At the end of the 1950s and 1960s, Atlanta was deeply segregated — down to its very hospitals.
At Grady Hospital, cardiac patients were separated by race, with white patients being addressed with the honorific “Mr.” or “Mrs.”, while black patients were referred to their name only.
In the meantime, black nurses were simply called “nurse” — without names — simply a title to disappear behind, despite the lifesaving work they were doing.
For a plainspoken doctor from New York who had already broken barriers as one of the first Jewish women at Harvard Medical School, this wasn’t going to fly.
The cardiologist — Dr. Nanette Wenger, recently transplanted to Atlanta with a strong sense of morality and community service — decided the practice should end, and that she would not allow people to be treated differently: Black patients would be addressed as “Mr.” or “Mrs.,” while nurses would be addressed by name, regardless of race.
It didn’t take long for Wenger to be called into the director’s office.
“Do you know what you’ve done?” he asked Wenger.
“Yes, sir,” she replied.
“Are you going to do it again?” he pressed.
Wenger didn’t miss a beat. “Yes sir,” she repeated.
The director could see he wasn’t going to change Wenger’s mind. “Well then, you’re going to be down here every week, and we might as well be friends.”
It was a small win for civil rights, but for Dr. Nanette Wenger, she was simply doing her job.
“It was a tiny step, but it salvaged my sense of what was right and what was wrong,” the 87-year-old still-practicing cardiologist says today. “I lived in an integrated society. Maybe it was isolated from the real world. But I just could not abide by people not being treated as equals. Everyone has core values, and those were mine.”
To her, her life as a trailblazer — as one of the first women to attend Harvard Medical School and then as one of the first Jewish female cardiologists in the heart of the deep South — doesn’t strike her as extraordinary or special. She was always simply doing her job. This past Saturday, Wenger received yet another piece of recognition with an award from the Black Cardiologists Association for her work in helping to identify demographic differences in cardiology between white and black patients, and her contributions towards understanding how heart disease affects those who aren’t old white men.
But Wegner’s story is rather remarkable, given that she was born in a time when being a woman would otherwise present difficulties for a curious girl aspiring to be a physician.
Born in New York in 1930, Wenger grew up in Long Island; she fondly recalls a happy childhood as the bookworm daughter of Russian immigrants who quickly threw themselves into the cultural fabric of the Big Apple.
Wenger’s parents instilled in her a deep sense of community early on. Wenger’s father worked with the Hebrew Children’s Immigrant Aid Society and was instrumental in pushing for and helping integrate Jewish refugees arriving from European ghettos. These were the years leading to World War II, and Wenger wanted to help, so she joined as part of a brigade of junior volunteers, rolling bandages for hospitals and filling capsules with crushed powder by hand.
It was there that Wenger’s childhood commitment to becoming a physician was solidified.
When Wenger entered Harvard, all medical schools had a quota system for classes based on race and gender; Harvard at the time was accepting women on a “provisional basis” for a decade before “incorporating” them officially into the system — which put Wenger and her female classmates in an odd sort of twilight zone. “We were ‘provisional,’ so we didn’t get housing,” Wenger says — which meant that she and her fellow female med school students had to get apartments in town.
Harvard was, in fact, a wonderful time for Wenger, who said she didn’t face discrimination and found the class “supportive for women. I learned something literally every day and had the chance to work with very bright and collegial people, the most amazing people.”
Wenger found that she was surrounded by giants of not only medicine, but harbingers of the latest, groundbreaking cardiology research, among them Sam Levine at Brigham, who pioneered the study and treatment of coronary thrombosis; Paul Dudley White, who pushed for patients to take preventative steps in protecting their cardiac health and helped develop the National Heart Institute; and Charles Friedberg, Wenger’s mentor later at her residency at Mt. Sinai who shaped Wenger’s thinking on how to approach patient care. “These were the giants of cardiology,” Wenger says of what influenced her to study cardiology.
It never occurred to Wenger that she couldn’t be a cardiologist.
“I’m not really sure I was aware of it,” Wenger says of potential obstacles she faced towards becoming a cardiologist. “My parents always told me that I could do anything I wanted to do. I worked hard in college and my grades were excellent. My philosophy throughout my career is that quality and excellence trump prejudice,” Wenger says matter of factly. “I performed well. People will look at performance and accomplishments.”
After completing a prestigious residency and internship in cardiology at Mt. Sinai in New York, Wenger became engaged to her husband, Julius Wenger. Julius had worked in gastroenterology at the University of Chicago and recruited by Emory University to start work at Grady, a hospital associated with Emory which was looking for adventurous new doctors looking to make a difference.
