While others quickly let go of their visions of being a doctor, Mary Romano held onto her dream with tenacity, even when the path seemed to be cut off early. The tendency to not easily be thwarted proved useful to her career, and ultimately to the population she decided to serve. Find out how seeking a way around the barriers in front of you can look similar to removing barriers for others.
Guest Mary Romano was sure she wanted to be a doctor. But she really loved Latin and Greek and didn’t want to give up everything for her medical dreams too soon. So she majored in the classics and stayed on the pre-Med track. When others were getting into medical schools—or letting their med school dreams go, Mary did neither. Without a place to land, she went back home and regrouped.
She ultimately went to medical school in the Caribbean, an experience in itself. And returned to the U.S. for her clinicals and hospital placements in the U.S. Having known she wanted to go into pediatrics, she honed in on adolescent medicine as the place she would be most happy, seeing patients but also educating them daily. As her career advanced, the teaching roles became more diverse for a wider set of audiences—from med students to young doctors to policy makers. This is all the more true now that she has built a practice and center for transgender and gender diverse adolescents and children. From educating the patients and their parents to making sure legislators understand the science and lives behind their bills, she is always busy.
In this episode, find out from Mary how finding a way around barriers and removing them for others plays on the same skills and personality…on ROADS TAKEN...with Leslie Jennings Rowley.
About This Episode's Guest
Mary Romano, MD, MPH, is Associate Professor of Pediatrics and Adolescent Medicine at the Vanderbilt University Medical Center, where she helped to cofound a center serving transgender and gender diverse children and adolescents. In addition to seeing patients through clinical service, she also provides education and training to gender diverse youth, their parents, and the providers that serve them. She lives in Nashville with her husband and their two children.
Executive Producer/Host: Leslie Jennings Rowley
Music: Brian Burrows
Find more episodes at https://roadstakenshow.com
Email the show at RoadsTakenShow@gmail.com
Mary Romano: I'm a “if you see something, say something” kind of person. So, I mean, I think as you fight for your patients individually, you're like…and you hear their stories of what they're facing in the world…I mean, how can you not be inspired to be like, oh my God, I'm not going to ask this 14-year-old to, like, go stand down the principal and ask to use the bathroom. Like I can do that for them. Right. If there's something you can do to help why wouldn’t you?
Leslie Jennings Rowley: While others quickly let go of their visions of being a doctor, Mary Romano held onto her dream with tenacity, even when the path seemed to be cut off early. The tendency to not easily be thwarted proved useful to her career, and ultimately to the population she decided to serve. Find out how seeking a way around the barriers in front of you can look similar to removing barriers for others...on today's Roads Taken, with me, Leslie Jennings Rowley.
Today, I'm here with my friend, Mary Romano, and we are going to talk about the things that happen in our heads and bodies and what that means about who we are and all kinds of things. So, Mary, thanks so much for being here.
MR: Thanks for having me. I'm excited to chat.
LJR: Yeah. So I start this the same way with all of my guests with two questions and they are: When we were in college, who were you? And when we were getting ready to leave, who did you think you would become?
MR: So, I guess when I was in college in terms of like who I was and what I thought my path was, I wanted to become a doctor, but I also really loved the classical languages. So for better or for worse—and there were probably many things that factored into that decision—I majored in Latin and Greek because I loved it. And I didn't want to sort of give all the things up to start medicine at that point. And I think as much as I knew I wanted to be a doctor, I wanted to do a little bit more exploring. So I did the pre-medicine stuff, but I spent quite a bit of time in that track as well. So it was cool. I loved it. It was a cool balance. I never felt kind of, you know, drowning in the science. I don't know that I was a mover and a shaker in college, which is probably why when I left college, I wanted to be a doctor, but actually didn't know if that was going to happen. For lots of reasons, I did not get into med school. So when I graduated college, I had zero plan, which thrilled my parents, I'm sure. You can imagine after spending four years at Dartmouth. But still I wanted to be a doctor, so moved home and took a job in my aunt's shipping company as a receptionist. And then moved my way up to like a sales rep organizer, because at the very least I'm good at talking to people. But still was like, I know I want to go to med school. So I tried to figure out how I could regroup and ended up going to med school in the Caribbean. I went to St. George's in Grenada, which is a third world country and not in the United States. And, you know, education-wise was awesome, but I lived in a third world country for two years and that was really, really hard.
