

Host Amber Smith: Dr. Fechtner, thank you so much for making time for this interview and telling us about this new optometry program.

Robert Fechtner, MD: Amber, it's a pleasure to be here, and I hope anybody who's thinking of a career in health care and is in college now will take a look at optometry and perhaps come to the program here at Upstate, in Syracuse.

Thanks for having me here.

Host Amber Smith: My guest has been Dr. Robert Fechtner. He's professor and chair of ophthalmology and visual sciences at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Get to know the sisters who brought medicine to women and women to medicine -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Elizabeth Blackwell was the first woman in America to receive a medical degree, and today we're sharing an encore of an interview with Janice Nimura, who wrote "The Doctors Blackwell -- How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine." This book was a finalist for the Pulitzer Prize in biography in 2022, after we conducted this interview.

Janice Nimura, welcome to "HealthLink on Air."

Author Janice Nimura: Thanks so much for having me.

Host Amber Smith: I think most people who live in Syracuse have heard of Elizabeth Blackwell. There's a street on the Upstate campus that's named after her. But I don't know how many of us were aware that she had a sister who also became a doctor. Did you know that before you began your research?

Author Janice Nimura: Yeah. Oddly enough, when I first encountered the Blackwells -- and I encountered them really late; I had never heard of them until I was an adult -- I actually met Emily first. I was poking around in the stories of women who followed careers and turned their backs on marriage and family, and she popped up, sort of through the lens of queer history, as someone who had had a career and had a partner, a female partner, who was also a doctor in the last decades of her life. And that intrigued me. So following where Emily Blackwell leads, you get very quickly to Elizabeth Blackwell. I was interested in the fact that no one at all had ever heard of Emily. So, when I set out to do this project, I really set out with the mission to reintroduce this as a story of two sisters and not just the first woman to get a medical degree.

Host Amber Smith: So what got you thinking about doing a book about them to begin with? Or how did, how did that all kind of come together for you?

Author Janice Nimura: Well, when you write narrative nonfiction and you do all of the research and the travel and all of the kind of weaving together of narrative threads that it takes to tell a story like this, you really, it needs to resonate with some part of your own identity. You need to be sort of in love with the material in order to put that much energy into a project like this that takes years.

Medicine was sort of the path not taken for me. I got to college intending to study medicine and swerved to English, and I had already written a book about trailblazing women in the 19th century, and I liked it in the 19th century. So when I went looking for a new project, the idea of circling back to my original interest in medicine via the lives of these pioneering women doctors was really attractive.

Host Amber Smith: So you had sort of a personal interest in medicine to begin with?

Author Janice Nimura: Yeah, and in the way that time is cyclical, my daughter who is now making her way through college, has a strong intention of pursuing medicine herself. So it felt very much like a full circle and an opportunity to kind of explore a piece of me that hadn't the path not taken, and also kind of join my own daughter in her new endeavors and projects.

Host Amber Smith: Well, what can you tell us about these sisters? Can, can we start with their upbringing?

Author Janice Nimura: Sure. So the Blackwells, Elizabeth and Emily, were two of nine siblings. They were mostly born in Bristol, England, and came to this country as children. They were the children of a man who was a sugar refiner and an Abolitionist, which is sort of a paradox if you think about that for a second.

His life's goal was to find a way to make sugar without enslaved labor. So he moved his family from England all the way to America, and then all the way out to Cincinnati, which in 1838 was a frontier town, trying to make sugar out of sugar beets. And then as soon as he got there, he died, broke, and left his large family sort of struggling to make a living and left his five daughters with a clear message that having a husband was no guarantee of security. As much as they loved him, he hadn't really provided for them.

So none of the five Blackwell sisters ever married. And two of the Blackwell sons married two of the most prominent feminists of the day, Lucy Stone and Antoinette Brown. So it was an interesting, iconoclastic family.

Elizabeth really became interested as a young person in the writings of Margaret Fuller, sort of the transcendentalist editor and writer who had written a best bestseller called "Woman in the 19th Century." And her point was really that women could do anything that men did. It was just a matter of talent and toil, not gender. And Elizabeth really had a healthy self-esteem and saw herself as someone who could embody this idea, find a way to prove that women could do anything men could do. And medicine turned out to be the path she chose as a sort of a graphic way of making this point.

