Think Of Your COVID-19 Vaccine Like A Very Good Raincoat, Says Dr. Leana Wen

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. You may know my guest, Dr. Leana Wen, from her appearances on CNN, where she's a medical analyst. She's commented extensively on CNN and in her Washington Post column about COVID and the precautions we need to take. She's had a pretty remarkable life, which she writes about in her new memoir, "Lifelines: A Doctor's Journey In The Fight For Public Health." She's an emergency medical doctor and served as Baltimore's health commissioner. She spent the first few years of her life in Shanghai, China. Her parents suffered through the Cultural Revolution, and her father spent time in prison for his work as a dissident.

When she was nearly 8, she and her father came to the U.S. to join her mother, who was able to move to Utah on a visa to attend grad school. Just before the visa expired, Wen's father was able to obtain political asylum, but the family was poor, and Leana Wen had bad asthma. The family's reliance on Medicaid and the public health system is part of the reason she became an emergency medical doctor and public health official. She and her husband have two children. The second was born when COVID was first spreading rapidly around America. Soon after, her husband and their two children got COVID. They're all fine now.

As I record this morning, the CDC is expected to announce later today that it's changing its guidance on masking and will recommend that vaccinated people resume wearing masks indoors in some areas of the country. That's a change from its guidance in May that said vaccinated people no longer needed to wear masks indoors. When the guidance was issued in May, the highly infectious delta variant was burning through India and starting to spread around the world. Dr. Wen was critical of the CDC's May guidance.

LEANA WEN: It was a mistake for them to lift their guidance in May. I said so at the time. There were many of us in public health who were very concerned because the CDC was relying on an honor system at a time when many people, unfortunately, were not behaving in the most honorable way. We also at that time did not have nearly enough people who are vaccinated. At that time, when that guidance was first issued, only 36% of the country was fully vaccinated. And we've actually now seen the consequence, which is that the unvaccinated began behaving as if they were vaccinated. And we are now seeing massive surges again across the country such that the level of infection today, the daily COVID cases, is five times where we were in May.

Unfortunately, we're in a situation now where the vaccinated are having to pay the price for the actions of the unvaccinated. We are now seeing even spillover infections such that individuals who are vaccinated are getting breakthrough infections again, not because the vaccines aren't effective, but rather because of the high levels of unvaccinated and infected people who are surrounding us. And of course, there is also a danger to those who are unvaccinated, not by choice, but perhaps for young children, for example, under the age of 12, who cannot yet be eligible. And immunocompromised people who don't get the full immune protection, they are at higher risk than before.

So I hope that what the Biden administration does now is two things. First is reimplement indoor mask mandates. They could have exceptions. For example, they could say, in areas where there is proof of vaccination - because we know that vaccinated people are safe around other vaccinated people. If you know that everybody in an office, for example, is vaccinated, then masks and distancing are not required. But I also hope that the Biden administration at this point gets behind vaccine mandates because we need to acknowledge that what we're doing thus far just isn't working.

I don't think that people should have the choice to infect others with a potentially fatal and extremely contagious virus. And I think we as a society need to figure out, what are our values? Do the value of freedom of choice for some really override the public's health for the most vulnerable?

GROSS: What power does the Biden administration have when it comes to mask mandates and vaccine mandates? Does the CDC just have the power to advise states and localities or can the CDC impose mandates?

WEN: Well, it's a combination. The federal guidance certainly is very important because local and state officials, as well as businesses, rely on the federal guidance for political cover. This is why we saw that when the CDC changed their guidance saying that fully vaccinated people don't need a mask anymore, so many jurisdictions overnight lifted their indoor mask mandates because they couldn't implement mandates that the CDC is saying are not necessary anymore. And in fact, we've seen, for example, in Los Angeles County that the sheriff there has said that he won't enforce the mask mandate because the LA County mask mandate directly contradicts with the CDC. And so the CDC does have a lot of power here in providing the kind of overarching guidance and recommendations that local and state jurisdictions will follow.

But I also think that the Biden administration can do a lot when it comes to signaling. For example, they just said yesterday that employees of the VA now need to be vaccinated within the next eight weeks. That's a really important signal for all health care institutions and nursing homes. I think the administration can go even further and say all federal employees will need to be vaccinated. And also, that if you go on planes, trains, in federal buildings, that you either have to show proof of vaccination or you have to have a recent negative test. Something like that will also pave the way for private institutions, including businesses and many more schools and universities, to implement that type of health screening as well.

