Dr. Angela Aslami

Photos: Ariel Thomas Bates Lane Photography

I Will Treat the Whole Woman

Editors note: Our conversation with Dr. Aslami invited a raw Q&A about her heritage and her ethnicity in the middle of a discussion about her medical practice. My questions were met with grace and guidance by Dr. Aslami. As an Editor, my questions were driven by a desire to learn her full story. As a woman, my questions were driven by my desire to learn about the world “right up the road” and into which I hope to be invited.  This transcript highlights our discussion. To read the entire conversation, visit www.livingcrue.com.

Our conversation begins here:

Did you grow up in Massachusets?

Dr. Aslami: I grew up in Sturbridge, Massachusetts. We moved there when I was in 4th grade. Prior to that, for 1st and 2nd grade, my dad took a teaching job in Saudi Arabia. In Saudi Arabia, we lived in a gated community separated from Saudi society. It was nicknamed the “community of infidels” because it was the French people, the Germans, the Europeans, the Americans. All of whom were teaching at the same university. So we had our own little “community of foreigners.”  ... We came back to the U.S. when I was in 3rd grade.

Do you remember how it felt for you and your family to settle into a life in New England?

It was in 1979. That was the year the Soviets invaded Afghanistan. My parents were born and raised in Afghanistan and they had no intention of staying in the United States their whole life. When my dad came to the U.S. in 1963, he came for college. He got a PhD in 1971, which was when I was born. They planned to go back to Afghanistan, but in the early ‘70s, there was a lot of communist infiltration in Afghanistan. So his parents were telling him to let it settle down and to stay in the U.S. for a little longer. Do what you can to get an education. So, their plan was to save some money, sell the house, and go back to Afghanistan. Then the Russian invasion happened in Afghanistan in 1979. So, he took a job with Corning Glass Works in New York and they helped him become a citizen of the United States. Then he helped my mom become a citizen. But their intention was still to go back. So when we first moved to Massachusetts, I was in the mindset that this is not going to last very long. I knew nothing about Afghanistan.

My mom was the oldest and my dad was the 2nd oldest of their siblings. I didn’t know them in 1979, this whole family that we had. I didn’t really think about it that much. I went to school and I did my after-school activities, and my sister had been born in 1977. I don’t remember there ever being a conversation where they said, “We’re not going,” but instead what I remember is them constantly doing immigration paperwork, and every couple of months somebody was coming to stay with us from Afghanistan and my parents were getting them set up with life here. Sometimes they ended up in Canada or Germany or France or wherever, but they were just constantly doing immigration stuff to get people out of Afghanistan. So I don’t think we ever had that, you know, “official” we’re-not-going-back discussion. I mean, that war was from 1979 until now. Afghanistan today is 100% different than how it was when they grew up. They grew up in a relatively stable Afghanistan in the ‘50s and ‘60s. It wasn’t all chaos and war.

They had a good life?

Well, that’s an interesting way to put it. My grandfather, my mother’s father, was a political prisoner from age 6 until 21. He was released from prison right at the end of World War II ... So from 1945 and until the early ‘70s, yeah, it was stable there. My grandfather tried hard not to talk about it. The whole family tried not to talk about what they’d been through, and their kids—my parents’ generation—didn’t really know. So from my parents’ perspective, it was a decent society. But my grandfather’s generation spent 16 years in political prison. Half of his family died in prison and many of the men were executed—this would have been around 1931.

Did that make you rewrite everything you remembered about your childhood and your past?

Yeah. He actually wrote a book. It was written like a story, not a documentary. But it is a documentary. I was like, “Oh wow!” Now I understand why my grandfather speaks 5 languages and why he’s such a forgiving person and why he’s so committed to faith. I mean insanely committed to the faith. And the same with my dad’s side of the family. I didn’t really understand how people could be that committed to optimism. And committed to picking up and starting in a whole new society—Western—that’s so different from how they grew up. And to embrace it to the max degree. To be anti-communist and pro-American and anti-religious extremism. The biggest insult that will come out of my dad’s mouth is to call you communist! But they came here sponsored by the Afghan government, which was stable at the time, to get a Western education, to go back and build roads and build factories and build a society. And they never really got that chance. But they never lost hope in that either.