And so I definitely feel like my sort of path to being a doctor has been sort of windy because I mean, going from Dartmouth to a med school in the Caribbean is probably not the path most people take, which is not to knock any people at Caribbean med schools. But I mean, like that's just, you know, so yeah, so I didn't know what I was going to be when I left Dartmouth because my path had not yet figured itself out. And even like, I mean, my mom came with me, God bless her, to Grenada. I mean, we got off the plane on this tarmac, in this third world country with just no air conditioning and like refrigerators out on the balcony because the electricity inside…I mean, she, I think was as scared as I was to leave me, but, you know, there but for the grace of God I…off I went.
So again, I feel like I don't think I knew what I was going to do or that it was going to be secure till I got to residency. Cause when you go to Caribbean med school, you know, first there's the living in a third world country for two years, which…Bug stories. And you know, now it's so funny cause we have something, I mean, I had no email, I had no cell phone to talk on the phone. You had to pay $1.50 a minute. And it had to be like a, like “call me at this time and I'll pick up” and to send emails, you had to type a word document and give it to someone. And then they would send it from a mass account. Like it was just…so it was really hard. So I think I just was like, I need to survive. And then it was like, where do you do your clinicals? Cause you could literally be anywhere. It says it wasn't like he went to this med school, that's linked with this hospital. And then it was like, oh my goodness. I went to a Caribbean medical school. Am I even going to get a residency? So I think not to like got a residency, I was like, okay, I can take a breath. Like I've made it past that hurdle. And I know that it was easier, but then at least the path felt a little bit more clearly defined, but it was, it was a…I mean, it was a challenging.
LJR: Yeah. And maybe part of the, not having all those things, like you had fewer distractions.
MR: My father was like, my, I think my GPA coming out of my first semester of med school was like a 3.9 or something, which I say not to brag, except that my dad was like, that's not what your science classes looked at Dartmouth. I think the fact that I didn't have a cell phone and didn't have a TV and didn't really have much to do helped a lot. And you know, it's one of those things, you know, now I'm like God old for many, many years out of it. I would never ever want to do it again. But I kind of can't imagine, like not having had that experience, like it was a really very character-building makes me sound like, I don't know, but like it was, I can't imagine not doing it, not going to go back and do it again. Sure. It would have been cooler to like go from Dartmouth to, you know, but it was a good experience.
LJR: Yeah. And so Mary, I talked to so many people who are like, well, I got to Dartmouth and I thought I was going to be a doctor. And then life came and I realized that wasn't my path. And I can imagine some people saying I didn't get into med school. Like I'm not cut out for this or this isn't really the path I want. Like, what was it in you that said, well, I'm going to figure it out and I'll be a receptionist in the meantime. And then I'll take this unconventional path and that'll be it because I am certain. Where did that come from?
MR: Part of it probably was. Cause I didn't find something else I wanted to do, I guess, but I also, I mean, not just snotty, like, I think that's probably my personality. I mean, I am very like, if this is what I want to do, I will figure it out. I was probably not probably, I am lucky enough to have parents that were like, okay, like, you know, my parents had to come to Grenada three times a year to visit me. Like, don't think that most parents think that that's the plan they're going to take, but my parents are pretty well with the punches. Like this is, so I think that. Instilled into my personality. So I was like, if this is what I have to do, this is what I have to do. There were definitely moments where I was like, what the hell am I doing? But I think it was one of those things that I really knew that that's what I wanted to do. And I try and tell this to my patients now, when I talk to that, I—this is going to sound so cheesey—I love my job. I love what I do. And like I'm in no rush to be done with it. Right? Like some people are like, oh my God, I just need to make money to retire.
I mean, I would like to work a few less hours, so I'm not like frantically cooking dinner at six in the morning for my kids when I get home. But I love what I do. And so I guess I feel like the drive to get to that was what kept me going.
LJR: Yeah. So at the point before residency, did you have an inkling of the type of medicine that you wanted to practice?
MR: I knew I wanted to do pediatrics. This is going to sound very, not nice. I didn't like old people feet, so I knew I wanted to do kids.
LJR: Old people feet?