GROSS: You know, we're hearing about breakthrough infections for people who have gotten vaccinated. I mean, the numbers aren't that high, but they're higher than they were before delta. And the CDC is not tracking breakthrough infections for vaccinated people unless the vaccinated person is in the hospital or has died. Do you know what the logic is behind that?

WEN: No, I don't, frankly. I mean, I've heard explanations from the CDC as to why, but it doesn't really make sense to me and to many other public health experts. I understand the gist of it, which is that what we really care about are the severe infections, the COVID infections severe enough to land you in the hospital or that you die from it. And yes, of course, we should be tracking those severe breakthrough infections, the infections in people who are fully vaccinated but still get COVID. But I don't understand why we wouldn't want to know mild breakthrough infections as well, because that number also really matters. Also, it matters if the individual, for example, is someone who's older or who has certain medical conditions or maybe who gets a certain type of vaccine. Maybe with Johnson & Johnson, there are more breakthroughs than with the mRNA vaccines. I mean, all those are questions that we need to know the answers to.

And we don't know the answer to another critical question, which I think is actually the most important at this point, which is if you have a mild breakthrough infection or if you are asymptomatic but still test positive, with the delta variant, are you able to transmit it to others? We don't have this answer. We know that the vaccines work very well to prevent against severe illness. We also know that, prior to delta, that the vaccines protected you well from becoming a carrier which can then spread it to others.

But with the delta variant, an individual who gets delta carries a thousand times the viral load than someone who got infected with the previous variants. And so could that person with the delta variant, are they carrying enough viral load that even if they were vaccinated, they're still able to infect others? We don't know.

GROSS: You know, just as an individual, I would like to know what my level of risk is. And I just feel like if I don't know what the numbers are for the number of vaccinated people who are getting mild infections or testing positive, I don't know what my level of risk is.

WEN: That's exactly right. I mean, we do know that if you are fully vaccinated, your chance of ending up in the hospital and then dying is vanishingly small. I mean, in my state of Maryland here, in the month of June, everyone who died from COVID were unvaccinated. Around the country, 99.5% of all those dying from COVID are unvaccinated. And so that's really important to keep in mind. I mean, that's what the vaccine is intended to do, to keep you out of the hospital and out of the morgue. But that said, we also should find out what is our chance of getting COVID - getting symptomatic COVID in some way and, I think, that critical question, are we able to transmit it to others? We just need to know that number and then to make the best decision for ourselves.

I think it would be a reasonable decision, for example, if - let's say that we find out that - we don't know that this is true. But let's just say hypothetically that an individual has a one in 10 chance of contracting coronavirus and giving it to others once they're fully vaccinated. That's a number that we can work with in thinking about risks. One in 10 differs from one in 100. It definitely differs from one in two. And I guess my concern with the Biden administration's messaging is that they are not incorporating nuance and recognizing that at this point of the pandemic, there is a lot of nuance. There's a lot of gray area. It's not clear-cut, black and white as to what people should choose to do, what risks people should take on for themselves and for their families. And being able to explain that risk is not undermining the value of the vaccine.

GROSS: Do you think - in workplaces where you need to be vaccinated in order to enter, do you think, there, everybody is safe without a mask?

WEN: I think that, based on the data we have so far, that would be a very safe setting. As in, if everyone around you is fully vaccinated, the chance of them carrying enough virus to infect you is very low. If you're also then fully vaccinated, your chance of contracting COVID from one of these individuals is very low. So I do think that it would be a safe environment. If everyone around you is fully vaccinated, then you do not need masks or distancing in that circumstance. But I also think that there is this narrative that is not true and, actually, quite harmful that once you're vaccinated, who cares if others around you are vaccinated, too? That's just not true.

I mean, we know that these vaccines are not 100%. We don't know exactly how well they protect against symptomatic illness for the reasons we mentioned earlier. But let's say that it's 90%, which, again, is very good, but it's still not 100%. The more risk you're exposed to, the higher likelihood you have of contracting COVID-19. And so you can think of the vaccine as a very good raincoat, that if there's a drizzle, you're well-protected. There's a rainstorm, you're probably still well-protected.

But if you're going in and out of thunderstorms every single day and now there's a hurricane, at some point you're going to get wet. And so if you're asking somebody who is fully vaccinated to now go into a workplace where they're sitting shoulder to shoulder in conference rooms that are cramped and not well-ventilated with unvaccinated, unmasked people, at some point that person could well get COVID and transmit it to others. And so I really hope that workplaces and schools will enforce vaccination policies for that reason, because it really matters whether others around you are also vaccinated.