Host Amber Smith: So getting back to nine siblings, did they all get along? Were they especially close? Do you have any knowledge of how they functioned?

Author Janice Nimura: They were. They were a tribe. And their closeness was actually a great gift to me as a biographer. The nine of them really functioned as a unit. They had been displaced and uprooted a few times from Bristol to New York to Cincinnati, and then orphaned. So they really looked to each other more than anyone else in the world. At the same time, they all sort of drove each other a little nuts.

So they were constantly leaving each other behind and writing to each other. So when I came to the project and started to look into what kind of archival material there was, there were thousands of letters, all of them writing to each other about everything that happened to any of them, which is a great gift because it gives you not just a lot of material to work with, but a lot of perspectives on the same events. So at times I felt like I was drowning in material, but as people who do this kind of research will tell you, if you're not drowning, you might not have enough.

Host Amber Smith: Right, right.

So what was their socioeconomic class, before he died? Before their father died, they were doing pretty well?

Author Janice Nimura: They were, although in a precarious way. Their father was an idealistic capitalist, and his fortunes fluctuated a lot. There were good years and bad years. And sugar is a sort of a fickle industry anyway. Sugar refineries have a bad tendency to blow up, and his did a couple of times. So they were definitely in the intellectual class, the educated upper middle class, but in terms of how much actual cash they had, that was precarious.

So they identified as genteel. At the same time they identified, not identified, but sympathized, I think, with less fortunate people. They also came from a background in England of being dissenters, dissenters from the Church of England, iconoclasts in the way they thought about the way society should work. So, I guess in today's terms, you would call them liberals, progressives, people who thought about improving the world. So all of that is a complicated way of saying their attitudes didn't always match their finances.

Host Amber Smith: So what was the education like for all of the children? Is this the time of one room schoolhouses, or how did they educate themselves?

Author Janice Nimura: Well, interestingly, for a family of this time, the girls and the boys in the Blackwell family received the same level of education, from a kind of a patchwork of schools, tutors, each other, their parents, their parents' friends. There was not a kind of a organized kindergarten through 12th grade education for them.

But books were a pillar of the Blackwell domestic life. And they all read avidly and read to each other and discussed and often met the authors of the things they were interested in. So, education and intellectual pursuit was of paramount importance. I don't think any of them spent all that much time sitting in classrooms. The boys more than the girls, but the girls also had governesses, sometimes tutors, sometimes, depending on how the family was doing, a patchwork education, but a very passionate one.

Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host Amber Smith, and I'm speaking with Janice Nimura. She's the author of the book "The Doctors Blackwell," about the first woman doctor in America who graduated from Geneva Medical College, which is now known as Upstate Medical University, and her sister, who was also a physician.

So, some of the reviews of your book describe the sisters as eccentric, so I wanted to know what about them is eccentric and whether they were considered eccentric in their day.

Author Janice Nimura: Well, in their day, any woman who stated a choice to study medicine, i.e. study the intimate processes of the body while sitting in a room among men, was profoundly eccentric, outrageous, appalling, you know, freakish. So by the standards of the day, their mission itself made them deeply eccentric.

On top of that, as I mentioned, the Blackwells were sort of clannish. They had a very high opinion of their own intellectual strengths. And any woman who spent more time reading than raising a family was also considered eccentric by the mainstream. Within their own circles, the Transcendentalists, various progressive schools of thought, the Abolitionists, they weren't necessarily considered eccentric, more just extremely idealistic, I guess I would say. But to the average person, the very idea of a woman choosing to study medicine was unspeakably strange.

Host Amber Smith: So they might have been more accepted if they'd been nurses or midwives or something? I mean, women did some medical stuff, right?

Author Janice Nimura: Definitely. You know, this was a moment in history where the field of medicine was in flux both scientifically and institutionally, right? Women, of course, had always been healers. They'd always been midwives. But those healing arts were more of a trade. And in terms of a class thing, if you were of the genteel class, that wasn't something that you would get involved in. There was a class aspect to this. The Blackwells really were, Elizabeth to start, you know, to her, a nurse was a working-class person. She was not a working-class person. So if she was going to be this this beacon of female independence, it was going to be as a doctor, not as a nurse. If you were a woman, you could be a nurse. That was sort of a working woman's thing to do. She wasn't really interested in proving that. She was interested in taking a place in a man's world. As upper-middle-class people. Working at all was a little bit out of the norm. So anything they did other than find husbands and settle down would've been considered unusual.