MR: Like when you do. Cause when you do medical school, like you rotate through all the rotations. And like, I was like, I don't want to—that may not be something we should include—but like I knew I didn't want to do older people medicine. I knew I wanted to be kids. And that was for sure where I knew I was. Within pediatrics. I actually didn't even know the discipline that I ended up doing existed until I got…I guess I figured it out in med school a little bit. So in med school, I did a rotation in adolescent medicine because the person who did the rotation was the chair of pediatrics and I wanted a letter of recommendation from him. That's the only reason I did it. And I really, really liked it because I think it combined the two things that I really, really liked. So it was Nelson, but it was a ton of teaching. I think it's like the older sister inme, I like to teach, or I like to educate or health education. And so adolescent medicine is like 90% teaching and education, right? Because when you think about the most adolescents are inherently healthy. So the things that make them sick and the things, unfortunately that kill them are the choices that they make. So it's a lot of health education and like, here's what you're doing. Like, let's talk about how the outcome of that may not give you what you, you know, so it's a lot of education. And I think I did my adolescent medicine medical school rotation in a really rough hospital in Brooklyn. So I definitely saw an at-risk population and they were awesome. Like they were scary kids and that freaked people out and they would bring guns to appointments. And like, had like, I don't, I don't mean it to sound like stereotypical. Like they were not the kind of people that I had probably, they were not a patient population that I probably encountered before. And I think it was amazing to see that I could connect with them and that they felt connected to me and that they listened to me and that they, you know, that we had a positive doctor-patient relationship. And I was like, this is what I love to do. And so we got to residency. You have to do this rotation. And I was like, no, no, this is still what I love to do. And then I just was like, yeah. And I don't know that I realized all the nuances of what I would do in adolescent medicine, because what you do kind of depends on where you are because you know, in certain populations, the risk may be this. And in certain populations you may see more of this. But I just something about that age group and talking to that age group, I—maybe it's something about my maturity—I could talk to teenagers all day long. Like if you're honest with them, they will be honest with you. And they're fantastic.
LJR: Yeah. Well, you had talked earlier, even in your sales role, you just like talking to people. I know that about you. So that does seem to be a good fit. So walk us really quickly through all the steps of post med school life.
MR: So I went a lot. So I went to med school in the Caribbean, but then I did my clinicals in New York city. So I lived in Brooklyn for two years and did all of my hospital placements in New York City, partially because unfortunately, while I was doing my training, one of my sisters got diagnosed with leukemia. She's fine now, but I wanted to be close to home. So I stayed close to home and the med school was nice enough to accommodate me so I could be sort of close to my family on Long Island. So I did my residency. In Brooklyn. And then after that I did pediatric residency actually at the hospital where my sister got treated for cancer, which was just interesting to sort of be there as a physician after having been there as a family person. And so I did my residency on long island and then to do adolescent medicine, you have to do a fellowship. So I did a fellowship in adolescent medicine at Miami Children's down in Miami, Florida, which is ultimately where I met my boyfriend now, husband. But that was another big move far away from family, but that's, you know, it was one of those things where I didn't get a fellowship close to home. I got a fellowship in Miami and I was like, Hmm, this is what I've got to do. And again, once again, my parents, my mom came down with me and we found that apartment. And then I moved to Miami. So I spent three years.
LJR: Better air conditioning.
MR: Exactly. With air condition. So not comparable to Grenada at all. The only hard part of it was being far from home and like all my friends, but I did Miami. And then while I was doing my fellowship, I got my master's in public health as well, cause that's kind of part of some of the academics of what you do in fellowship. And then I got a job as an attending, which is sort of your post-fellowship real doctor job, quote unquote at Vanderbilt Children's Hospital. And I've been there since 2007 and now I'm an associate professor. So I've been there, whatever, 2007 plus 2021 is. And I like, I work with awesome people again, once again, I know, like my parents were like, you're moving where, like I interviewed for a bunch of jobs in New York and could have probably gotten a job in New York if I wanted it, but something about the people and the job, and honestly, the chance to be at a place like Vanderbilt was sort of something I couldn't pass up. So off I went to Tennessee.
LJR: Right. And so while adolescent medicine itself has that element of teaching, like in a day to day, point of view, You are also split now you're in a teaching research hospital, right? So how does your life, what does your life look like?