GROSS: Well, let me reintroduce you here. If you're just joining us, my guest is Dr. Leana Wen. Her new memoir is called "Lifelines: A Doctor's Journey In The Fight For Public Health." We'll talk more after a break. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Leana Wen. Her new memoir, "Lifelines," begins in China, where she spent about the first eight years of her life. When her family emigrated to the U.S., they were poor and relied on the public health system. Her new memoir is called "Lifelines: A Doctor's Journey In The Fight for Public Health." She's an emergency medicine physician, a CNN medical analyst and Washington Post contributing columnist and former Baltimore health commissioner.

I want to ask you about children returning to school and what advice you would have for parents and for schools concerning children who are under 12 and are not yet eligible for a vaccination.

WEN: Well, it's certainly something that I think about a lot myself, as my almost-4-year-old is going to be returning to preschool. Here's what we know based on the last year and a half now of data as it pertains to schools and COVID-19. Schools can be some of the safest places for children from a COVID-19 transmission standpoint if mitigation measures are followed. And so what that means is - here's where the CDC has gotten it right. The CDC recently issued guidance on what schools should be doing come the fall. And they said two things that are very important. One is that we can and must have in-person schooling full-time all over the country.

And No. 2, you can do it safely if mitigation measures are applied. So for example, if you want everybody in class full-time, it's difficult to do that and still maintain six-feet distancing. If you're now going to move to three-feet distancing, as an example, or even less, then you really need to have indoor masking for all children who are not vaccinated. And I would also add, if they are not vaccinated or it's not clear whether they're vaccinated if they're over 12, they should still be wearing masks, too. But indoor masking is absolutely critical, improving ventilation as much as possible, also having regular testing. Testing is also a prevention strategy that should be employed. And so I do think that it's possible for schools to come back safely in-person. But these measures have to be in place. And I really worry about the parts of the country - I mean, there are at least eight states and counting that have actually forbidden schools from mandating masks. I mean, that's a really substantial problem. And I hope that parents in those circumstances will still choose to ask for their children to be masked as much as possible to protect them and others around them.

GROSS: You are an immigrant from China. You moved here when you were around eight. And Trump, when he was president, called it the China virus. And taking their cue from that, a lot of people in America became very anti-Asian. There have been a lot of attacks against Asians, just a lot of insulting behavior directed at Asian Americans. And I'm wondering if you've been the recipient of any of that.

WEN: Unfortunately, yes. And I would hate to tell you the frequency at which I receive these anti-Asian comments. I would say that every time I am on air, I will receive actually quite a few messages that specifically tie me to the Chinese Communist Party - which is ludicrous because my family left on political asylum from China - or that will blame me and, quote, "my people" for the coronavirus. And, of course, there are many, many messages telling me to go back to my own country, which - at this point, of course, I'm an American citizen. I am here in my own country.

But look. This is not just about me. I mean, there are so many Asian American people who have suffered during this pandemic. I mean, there are shop owners who have had their shops burned down or graffitied over them by people directly attributing the coronavirus to them. There are people who have been assaulted, nurses, physicians who have been spat upon and assaulted leaving the hospital by individuals who are, again, attributing the coronavirus to them. And I say this because - look. There is a consequence to the words that we have, and we really have to be careful about the language that we use.

GROSS: So you were pregnant during COVID. Your last trimester is when COVID was really spreading. And you gave birth in April. So, I mean, people weren't even wearing masks. A lot of people were not even wearing masks yet. The other twist in this story is that last December, your husband and then your two children got COVID. And, of course, as you say, you know, you always tell your patients, like, if someone in your family has COVID, try to distance from them. But if your husband and two children have COVID, like, you have to take care of them. You can't stay in another part of the house and never see them. So you had to kind of violate the advice that you'd give. And you understand, of course, why other patients might have to do the same.

But you're in a kind of unique situation because you had participated in a Johnson & Johnson vaccine trial, but you had no idea whether you got the placebo or you got the vaccine. So the level of uncertainty and confusion was still so high for you. Can you talk about, like, not knowing if you had protection or not and what that period was like for you? And you must have been so worried about your family.

WEN: Right. I mean, for all the work that I was doing around COVID, I just never really thought that COVID was going to hit home for us. I mean, of course, I thought that that was a possibility. But actually, I thought that if anyone were to get COVID, it would be me because I was seeing patients. And I definitely had the highest level of exposure of anyone in our family. We had pulled my son out of preschool at that point. My husband works from home. And so we thought if it's anyone, I would be the one at risk.