Host Amber Smith: What was their birth order? Was Elizabeth or Emily, were they the first born?

Author Janice Nimura: So there were two older sisters before Elizabeth, and then Emily was the next sister after Elizabeth.

Host Amber Smith: OK.

Author Janice Nimura: And they were five.

Host Amber Smith: And then they had younger brothers?

Author Janice Nimura: And they had younger brothers. Exactly.

Host Amber Smith: OK. So, did you get a sense of why, besides wanting to sort of move into the man's world, did they have a passion for medicine or for the body, or learning about it? Why did they really want to become doctors?

Author Janice Nimura: Well, interestingly, starting with Elizabeth, Elizabeth chose medicine not because she was interested in science, the body, healing, caring for people. I mean, I think in many ways the opposite was true. She thought being sick was a sign of weakness. She thought most bodily functions were fairly disgusting. But medicine was an unusually clear way of proving this point because, increasingly, the way you became a doctor, by the 1840s, was that you went to a medical school, took classes, sat for examinations, passed them and received a diploma. You know, medicine hitherto had been, especially in America, had been more a question of apprenticeship, following the village doctor around, learning to do what he did.

Now with the emergence of medical schools in America, there was this move toward medicine as a profession for men that came with a diploma. And so it occurred to her that if she could find her way into one of these medical schools and study, she knew she had the intellectual power to be successful as a medical student. If she could get in there, study, pass the examinations, who could say that she wasn't a doctor as qualified as any man?

So it seemed like a very graphic, clear way of proving this point about what a woman could do. And so she went into it with that in mind to prove this point, not necessarily to be a healer or because she was passionate about biology.

And as for Emily, I think Elizabeth, realizing that being a woman doctor was going to be a lonely path, looked around, decided she really would like a companion on this path, really thought more highly of her own family than anyone else, and recognized Emily as the most talented of her sisters and said, "Emily, I anoint you. Will you join me in this quest, this medical mission that I have?" And Emily, I think, was intellectually hungry enough for that to appeal to her. And she said, "OK, I'm in."

Host Amber Smith: "HealthLink on Air" will be right back with more from author Janice Nimura.

This is Upstate's "HealthLink on Air." I'm your host, Amber Smith, and I'm speaking with author Janice Nimura, who's talking with me about her new biography, "The Doctors Blackwell, How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine."

Now, Elizabeth went to school at Geneva Medical College, which is now Upstate Medical University. But where did her sister Emily attend?

Author Janice Nimura: Well, interestingly, in the wake of Elizabeth's clear success at Geneva, male medical schools really got cold feet at this spectacle of a woman being incredibly successful in one of their schools. So, in the wake of Elizabeth's graduation, five years down the road when Emily came along, they shut their doors to her and said, "No, no. We won't be accepting any more Blackwell sisters. One was enough." So Emily had to struggle even harder to find a spot. She started at Rush University in Chicago.

Medical school at that point was two successive terms and two successive years. And after her first term at Rush, the trustees of Rush got cold feet and said, "Please don't come back. We really aren't comfortable with having you around." And she was determined and found her a way to finish up at Cleveland Medical College, which is now Case Western.

Host Amber Smith: But they did well in school, right?

Author Janice Nimura: Of course. They did very well. In fact, I mean, the old line about "doing it, but backwards in heels" very much applied to them. They knew that in order to be taken seriously, they had to be excellent, and they were.

Host Amber Smith: Well, do you think that they would be impressed at the progress women have made in society and in medicine, or do you think they would expect there should have been more progress by now?

Author Janice Nimura: I think they would be gratified to know that more than half of medical students are women, for sure. I think they would be, bemused and resigned at the struggles that women still have in the profession -- and not surprised at all.

Host Amber Smith: How do you think they would feel about racial equality today?

Author Janice Nimura: Again, I think they would be, they would sigh with disappointment at how little progress we've made since their time and how much they recognize the struggles that we're still having. I mean, as I mentioned, they were ardent Abolitionists, and in fact, one of the first Black female doctors was a resident doctor at the infirmary that they founded in New York.