What were the differences in cultures here and in Afghanistan at that time?

Well, the roles of gender. Completely different, right? Women all stayed home. Most of them didn’t go to school. The expectation was they would go, they would get literate and then they would stay home and take care of their family. And that’s what they did. My mom, her sisters, and my dad’s sisters, they all graduated high school. Some of them went to college and even worked outside the home, but always with a job or career subservient to their husband’s job. There’s no rock & roll there, there’s modest dress, no dating, no sleepovers, roller skating parties, movie theatres, or kids hanging out together on the streets. As kids, you would go to school, come home and help in the house. They didn’t have washing machines and dishwashers and things like that. There’s a lot of manual labor that had to happen.

How did this reflect in your household growing up?

It’s interesting. In our home, [my mother] took care of everything including everything about the kids. My dad worked and financially supported everybody. Between his financial support and her getting thrust into having to do all the immigration work, she started to learn the whole path to citizenship. I have 2 sisters. Both of my parents were very much in favor of us getting as much education as we could. My mother, you know, taught us we need to stand on our own to get our own job. Don’t depend on anybody. My dad never said those types of things. He just said that you need to do the best you can in everything you’re doing. There were never any conversations with my dad about what would it be like if I decided to be a stay-at-home mom. Not with my sisters either. Whereas my mom was like, “Get a job, get on your own feet, don’t be dependent on other people.”

Growing up, she did not allow us to have sleepovers or boys in the house or go to birthday parties, and when some of the school activities came around, you know she was not happy about that. Dating was not allowed. I wanted to go to the prom and she just didn’t like it. I was planning to go no matter what, and so there was a lot of battling over the prom and she’s like, “Don’t let your father see your dress, don’t let him see the pictures!” My dad didn’t say anything about it one way or the other. He just buried his head in the sand and I don’t even know if he knew the prom happened. [laughing]

Tell me what it was like leaving your small town in Massachusetts.

Yeah, that’s why I picked a small college because I didn’t want a big city. I was very scared of big cities for no particular reason. But I never had a bad experience. I just didn’t want to go. But then when I did go, I didn’t want to go back to a small town. Single, no kids, lots of things to do, you know. So that was great. And then I was accepted to law school (that was my plan all along,  to go to law school). Then senior year of college I had shoulder surgery, which then resulted in a lot of physical therapy and a change in my mindset on what I wanted to do ... I took pre-med classes at North Carolina State University, met my husband there, and applied to medical school from there. I didn’t really have a clue what kind of doctor I wanted to be. I was a women’s studies minor. So OB-GYN was kind of always on my radar, but so was primary care and cardiology. But ultimately, I decided I didn’t really want to have patients who were men, and part of that was because of some of my experiences in med school with patients who were men. You know I would walk in there to take care of medical stuff and get, “Oh, you’re so pretty,” and comments on my looks and I just didn’t like that. I didn’t appreciate it, and I didn’t want to experience that in my career. One encounter that really stands out occurred in the ICU. I was a 3rd-year medical student and part of a large team comprised of other  students, residents, ICU doctors, cardiologists, anesthesiologists, pharmacists— 20-something people on this team walking in to care for a 40-year-old guy who just had a heart attack. The ICU doctor says to the guy, “We need to do a treadmill test on you. Do you think you can get on the treadmill?” And the guy looks at me and says, “Well, if that little lady will stand in a bikini at the end of the treadmill, then  I can do it.”And that was the day I said no cardiology, no male patients. I didn’t want to have any male patients.

How often since then do you experience any kind of sexism or racism, on the street or on the job?

I have not experienced sexism or racism from any of the doctors, the nurses, or the hospital administration. I am also somewhat confident, so if there were things, I probably missed some of them or didn’t really put too much stock in them. There are always a lot of people assuming Dr. Aslami must be a guy. You know, there are a lot of automatic references of doctors being “he” and not “she” and thinking I’m a nurse.