MR: I feel like my life is a big balancing act is way. No, I mean, just balancing all the things, but no. So right now I'm, what's called the clinician educator. So my primary appointment is to see patients and. Most days of the week, but then I do a lot of education on an institutional level. So I run a course for the medical students on sexual health and medicine, trying to sort of make medical students more, you know…So in adolescent medicine, we do a lot of sexual health, right? Adolescents have sex, they need birth control. They need to be screened for STI. I take care of a lot of sexuality and gender minority patients. I started a transgender clinic, so I try to inform the medical students about those things. So they can bring that into their practice regardless of what they go into. So I teach the medical students. I do a lot of teaching for the residents on various topics in clinic. I'm often, you know, the resident goes to see the patient and then we, we talk about it together. So there's teaching there and then like any job as you sort of move up in your career. And now I do quite a bit of teaching on a national level. So I will present at various conferences about. My areas of expertise at this point are really sexual health, contraception, and I really, the last few years, which has been really an amazing journey to see my patients on their journey, as well as just for me to kind of get sucked into this awesome world, taking care of sexuality and gender minority patients.
So, you know, in adolescent medicine, it's a very big to know who are your patients, right? Like, I don't just care that you have a cold and you need an antibiotic. What I care is like, how's your mood? Who are your friends? Who are your romantic relationships? What are you doing that I need to talk to you about ways to protect yourself. And so I ultimately encounter lots of patients who are LGBTQ. And then sort of, as we amassed this patient population realized that there was a need for more care. So our clinic in and of itself has become a site for just making sure that we provide culturally competent care to sexuality minority patients. And then now we started a transgender clinic, so, or gender clinic where we take care of a lot of gender diverse youth and are, for some, providing medicines that may help support them in their affirmation and for others, or just educating patients and parents and getting their mental health resources and helping them with school bullying and school discrimination. And unfortunately, you know, given that I live in Tennessee is now kind of spilled over into advocacy. So now we're really working with our legislatures cause you know, all over the country, but especially in Tennessee, a lot of really harmful bills have come up that really threatened the wellbeing of these patients and scare patients and scare families. And so we try to come from a place of science and work with our legislatures to sort of say, Hey, we get what you think you're doing. And we want to hear your concerns, but here's some of the evidence that would say that what you're doing is really counterintuitive to the wellbeing of patients. And that's been a interesting, sometimes frustrating, and really humbling journey. I think that the parents and the patients and their kind of bravery and fortitude in the face of such discrimination is really inspiring.
LJR: So, yeah. Yeah. And was that. Seeing a need and it growing organically, or was there just something that kind of something else that spurred you to be the person to help bring this center to life?
MR: It's probably a little bit of both. I mean, it's definitely was seeing a need and definitely it was a Hey in the adolescent medicine world. Here's what I'm doing. And then the great thing about working at a place like Vanderbilt, right? Is that there are lots of awesome, smart people doing things all around me. So, Hey, there was an endocrinologist that they would see and she would be in her and do her thing. And then there'll be a psychiatrist that they would see and they would be in their space and we're like, wouldn't it be great if we could all be in the same space together? And I do think that pediatrics in general, right? There's a lot of when kids get sick as kids, unfortunately it's not just the illness that needs to be treated. There's so many different areas, you know? So if you get…Often there's a mental health component. Often there's like a physical therapy component. And so I think sort of the need to all be together said, Hey, we should get together and at least talk about what we're doing. And then once we started talking about what we're doing, I think we were like, Hey, let's physically be together and do it together. And you know, if they build it or if you build it, they will come. I mean, once we started it, it was just patients coming out of the woodwork. And I think advocacy part is probably something that gets spurred, I mean, you know, I'm a, if you see something say something kind of person. So, I mean, I think as you fight for your patients individually, you're like, and you hear their stories of what they're facing in the world. I mean, how can you not be inspired to be like, oh my God, I'm not going to ask this 14 year old to like go stand down the principal and asked to use the bathroom. Like I can do that for them. Right. If there's something you can do to help, why wouldn't you? So I think that kind of thing, we all sort of have that passion for this patient population. And then it kind of spilled into advocacy.
LJR: And all of this while you're also balancing a home life. So how do you do that? And I mean, you talk to young people all day long, then you come home and there are other young people.