So they certainly understood that in the same way that they were trying to prove something about what women could do, there was equal prejudice against what Blacks could do. And you know, we're still fighting that.

Host Amber Smith: Well, I wonder back in that day, how well known they were. Were there newspapers covering the first woman going to medical school? Or did this sort of, did they just go kind of under the radar for a while? How much were they known?

Author Janice Nimura: They were known.Certainly around the time when they were studying, receiving their degrees, which was unprecedented and unheard of, there was plenty of press coverage. A lot of it was rather satirical, mocking. The London satiric newspaper Punch wrote about each of them in turn, with mockery. There was also some admiring stuff. The thing that it's important to remember about the 1850s, basically when they were emerging, is that the term female physician was generally understood to mean abortionist, a woman who was working in the shadows, in sin, on the wrong side of the law.

So the phrase itself was sort of notorious. And that's what they had to combat, this idea that being a female physician was somehow notorious rather than just being a female version of a male physician. There was certainly plenty of press coverage around the founding of their institutions in New York.

I'm not sure how far beyond the Northeast that that press coverage moved. I think there was some frustration on their part as they went along, especially on Elizabeth's part, that she wasn't better known in some ways, that, that people like Florence Nightingale were hugely globally famous. Elizabeth Blackwell never achieved that kind of celebrity.

Host Amber Smith: You are listening to Upstate's "Health Link on Air." I'm your host, amber Smith, speaking with author Janice Nimura, whose new biography, "The Doctors Blackwell," tells the story of Elizabeth and Emily Blackwell.

Now together, the Blackwell sisters founded the first hospital staffed entirely by women in New York City. What can you tell us about how that project came together?

Author Janice Nimura: Well, when Elizabeth finished her degree and her practical training, and when Emily did also, they struggled to find private patients. Most women who were wealthy enough to choose their doctors didn't trust the idea, as I said, of a female physician. So they really didn't have a lot of work. What became clear was that in order to work, they were going to have to turn toward founding a charity, a charitable institution, and serve poor women who didn't have the means to be picky about the gender of their doctor and fund themselves with charitable donations from wealthier people who liked the idea of a woman doctor serving the poor, but didn't necessarily want to be consulting one themselves.

So first, Elizabeth opened a tiny dispensary, one room, to serve the women of the Lower East Side, sort of in the German immigrant population largely. And then gradually that grew into the small hospital called the New York Infirmary for Indigent Women and Children, which opened in 1857. And their purpose there was both to serve poor women with female doctors that they could consult about their intimate illnesses, and also to be a place for the slowly growing numbers of female medical graduates to come for practical training. Because even those women who were slowly finding their way toward medical degrees, once they had them, they had nowhere to train because most hospitals still didn't want a woman doctor walking around.

Host Amber Smith: So on top of all of the medical, providing medical care, they had to come up with, like, the funding to start this, too?

Author Janice Nimura: Yes, they did. And they had a small but really passionate group of supporters in New York. Many Quakers, people who had progressive ideas about ideal social progress, like-minded people who believed that this was a good idea, and they could promote it. Again, some of them became the Blackwells' patients. Many of them didn't. Many of them just supplied their money.

Host Amber Smith: Well, whatever happened to the New York infirmary for Indigent Women and Children?

Author Janice Nimura: It survived. It morphed through many incarnations, as hospitals often do today. It persists as, I guess its DNA is still part of Downtown Hospital, which is part of New York-Presbyterian/Weill Cornell. But it persisted as the New York Infirmary for Women and Children for almost a century on the Lower East Side.

Host Amber Smith: Interesting. Well, I want to ask you about how you came to write this book. How much time did it take, for the research and the writing?

Author Janice Nimura: I would say about four or five years altogether.

Host Amber Smith: And did you, how did you learn about the journal entries and the letters, and how did you gain access to those?

Author Janice Nimura: Well, the vast bulk of the Blackwell material is in two places, at the Schlesinger Library for Women's History at Radcliffe, in Cambridge (Massachusetts), and at the Library of Congress.