When I was looking for an OB-GYN residency around the 1998 time-frame, that’s when it was starting to be around 50-50 males and females in residency positions, and it has since become more women than men. But that was the beginning of it, and all the other fields of medicine were still heavily male-dominated. That has really changed a lot in the last 20 years. Given how recent it is that these gender ratios have flipped, it’s hard to expect society to undo the thinking that everybody in a medical building who is female is a nurse and male is a doctor. That takes a long time.

When I was in school at Wake Forest University in Winston-Salem, in the deep South, I saw racism directed at other people. We had a very high population of immigrants from Mexico, so a lot of migrant farmers and a lot of labor that was needed. They didn’t have health insurance, and so they were primarily the people that the students and the residents took care of in the hospital. So I learned Spanish because it made life a lot easier to be able to speak medical Spanish.

What were your parents thinking through all of this?

Just supportive. They were proud, you know. I was the first one in the family to become a doctor, so they were pretty proud of that. The joke is, Jennifer Lopez, JLo, and I were pregnant at the same time and that was the year of the bird flu. Flu shots were hard to come by and so I wanted my parents to get flu shots because I was going to have babies and they never get flu shots. They were like, what’s the big deal? And then my mother called me and said, “You know, I saw JLo on TV talking about how important flu shots are.” And I’m like, “Mom, seriously?! I’ve been telling you to get the shot for months!”

You were pregnant with babies, plural?

Yes. I have two sets of twins and one in the middle. At the time, I had just finished my residency, so I was in my first year of private practice. You would think as an OB-GYN I would know what pregnancy is like, but you don’t know until you know! That was rough. Then, you know, you don’t know anything about motherhood until you’re a mother. So then I was begging my mom and dad to come and live with us, too. ... So, yeah, motherhood is a whole other residency.

All 3 of [my sisters] married Americans and married Christians. We were all raised as Muslims and my parents, shockingly, rolled with it very well. They have a lot of younger siblings who raised their kids in the United States and Germany. Some of them are very conservative, and kind of gave their kids a hard time about assimilating, and some of the kids toed the line and others became very rebellious. My parents were a little more easygoing with all that. My dad has a much bigger family and I think it’s just because my mother’s father, after everything he went through in prison, was just a lot more open to other points of view and other cultural forms, and so they weren’t that dogmatic.

You married Americans, but you’re American.

You picked up on that!

Did you mean to say that? I’m curious because because I’ve met a number of people who sort of put that out there first, as if they need me to know, whereas I never assumed otherwise.

It just came out that way! Right? I was born and raised here ... I’m first-generation born here. My entire family—mother, father, and all of their siblings have married Afghans. They are all 100% Afghan, so I also feel 100% Afghan. Genetically, I am 100% Afghan. But yeah, I was born and raised here and so when I say “married an American,” I guess I mean I married, well, not the type of person my parents expected. They expected an Afghan or Iranian and Muslim, and he’s none of that. They didn’t give me a hard time about it. They told me growing up I had to marry somebody “of the book.” So, Christian, Muslim, or Jewish. My spouse had to be one of these.

You grew up Muslim, but are now Christian?

Yeah, so I started going to church in med school. My roommate was a devout Christian, so we started going together and I really liked it. My husband was also a regular church-goer. I don’t think we actually had a sit-down conversation about what religion we were going to raise our kids, but we just raised them Christian.

I think part of why I really enjoyed going to church is because the places we went were non-denominational Christian churches ... So I learned a lot, I experienced a lot of peace going there, and we definitely wanted our kids to have that foundation.

Are your kids learning about their Afghan heritage?

Most of the exposure to Afghans was really with my parents, and maybe a couple of their friends. When our kids got older, and were easier to travel with, they experienced more cultural exposure as we traveled around the country visiting family scattered from coast to coast. When we get together, we eat. The food is all homemade and it’s all very labor-intensive and it’s delicious. They’re like, “Mom! Why can’t you cook like this?” Because this takes 8 hours to cook!

You once said to me, “When we’re young, we don’t expect the older generation to change their ways.” How do those expectations translate into your profession?