MR: My young people are younger than my patients, so. I mean, I don't want my kids to hurry and grew up, although sometimes I do, because maybe there'll be less annoying. But, I dunno, like I'm curious to see how my teenagers are compared to language teenagers, but I mean, we all do it right. And we all have to balance kind of where we need to put our energy. I was thinking about this the other day, someone gave me this great analogy. Like it's a juggling act and some of the balls are glass and some of them will bounce. And the trick is to figure out like which balls you can drop. Cause they'll bounce in which walls you can't drop because they'll break, which I thought was a really good analogy. And I feel like early on in my career, I probably let like home stuff drop because your career feels like, oh my God, if I make a misstep, I'm going to get, you know, they're going to find out that I don't belong here and they're going to kick me to the curb. I think now that I've been at my job longer and probably now that I feel more comfortable and confident in what I do, I definitely feel like I have a little bit more liberty to say like, Hey, this is what my family needs. This is what, although I feel like all moms with. I have this tendency—not to insult men—probably the thing that you left dropped the most is your own self care. Right? Like I have time for kids and my job, but I don't have time for sleep or so, I mean, I think it's probably just practice. I get actually worried because I think we stress so much as moms about babies and babies are really easy. Right? Like I find raising kids. Like my kids are seven and nine. Now's the part where I get stressed. Like, cause it's not about like, did they pee, did they poo, did they eat? Now its like, are they nice people? Are they empathetic? And we haven't even gotten to the teenage years already to make sure they like don't end up pregnant before they want to be pregnant. So I mean, I just think I get a little anxious cause I feel like I can see are your kids need you more as they get older, not less. And I think we think so much about the like early years and not that that's not, I almost feel like that's physically demanding, but now you kind of have to make sure you have enough mental health to answer the 12,000 questions. And my kids are probably for seven- and nine-year-olds more informed about a lot of things. [LJR: Yes they are] Just because I think 1) they hear me talking about stuff and 2) you know, as I was taught, like if they ask me a question, I'm going to answer honestly, you know. So I feel like they probably, which they ride in the car with other kids to school and my friend was kind enough to drive them to school in the mornings. And she’ll be like your friends mentioned, your kids mentioned this today, and we hadn’t talked about that yet. And I'm like, sorry. So, but I also am, this is like, I think the way I bounce, I get up really early in the morning. I get the most, I'm like super productive from 5:00 AM to 8:00 AM. From 10 PM onwards I am a wasted person, but from like five to 8:00 AM is my sweet spot.
LJR: So has that always been the case? Like even in college?
MR: Yes, I am. Well, no, probably not even in college because then I would've made it to more classes. Right?
LJR: And I wouldn't have seen you, so, I mean, I think I've always been a high. I have a lot of energy, but I definitely, like, I am a person that once I'm a week kind of hit the ground running much to my sister who shared a room with me and my husband's dismay, but I think as a resident, you also, right, like, I mean, I'd have to go 36 hours, like 24 hours without sleeping. So I think that probably helped a little bit in terms of like my ability to get up and be ready. But as I've gotten probably in my thirties, I just have become more of a morning person.
So like, I don't know. Which my dogs appreciate.
LJR: Yeah. Yeah. So thinking back to Mary at 20ish…
MR: Like five years ago. Sure.
LJR: Yes. Right. In our very recent youth. What about that kind of formative experience of saying, I love this medicine. I know I'm going to do it. I'm going to take these other experiences though, that I also cherish and run with them. Oh, I hit a roadblock. Oh, I'll figure it out. How, does translate to where you are now and who you are now.