I had decided to enroll in the Johnson & Johnson clinical trial, and at that point, I had gotten something. I didn't know what it was. I had a 1 in 2 chance of getting the vaccine versus the placebo. And my husband had been working really long hours. He felt fatigued, and we just thought that he was run down. We really did not think that he had COVID until one day he spiked a fever and got tested, and he was positive. By that point, I had been exposed to him for quite a few days. And, again, I really thought maybe I'm the one who gave it to him, except that I had been getting regularly tested at work and through the clinical trial and I had tested negative.

So our children then started having symptoms as well. And I made the decision that I think a lot of moms - a lot of parents but I think a lot of moms probably make, which is, how can we possibly isolate and quarantine ourselves, even if that's the right strategy, if everybody around us need to be taken care of? And in my case, I thought, I have a 1 in 2 chance of actually having the vaccine. And so let me take this 1 in 2 chance, this flip of a coin, and continue to take care of my family. And I did. Incredibly, I did not get COVID. As a result, I was convinced that I'd actually gotten the vaccine as part of the clinical trials. So I was really surprised a few months later when the trial was unblinded and it turns out that I got the placebo.

GROSS: Wow, that's amazing. Oh, so have you since gotten vaccinated?

WEN: Yes, of course. I got the vaccine. Right as I got unblinded, they said, you got the placebo. Would you like to have the vaccine? And I said, please, yes, I would love to be vaccinated.

GROSS: Let me reintroduce you. If you're just joining us, my guest is Dr. Leana Wen. Her new memoir is called "Lifelines: A Doctor's Journey In The Fight For Public Health." We'll be right back after a short break. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF PETROS KLAMPANIS TRIO'S "EASY COME EASY GO")

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dr. Leana Wen, author of the new memoir "Lifelines: A Doctor's Journey In The Fight For Public Health." She's an emergency medicine physician, CNN medical analyst, Washington Post contributing columnist and former Baltimore health commissioner. Her new memoir begins in China, where she spent the first eight years of her life. When her family emigrated to the U.S., they were poor. She had really bad asthma and relied on life-saving care from the public health system.

You became an emergency medicine doctor and public health expert in part because of your experiences as a child with really bad asthma. You had really bad asthma. In China, you had to go to the hospital about once a month. And then as an immigrant in the U.S., your family was poor. You relied on public health. You relied on Medicaid and emergency rooms. How aware were you as a child of the relationship between money and access to health care?

WEN: I was very aware of it, even if I didn't have the words to describe it as you have. And that's because of so many instances in my life when I saw that people didn't have access to care because they couldn't pay for it.

I remember there was a neighbor child who was just a couple of years younger than me who also had asthma. He had a very bad asthma attack. And I remember rushing to help him because his grandmother was screaming for help, and I knew what to do for asthma. I also know how terrifying it is to be struggling to breathe and was trying to give my inhaler to this kid. And I knew at some point that he really needed to go to the hospital for treatment. But his grandmother was too afraid to call for help. And actually, because we didn't get help for him in time, he died.

I mean, he died in front of me due to this entirely preventable cause. And I mean, even as I think about this now, this is - this image is seared on my mind because I kept on thinking this did not have to happen. I mean, his grandmother was just too afraid to call for help because they were undocumented immigrants, and she was afraid of the authorities coming and their family being deported. And I thought at that time - and I remember having a discussion with my mother about this afterwards - that we're in a society where people's lives are valued differently depending on where they come from and whether they have the money to pay for care.

GROSS: When you were Baltimore's health commissioner, there were so many issues that you had to take on. You were the health commissioner during the time that Freddie Gray died. And just to refresh people's memories who may not remember exactly, Freddie Gray was a 25-year-old Black man who was arrested by police, charged with carrying a knife and taken in a police van. In the back of the van, he was shackled, but he wasn't secured to the van. And he was given what's sometimes called a rough ride, or at least that's what people think. And he broke his neck. His neck was broken during that ride, and he died in the hospital.

You were the health commissioner during this time. You know, the death of Freddie Gray was traumatic for so many Black people in Baltimore and around the country. There were huge protests in Baltimore. There was also looting. Stores, including pharmacies, were set on fire. So among the things you had to deal with as Baltimore health commissioner was this, like, massive trauma to people in the city. And just on another level, a lot of people couldn't get their drugs because their pharmacy was burned or looted or closed, so you had to deal with things on that level, too. What could you do about that?