I was more politically active as a younger person, marching in the streets for abortion rights, writing letters to Congress, and things like that. For most of my professional life, Roe v. Wade was the law of the land. Not so much anymore. And so all that activism has been more in the rooms, with patients, individually.

I tell them, “These are your decisions, these are your choices, these are your options, these are the places to go, and this should be your decision to make. And tune out all the noise about what you hear from various groups on TV, political or religious, predicting the impact of this decision. You’re the one that’s going to have to live with it.” With the younger kids, I’ll say, “You know, I’ve got patients who are 30 and 40 years old, who made some of these decisions, and this is how it affected them.” We discuss the pros and cons. I’ve got patients that are ages 12 to 90, they’re all women, so there’s a lot of cultural changes in that, no matter their ethnic background. I try to keep it just related to females and women and how your life goes on.

So, when I have a 17-year-old telling me, “I don’t need birth control, I don’t want to put those things in my body,” I’ll say, “Well, listen, let’s talk about what a baby in your body is going to be like for the rest of your life. And if you choose to terminate the pregnancy, let’s talk about how that would affect you. Because I’ve seen it both ways, and you have to know the pros and cons.” And so then, if they’re still opposed to birth control or whatever I’m like, “Okay, well, here’s a bunch of things I want you to read, and we’re scheduling a follow-up in 4 weeks because I’m not going to expect you to make a decision right now. But I do know that not doing anything about protecting you from pregnancy has a whole lot of implications for the rest of your life that you know you’re not thinking about right now.”

And then I have a lot of people who have all kinds of sexual dysfunction issues and they don’t want to talk about it. I bring it up and then, if they’re hesitant, then I nudge them. It’s easier to do it with long-term patients. But eventually the story comes out—of everything that’s going on in the relationship or what they feel about their own self or their own body.

This was one of the nice things about the pandemic. People learned Zoom, including myself. I had never even heard of it before. So now I’ve started putting a lot of these really sensitive conversations and educational things into these online classes that are like 4 hours long. Here are 4 hours about your sexual function, what your anatomy is, what it’s supposed to do, how it changes over time, and what treatments are available ... Some parents don’t necessarily want to talk to their kids about this kind of stuff either, and I’m like, well, you could just go on the website and they could find it out on their own. But my kids tell  me, “Don’t send my friends to your website!”

Did it make you come out of your comfort zone to have these open conversations?

The office conversations were easy because it’s what I was professionally trained in. I’ve never terminated a pregnancy, but the procedure to do it is the same as the procedure to treat a miscarriage. Because I know how to do it, I can talk to people about the procedure. We were trained on that. So that’s an easy conversation. We weren’t really trained on sexual health and sexuality and how to help people with all that. That came later, and so I grew up with my patients in this process. Having these conversations over time—and the medical profession didn’t have a lot to offer until recently—so a lot of the conversation for 10 years was, “It sucks, and there’s not much you can do.” Now there’s a lot you can do, and so it’s fun to actually talk about it. It’s easier to have those conversations in the office.

Is it because there are more women in your field and they are the ones changing the approach to your specialty?

Unfortunately, women still hear that there is nothing that can be done to improve sex lives and they hear it from men and women. They hear it from primary care and they hear it from OB-GYNs and they hear it from nurse practitioners.

And so it’s really a matter of, do you have the interest to learn it? Because even in the residency programs there are still not a lot of conversations and education about sexual dysfunction. It’s a very small lecture and you know it’s a very small component of what they teach. You have to be interested in it and then you have to go look for the material.

And the other piece of it is a lot of it isn’t covered by insurance, so they don’t really teach you and train you on things that are going to cost money. Because patients come in with the expectation that insurance is going to cover everything. And we know that’s not true, in general. But really, the insurance companies don’t care about female sexuality. So that’s a whole battle.

There have also been issues with restrictions. When I was a resident there were no work restrictions, so you could work 150 hours a week if they made you do that. Right after that, there became work hour restrictions and now residents have to learn obstetrics and gynecology and surgery and women’s health in 4 years. So things had to fall by the wayside because the working hours were restricted, and sexuality education was one of those things. As a provider, If you are interested in improving sex lives, you have to educate yourself about the available treatments, because it is not part of routine OB-GYN training. Treatments have been available for male sexual dysfunction for decades, and are even covered by insurance, but I feel like Bob Dole was the first guy who was on TV talking about that. He set the stage for the public discourse on sexuality.