Those are the two biggest dumps of material, so those were easy places to start. And then, you know, doing this kind of research is a lot of detective work. You sort of follow the bread crumbs where they lead, into different university collections, into sometimes into private collections, just picking them up as you go.

Host Amber Smith: So the letters themselves, are they written in pen, ink ...

Author Janice Nimura: Yes.

Host Amber Smith: ... on just paper? I mean, what are they like?

Author Janice Nimura: Well, I'm always grateful to these collections that have digitized a lot of their holdings so that you can actually pull up the letters on your screen, which is a great gift to my weakening eyesight.

Victorian, 19th-century, letter writers, when postage and paper were both fairly expensive, would do a lot of what's called cross writing, when you fill a page with closely written handwriting and then you turn it 90 degrees and write another whole page on top of the lines you've just written.

It takes a little bit of practice to actually decipher those kinds of pages, but I actually take great delight in deciphering people's handwriting and really getting to know them. You can get an extra sense of someone's personality when you become intimate with their handwriting. And after a while, I think I was able to discern most of the siblings' different handwritings.

Host Amber Smith: Wow. Did you travel to Geneva or Syracuse for any of your research?

Author Janice Nimura: Absolutely. Geneva is wonderful because South Main Street, where the medical college building was, is still very much as it looked in the 1840s and 1850s. So I had a wonderful feeling of time travel where I could go and stand on South Main, walk up and down, see the buildings that Elizabeth saw, see the lake, you know, right beyond the boulevard there and really get a sense of how it felt to be there in 1847, alone, trying to kind of dodge the stares of the townspeople and win the respect of your fellow students and your professors.

I was also blessed because when I stayed there, I made the acquaintance of several of the people who really treasure the Blackwell story in Geneva, one of them being the proprietor of the inn I was staying at was the retired director of the Geneva Historical Society. So that was a great...

Host Amber Smith: Wow.

.... way in. Well, can you describe your writing process? Do you write in the daytime, the nighttime? Are you disciplined about when you write? How does it come together?

Author Janice Nimura: I try. Generally, I think that the rule is that if you can just sit yourself down in the same place at the same time every day and do something, you eventually can make some progress.

I balance my writing and research with my parenting and family cockpit work, so like many other writers. But mostly, try to put a few hours together during the day when everybody else is off doing whatever they're doing.

Host Amber Smith: Now, how did you end up deciding to become a writer?

I know you, you did have some interest in medicine at one point, but how did that turn into "I want to be a writer"?

Author Janice Nimura: It was never a conscious choice. I was never that kid who had four unfinished novels under my bed or anything like that. But I've always been a passionate and profound bookworm. And I think when you read obsessively and deeply, the way I was always reading, you, writing kind of becomes the natural way to express yourself. And I've always loved stories of the past, and it was a revelation to me in college that history was just stories. It was just stories about people. And I think the combination of being able to be a storyteller and kind of a detective in the archives became where I felt happiest in a way.

Host Amber Smith: Can you tell us about your first book, "Daughters of the Samurai?"

Author Janice Nimura: Sure. In college, I met a guy who had been born in Japan, and we eventually married and moved to Japan for a few years. When I came back, I did a master's degree in East Asian studies and Japanese history. And I became fascinated with the moment that Japan turned itself toward the west and started to be curious about Western ways, Western technologies and vice versa, the way, the moment when the West started to recognize that Japan was an interesting place to think about, at the end of the 19th century.

And then I stumbled onto this story of three little girls who had been sent by the Japanese government to America in the 1870s, to spend 10 years here, grow up American and then come back and help with the project of modernizing Japan. It was kind of a crazy story seen through the lens of these three little girls. It kind of captured my imagination and wouldn't let me go, and that became my first book.

Host Amber Smith: Well, let me ask you again about "The Doctors Blackwell." What do you want readers to take away from this book?

Author Janice Nimura: Good question. You know, I think we're in a moment right now, especially with the inauguration of our first female vice president coming up, where I think it's a ripe moment for redefining "heroine" in our imaginations.

I think the Blackwell story interested me because there's the sort of children's biography version of Elizabeth Blackwell, first woman doctor. But Elizabeth and Emily were very complicated people. They were paradoxical people, sometimes. They were the first women doctors. But they were out of step with the emerging women's movement in the 19th century. They didn't believe in women having the vote.