Wenger, by then an East Coast transplant and comfortable back in New York, decided to take the plunge and join her husband in Atlanta. Little did Wenger know that she would be at Grady for the majority of her career.
There, Wenger took on cardiac rehabilitation. While at Harvard, she and Sam Levine, one of her medical school mentors, implemented the then-unheard of practice of putting patients who had just experienced a heart attack up in a reclining chair. The standard practice for heart attack patients was a strict 6-month long regimen of bedrest, but Wenger had learned through observation that getting patients up and active as soon as possible allowed them to recover faster — and better. So Wenger tried to duplicate this with her patients at Grady, attaching EKG monitors on patients to keep an eye on potential arrhythmia and putting cardiac infarction patients up for what began as a 21-step program towards rehabilitation.
“We did something different and had them sit up in bed and dangle their legs,” she said. “There were no serious disturbances, [which meant] our patients went home after 21 days, while others stayed in the hospital for six months.”
Though many among the faculty were suspicious of the program, Wenger presented clear data and evidence. But Wenger persisted, and cardiologists took notice. That 21-step program became a 14-step program, and then to today’s iteration of 7-steps that continues to be the standard for cardiac rehabilitation, which includes exercise three times a week.
It was at this time that Wenger began to notice that there was a huge gap in knowledge in understanding women and heart disease. Thus far, research for heart disease had been focused on studying men — and middle-aged, white men at that. “I was taught that heart disease was a man’s disease,” Wenger says. “But I began to see women with this disease, and they weren’t doing well [with the prescribed medication].”
It got Wenger thinking that there was something wrong here: She couldn’t be prescribing women the same medication and rehabilitation plan as the literature prescribed for men because, well, these were women, and women were fundamentally different.
How was she supposed to tell women to follow a man’s regimen when their biology was different and furthermore, there was no data proving that the regimen that worked for men would work for women? Wenger contacted people at the American Heart Association and National Heart, Lung, and Blood Institute, with a plea: “We really need data for women.”
“The term gender-specific was not there at the time,” she says, her voice still brimming with passion on the topic. “These women weren’t doing well. I just needed data for women to treat my women patients.” Among signs that Wenger found to be crucially different between men and women: Chest pain could show up as depression and anxiety disorders for women but really be a sign of tachycardia; post-menopausal hormone replacement therapy potentially helped prevent the appearance of heart disease.
Frustrated at not being able to find this data, Wenger decided to spearhead research into how women deal with heart disease by organizing a workshop with the National Heart, Lung, and Blood Institute and co-chairing a conference on the topic. Her work helped launch various public health initiatives addressing heart disease for women through the 1990s and arguably helped save lives for women. Those viral campaigns that are now embedded in public consciousness for women’s health — Go Red for Women with the American Heart Association and the Red Dress Campaign for the National Heart, Lung, Blood Institute — would not have been possible without Wenger’s passionate push.
“The heart disease for women’s movement, if you want to call it that, was born,” she says. By 2000, clinical regulations for women were being set up for women with heart disease; in 2014, for the first time since 1984 when gender specific data began to be accumulated, health data was organized and collected for women in a separate category for women, with separate clinical regulations that led to marked improvement in female heart disease patients.
For Wenger, though, this was just another situation of addressing a need for a community that was silently suffering and required fair treatment and attention. “My role was asking questions and identifying knowledge gaps,” she says.
She went on to examine heart disease for the elderly; as the population ages into the 80s and 90s, research is scant on how heart disease affects geriatric patients. “Studies didn’t enroll anyone over the age of 65,” she says, “but the fastest growing population of Americans are those aged 80 and above.”
Wenger did what she does best: Drum up support on her own, first by starting and editing the American Journal of Geriatric Cardiology, then by starting the Society of Geriatric Cardiology, a division within the American College of Cardiology. “Older patients have multiple morbidities,” she explains about the importance of understanding the health of the elderly. “Most patients want to simply be independent and are less concerned with longevity. For most of them, that determines decisions for procedures.”
For Nanette Wenger, retirement is nowhere on the horizon. “I expect to mentor a lot of women who are cardiologists,” she says of her future plans. “Many of my concerns are specific to women, and teaching more versus clinical.” She still jet sets around the world to give lectures, and has served as President of Atlanta Hadassah, the Atlanta Bureau of Jewish Education, and the Jewish Children’s Service.
There’s no slowing down for Nanette Wenger — there’s still too much work to be done.
Tanya Basu is the senior editor in science at The Daily Beast.