JLo needs to put out a commercial about it! How has your practice evolved from the way gynecology was practiced in, say, the ‘90s?

There’s a lot more listening and educating, and treatments that are not necessarily medication based. We have a very educational website where patients can do their own research, and every time we find a new resource we add it.  We try to protect people from “Dr. Google.” And we also have the ability to communicate more efficiently, right? So they can communicate with us on HIPPA-secure platforms. But there are also a lot more certifying bodies for integrative medicine, You can find the doctors who studied it and are certified in it. And they’re not just saying, go to the dollar store and get a multivitamin. There’s actually evidence-based medicine around all these things. If you seek it out, you can get certified in and then you can offer it, and people want it. You know they want guidance on that. Usually, when you go to your regular doctor and ask about vitamins, the majority of them say it doesn’t really matter you’ll just pee it out in the toilet, don’t waste your money. But it does matter. Yes, some of them are a total waste and you will just flush it down the toilet and other vitamins are not a waste. And then the dose matters. And if you want to use natural products, or if there’s a medical condition, then it does matter which product and how many times a day and the doses and whether you’re taking it with food or not, and what other medications you’re taking or not. There’s a whole science behind it, none of which is taught in traditional medical school or nursing school. So you have to seek out a provider who has that training.

Why does it seem the onus is on women? Gender shouldn’t matter when it’s about a logical approach to health and wellness. At what point will Western medicine catch up and not require you to seek out certified doctors but make this part of medical education?

Well, there are 2 answers there. As to the first question: why is it up to women? Women are the caretakers of the whole society, we are the caretaker of our individual families, and multiply that by 100 million, and that’s the whole society. So we’re kind of hard-wired; our role as a family caretaker is a gender-defined role. There is some blurring of gender-defined roles, obviously, but for the majority of families, it’s the women who make all the healthcare decisions. So that’s just the experience I hear from lots of my patients also. The other piece of it is that women are more likely to seek care for themselves. There are a lot of guys who will not go to the doctor unless their wife or their girlfriend or their mother makes the appointment for them and takes them to it or demands that they go. They’re not going to do it spontaneously and honestly, if they do go in because there’s something bothering them, it’s usually serious. Since women seek out treatment, they also come up more frequently against treatment failures and then they look for alternatives. Women also talk. We’re more likely to go online and get in a chat group or get in a support group or ask 10 other people and then go with those recommendations.

But why medical schools don’t teach it? That’s a whole other ballgame! Residencies are funded by the Center for Medicare and Medicaid Services. So it’s sort of like having the NFL draft and there’s only x number of slots. There’s only x number of training slots across the country—for primary care, surgery, psychiatry, and so forth. So all the institutions that receive that money have to stay within the guidelines of what the government decided. But then when you go to what are they being taught, some of that is influenced by big pharma, right? So if you’re learning about cholesterol management, you can’t make money off telling people to eat the Mediterranean diet.

And you know the organic farmers are not the ones coming in and sponsoring a lunch to educate the doctors and the medical students. You know the cholesterol medication manufacturers are doing that. So there’s a sort of inherent bias in training. They have tried to limit that. I mean, there have been a lot of limitations placed on big pharma and they get around it somewhat by disguising it as education. They do educate, but it’s a little biased. Doctors learn it on their own, but they have to have the time to do that. In residency, there’s no time. And then, you graduate from residency burdened with debt, and now you’re in your late twenties or early thirties, starting a family, young children, and maybe even taking care of your older parents, and you’ve got a new job, and for the first time, you’re the primary caretaker for your patients—no one’s looking over your back and you’re not running things by them anymore—you don’t really have that time. You feel a little bit uncertain in your early career about what you’re doing. So you spend more time reinforcing what you learned to begin with, to make sure you’re sticking to the standard of care, and then later on, when you’ve had enough treatment failures, you start looking for other approaches. Some people—not all—some people, will start looking for another way.