They often disagreed with some of the ideas that we think of as basic feminist principles. They weren't always adorable. They could be cranky. They could be opinionated and formidable. And I love them for that because they made me feel, they made me think of the people I know today, women who I admire, but who are not cartoon versions of heroine.

And I think it's a really ripe moment for all of us to think about how we admire female heroes and to embrace people with all of their contradictions and ambiguities intact, and not just because they suit some saintly legendary idea of how a hero is supposed to be.

Host Amber Smith: Well, thank you to Janice Nimura. She's the author of "The Doctors Blackwell, How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine." I'm Amber Smith for Upstate's podcast and talk show, "HealthLink on Air."

Upstate Medical University: Here's some expert advice from Dr. Robert Gregory from Upstate Medical University: How can a person recognize if someone is suicidal?

Robert Gregory, MD: A common indicator of depression is withdrawal from people and difficulty functioning at work or school. There may be a lot of expressions of pessimism and negativity. But on the other hand, many people are very good at hiding depression. So, don't beat up on yourself if you miss it. The most important take-home point is to not be afraid to ask about depression and thoughts of suicide. So many people who are struggling with suicide do not share their pain with others. It's a very isolating kind of condition, and they don't let them know that they're on the edge. And I've known so many people who wish that they had asked their loved one that question.

So go ahead and ask the questions: Have you been feeling depressed lately? And then, have you been having thoughts of suicide? If the answer is anything other than a definitive no, please refer them to the many resources available to them. There are 24-hour national suicide hotlines. (Call or text 988 for the national Suicide and Crisis LIfeline). More locally, there's Contact, which provides twenty four seven counseling by telephone (315-251-0600) as well as referral to resources. There's always the emergency room.

And, thankfully in Syracuse, there's also the Psychiatry High Risk Program. This program was started to meet a need. We were having record numbers of suicides in young people in Central New York and around the country, but there were no programs specializing in the treatment of individuals who were at high risk for suicide.

So that's what this program is all about. Our mission is very simple: to save and transform lives.

It's a comprehensive outpatient program. And we offer a full range of treatment options, including weekly individual psychotherapy, medications and family and group psychotherapy, as indicated. It's a 12-month program, since it takes a while for transformative healing to occur, enough time for individuals to change lifelong coping patterns and ways of perceiving themselves and others. So we offer up to 12 months of weekly treatment with the goal, not a complete cure by 12 months. But rather our goal is for them to be well enough so that those individuals can continue the process of healing and the recovery without needing to be in the mental health system the rest of their lives.

About half of our patients are referred by a hospital or an emergency room, and others are either self-referred -- they just call up our program -- or referred from other healthcare providers. So self-referral is actually very common and very easy. The person just needs to call our intake number. That's (315) 464-3117.

Host Amber Smith: You've been listening to Dr. Robert Gregory from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: The memories we have of those we have loved give the Muse some heartbreakingly beautiful poems. I'd like to read two of them now. The first is by writer and retired teacher and illustrator Mary Beth O'Connor. It is called "Afterward":

As October days fall into ripen and char,

I lean toward what comes next: the darkening,

the frosts, the nights full of nearer stars.

I put on your coat, venture out, harken

to the news of changing seasons -- hushed

but for crunch of boot steps toward the last

squash to gather -- then mow dead leaves to mulch,

sweep the porch, store cushions, watch the forecast. ...

Down by the pond the red-winged blackbirds

have departed, no more chatter and shrill.

I'll not see them until the spring return

even though I keep the bird feeders full.

I'll bring in firewood, clean the smoke-smudged glass,

light the match -- watch flames devour what's passed.

The next is from semiretired publisher and poet Jack Hopper, who has published four poetry collections. Here is "Your Presence":

Were it not for you

I'd be sitting here alone.

You're gone and I accept it

as the end at last to so much pain

you had to suffer just to die

while others whom I've loved live on,

or pass into the ether

of distance and neglect.

Occasionally we still meet

in that variant version of reality

we call dreams and you are

quite real until the sun paws

kind and quietly at the blind,

reminding me there is another world

wherein you will not walk.

I will not hear your voice,

will not lie down beside you

or reach out for what we both desired,

as you pass by.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air": how to care for aging skin.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.