MR: Ooh, good question. I may have to think about that for a second. I get, Ooh. I mean, I think it translates to who I am now in that I don't think that I'm easily thwarted. If that makes sense. I think I also for better, for worse, I'm good in a crisis. So like, if something's going down, I mean later I may lose, like I may freak out and panic, but like in the moment I think I'm pretty good under pressure. And I think that comes from like challenge move forward. I mean, I think some of that, right? I mean, not to sound obnoxious, like that's kind of what you have to do as a physician, right? I mean, if somebody is leading in front of you, like internally, you can be like, holy crap, but externally one, you need to keep it together to do the right thing. I think the other thing which maybe is more of a pediatric thing, we're probably all of medicine: You have to keep it together. Other people have confidence in you, right? Like, so the parents can't know, like, I, this just happened to me. My God, of like a couple months ago we had like family golf night for my kids' school. And my child's for better, for worse accidentally hit a kid in the face with a golf club. And this kid was like gushing blood all over family golf night, which was fantastic. But I think the like, okay, cool, nobody panick, like get a tissue get like, so I think that. Here's the thing, what are we going to do in the moment to fix it probably translates. Right? So that, like my kid was freaking out that she killed this child, right? Like, oh my God, like it's a child leading this child is freaking out and the parent was freaking out. So I think the ability to sort of like set the stage and be like, Hey, it's a problem. We've got this. I think that's probably carried over from…
LJR: Yeah, and I would also say into your advocacy work because it's like, Hey, I see this problem. Let's not freak out. Let's look at science. Let's look at rationality, let's look at the needs of these populations and, you know, get our stuff together in a rational, calm way. That probably is effective in the policy. But it certainly is. As you say, engendering respect and trust in you as a practitioner to these people that need you.
MR: And I think, I mean, I guess that's my thing. When I said I love adolescents. I think adolescents are very genuine, right? If they can't stand you, you know, if they're over you, you know, but I think they also, and I guess that's where like the advocacy kind of translates. If they know that you care about them, then they respect that. And I think, again, for some of my kids at risk, it means something to them that your counting, like, they don't want to disappoint you. And not that your patients should do things to disappoint you, but like they respect that you care and they see that you have a vested interest in their outcome. And I think that vested interest to me includes advocacy, right? So like, if there's a barrier to your outcome that I can help mitigate, whether it's handing you condoms, prescribing you birth control, or going to talk to the Senator about why their policy sucks, then I'm happy to go to the mat for you. And I think teenagers respect that and I think they'll do the same, right? So, I mean, I still tell this story about when I was a med student, I had. I just a couple of teenagers that I took care of and I was walking home from the hospital. I don't remember is late at night, early in the morning. And two random teenagers came over to me in like a somewhat threatening way in not the world's greatest neighborhood, nothing terrible happened, but like clearly a scary moment. And I was still standing there in my head thinking like, holy crap, what do I do? And all of a sudden I hear out of nowhere: Hey, that's my doctor, back off. [LJR: Whoa.] So again, I think they got my back cause they knew I had their back. Right. They knew I didn't judge them for who they were or where they came from. And then I was going to sort of not treat them the same, but like you need, you know, and so I mean, that to me is sort of what I that's the most positive thing I can take away from my patients. When my patients come in are like, Hey, you told me to do this this time. Like, look at what I did. Aren't you proud of me? Because I do think for some of my kids at risk, they don't have. That person. Right? And so for some of my sexuality and gender minority patients whose parents don't support them, who don't validate them, the fact that like you have a vested interest and you care gets their respect. And that means that they listen to you.
LJR: I would say that's pretty good parenting advice for all of us too.
MR: Yeah. Yes. Agreed. But like, someone's going to have to play back all the parenting, not podcasts where like, I've done a bunch of, like, I do a lot of like how to talk to your kids about sex or sort of why it's important. Can you talk to kids about sex, like starting at a really early age and like, it looks different at different ages, but someone's gonna have to play them back to me when it's time to, for my kids to go through and be like, no, just go to your room. Don't do it. You're done. Stop talking.
LJR: Well, Mary, this has been a delight to hear. Your paths, how you've gotten thwarted, how you've gotten around it, that you've advocated for yourself and others. And it's really wonderful to see that you're on a path that you have no intent on getting off for awhile. So thank you so much for sharing this.
MR: Thank you. Thanks for having me. Thanks for letting me talk about the things that make me happy.
LJR: That was Mary Romano, MD, MPH, Associate Professor of Pediatrics and Adolescent Medicine at the Vanderbilt University Medical Center, where she helped to cofound a center serving transgender and gender diverse children and adolescents. In addition to seeing patients through clinical service, she also provides education and training to gender diverse youth, their parents, and the providers that serve them. She lives in Nashville with her husband and their two children.
Mary said she was a “see something, say something” kind of person. Well, we fully advocate your being a "hear something, say something" person, sharing a bit about what you've heard on our show with your friends. Please tell them to listen wherever they find their podcasts and to subscribe or follow, rate, and review so we can bring more stories to life each week from my guests and me, Leslie Jennings Rowley, on Roads Taken.