Is that what happened to you? Did something happen specifically with failures and treatment plans that made you take the step?

Yeah, and it was, personal. I was 33 when my first kids were born, and when they went to daycare, all of a sudden I’m getting sick with everything that they got sick with, but not recovering. My husband was getting sick, too. I mean we’re both getting sick all the time, but he would recover and I would have a 6-month coughing fit that ultimately was diagnosed as asthma. It didn’t behave like asthma. We live in an area with no shortage of access to world-class medical care and I went to lots of places for 2nd, 3rd, and 4th opinions. How do I have uncontrollable asthma on 6 meds a day when I don’t smoke, I don’t have pets, I don’t have allergies, and all I have are kids? It was an ongoing problem ... I had to have my nebulizers in the office, in my car, and at home. I had to have rescue inhalers everywhere, 5 meds a day routinely, and stay away from smokers and people wearing perfume and cologne and flowers and all that stuff. It never really behaved like normal asthma. Anyway, a patient came in one day and said “You know, you should just stop eating gluten and dairy.” I had no idea what she was talking about because I didn’t have any abdominal symptoms at all. But I was pretty desperate and I was miserable. So I said, “All right, fine, I’ll try. What have I got to lose at this point?” ...  I started going to conferences on how gluten affects asthma, well, it actually affects more than asthma, it affects psoriasis, eczema, sarcoidosis, rheumatoid arthritis, inflammatory bowel disease, colitis, Hashimoto, I mean a really long list.

And so the sort of philosophy from the functional medicine world is that the gut is not functioning well and it’s triggering your immune system. And your immune system is coming down with the hammer on the wrong body part. In my case, it’s my lungs. But it might be joints or brain fog or whatever. I accidentally discovered this, honestly. I wasn’t actually looking for it, but that’s how I found it.

Did you and do you get a lot of pushback from the traditional practitioners [about practicing functional medicine]?

No, not from the doctors in my main hospital group. I didn’t get it from them. I have a lot of primary care docs who cross-refer with me. So in the beginning they were kind of like, “What do you mean? Replace your statin with fish oil?” I have to walk a line. I say to patients, “I’m not going to take you off meds that other doctors put you on. I’m going to suggest you could use this in addition to—and there are pros and cons to this, right?” If you’ve already had a heart attack or stroke or whatever, I’m not going to mess with the cardiologist’s recommendations, but I am going to say, “Yeah, the weight loss would help and you know the Mediterranean diet would really help, and eating organic would help. But I’m not going to tinker with your meds.” So this is sort of how I walked that line, because I think that if I tried to be more aggressive and say “Oh no, I don’t agree with what your doctor is doing, I think you should do it this way,” it is going to cause a lot of pushback and it could hurt people. I do have some patients coming in with unreasonable expectations. They’ll say, “You know, I had a little bit of breast cancer. It’s gone and I want you to give me hormones.” I’m like, “Well, you know what? That’s actually not the best idea for you,” and they’ll bring me research studies that say it’s okay. But it’s small numbers of people and niche studies, not the standard of care. And they don’t like my answer and they’ll say, “I thought you were a holistic doctor?” I’m like, “I am, but I know traditional and functional medicine usually can play together.” Sometimes, you really have to be on one side or the other.

Did you see yourself here?

Well, it’s interesting that you ask, because I found the essay I had to write to get into medical school and that was probably written in 1993. So it was me writing what I thought my practice was going to be like in 2010 and I was like, “Wow, I’m not that far-off from it!” I used to watch “General Hospital” back in those days—did you watch it?

Yes!

So you remember the health club where everybody hung out? I thought my practice was going to be like a medical practice in one building and the spa on the other side of it, but there was going to be a smoothie bar and dance classes and a place to hang out and socialize and aerobics classes and you know, massage tables, and all that! That’s what I thought it would be like. So I don’t have a spa. That’s next. Put it on my future to-do list.

Dr. Aslami’s practice, Horizon Health and Wellness, is in Bridgewater, Massachusetts.