WEN: Well, it was our job to figure out what to do. I mean, when you are the health commissioner, you don't have a manual that says here are all the possible things that could happen. And even if we got such a manual, I'm pretty sure that civil unrest followed by the burning and looting and closure of more than 12 of our pharmacies would not have been on that list. But you have to adjust.

I mean, I - you know, I don't know that we could have predicted at all that this is what we would end up doing. But we started hearing these stories in the hours after the unrest about individuals who couldn't get access to their pharmacies. And I have to tell you, it was very frustrating at that time because we knew, on the ground, that these were individuals who depended on their pharmacy for so much. Yes, it was for their medications, but for many people, this was also where they went for their other supplies or even for their food.

And I remember contacting these major pharmacy chains and saying, hey, this happened, can you help us out? And they would say, but you're in Baltimore. There are dozens of other pharmacies. Can't these people just go to other pharmacies?

And look, I could do that. I'm a physician. If I have a prescription at Walgreens, I can easily transfer that prescription to a CVS. I also have a car. I can drive myself to another pharmacy if needed. But what about the 80-year-old who is oxygen-dependent who is in a wheelchair and may not even have a telephone? They don't know what medications they're necessarily on. How are they supposed to figure out this kind of transportation to go somewhere else?

And so we ended up setting up a prescription hotline service where anyone could call us 24/7, tell us about what they needed, whether it was food or medicines or supplies, and we would figure out a way to get it to them. We also then realized that people may not know about this service. Because if you're not monitoring social media, if you're not watching the news, how would you even know this thing existed? So we went to senior buildings and public housing in areas near pharmacies, knocked on doors to let people know about this program.

And I'll remember this very well because people had two questions. The first question that we got was, what candidate is this for?

GROSS: (Laughter).

WEN: This was not election season.

GROSS: Right.

WEN: And that's what people thought. And also, we had just - I mean, we're talking about 48 hours after the unrest, and people really thought we were campaigning. And the second question they asked - and this one really broke my heart - was, what survey is this? Because I filled out a survey last week.

I mean, our residents were telling us that they always saw us there for our needs and not for theirs. And they weren't trying to make some kind of political statement, they were genuinely saying, I don't really - you know, I just filled out a survey. I don't really want to fill out another one. And so I think it really changed the way that we approached our work in Baltimore. Not so much from this, we are the health department and we know what you need as opposed to what is it that you need from us?

GROSS: While you were Baltimore's health commissioner, you had to deal with the opioid epidemic. Do you feel like, as a country, we've made progress in treating addiction more as a disease than as a crime that needs to be punished with prison?

WEN: Yes, I think we've made huge headway. The difference between when I was first appointed to my position in 2014 and now in 2021, I think the conversation, the tide, has totally changed. That said, there's still a lot of work for us to do in fighting stigma, in accessing treatment. There's still this NIMBY problem, the not-in-my-backyard problem, that we have to recognize that it's not just random people who have the disease of addiction; it's our family members, our friends, our neighbors, and so we need to provide treatment for them.

But I also think there's something else. I was at a community meeting in Baltimore where an older African American gentleman stood up - and this was not long after I declared opioids to be a state of emergency in Baltimore. And this gentleman stood up and just said to me - he said, I really do want to understand why it's suddenly an emergency when, actually, Baltimore has been faced with the heroin epidemic, the crack epidemic, for decades. And I do think there is a part of this that we have to acknowledge, that when it was Black and brown people in minority communities who were disproportionately affected, we did regard addiction as a crime. And now that the face of addiction has changed more to prescription opioids, to college students and rural areas - again, we really need to be treating addiction as a disease. And so, of course, all these individuals need to be treated, too. But we do have to acknowledge that part of the change occurred because the face of addiction changed. And that does tie into these systemic inequities and, frankly, the racism in our health care system.

GROSS: Let me reintroduce you here. If you're just joining us, my guest is Dr. Leana Wen. Her new memoir is called "Lifelines: A Doctor's Journey In The Fight For Public Health." We'll be right back. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Leana Wen. Her new memoir "Lifelines" begins in China, where she spent the first eight years of her life. When her family emigrated to the U.S., they were poor and relied on the public health system. She's now an emergency medicine physician, a CNN medical analyst and Washington Post contributing columnist and former Baltimore health commissioner.

I want to ask you about another personal decision you had to make that has implications for your work as a doctor. Your mother had cancer, and it had metastasized through her body. She went through a lot of chemo. She survived longer than she was expected to. But at some point, she told you that she wanted to die at home. She didn't want more treatment. And she had her DNR, which said that she didn't want to be put on a ventilator to keep her alive or any other, you know, like, life-saving things when she was at the point she was going to die pretty soon, one way or another. She had pneumonia and was taking antibiotics for that at home, but one day it got really bad. Your father was with her, and he panicked and called 911. So she was taken to the hospital, and they wanted to put her on a ventilator. And you and your sister were saying, like, you can't do that. That is not honoring her wishes. We have to honor her wishes. And you were the official - what's the word I'm looking for? Health surrogate? Health...

WEN: Health care proxy.

GROSS: Health care proxy, yeah. And so you had to be the one who asserted, like, I'm the person who has, you know, official say here, and I'm telling you, do not put her on a ventilator. But you had to decide first whether you wanted to say that. Can you talk a little bit about what went through your mind at that time?

WEN: Well, first, I want to say that my mother was a brilliant woman who actually had anticipated exactly that this could happen. She was young at the time. I mean, she was in her 40s when she was diagnosed with metastatic cancer. She was in her 50s when she died. And so she - you know, she had wanted, of course, to be there for her children. I mean, my little sister is much younger than me. She was 16 when our mother died. Our mother really wanted to see her go to college and graduate. And I think about my mother all the time now, as she was a teacher and loved little kids, and she never had a chance to meet my little kids.

But my mother knew what she wanted, and she also knew that it would be very, very, very difficult for our family to honor her wishes unless she made it really explicit. I mean, my mother sat me down, talked me through it. We had many conversations as a family. My mother went to a lawyer, drafted her will, made it very clear what her wishes were. She enrolled herself in hospice care. And it was very clear. It was - no one could possibly question that this is exactly what she wanted, given how she had written everything out. It was legally documented. And yet when we were in the hospital - and yes, we loved hospice because my father, understandably, saw that my mother was really struggling to breathe and took her to the hospital, so we were no longer in hospice care.

But we had all these doctors and nurses around us, who I'm sure were well-intentioned, who kept on saying things like, but she's so young; how could you possibly let your mother die? And it was certainly the most difficult decision I made to date, and yet it was definitely the right decision because it was honoring what my mother had so clearly and explicitly expressed - that she wanted to die in peace. And so my sister and my father and I sat by her bedside and waited for her breathing to subside, without her having to be on a ventilator. And I remember, actually, it was a very busy day that day in the hospital, and I knew that there was all this noise all around us. But there was a nurse who, I suppose, at that point really wanted to make sure she honored our wishes, too. And she drew a curtain closed around us, and even though it was really busy and I'm sure they needed that bed, we were able to spend as much time as we needed with our mother, who died that day.

GROSS: Your mother really sacrificed so much to get the family to the United States. When you were very young, she basically left home. Her plan was - she was going to go to college, get a degree and then go to graduate school in the U.S. so that she could get a visa and then bring the family over and hope that - in one way or another, that you would be allowed to stay. So she had to leave the family and live on the college campus 'cause you were required to live on the college campus to go to college. And you didn't understand all of that. I mean, you were basically raised by your paternal grandparents. And I don't know, you might have thought, like, Mom doesn't really care about me very much, she's not even here. And then she left for the United States, and you and your father didn't join her until later.

WEN: We joined her pretty quickly.

GROSS: Oh, pretty quickly, OK. But still, she went first and...

WEN: Yes. We didn't know when we would be able to join her. We ended up going to join her pretty quickly, but we didn't know that that was going to happen.

GROSS: And then she had to work all these jobs, so she wasn't home very much. And so until you were old enough to really understand your mother's sacrifices and this long-range plan that she had to bring the family to America, in part for your benefit so that you could get an education and you could be free, you had a pretty fraught relationship with her and didn't really comprehend that she could do all this and be gone so much and love you.

WEN: Right. And I feel so badly about this now. I just had no concept of this as a child. I saw all these other families with their mom who would go with them to school. I saw my mother once a month because she had to go live at this college campus. And just to explain also how unusual this was, during the Cultural Revolution in China, education stopped. My mother, the last grade that she went to before the Cultural Revolution was the fifth grade. And so she wasn't even supposed to be studying. But because of her mother - her mother, my grandmother, smuggled in books that they read by candlelight at night. And then my mother beat out many, many people across the country to be in one of the first classes to enter university. But she hadn't gone to any class before she entered university.

And so - because it was such an honor to be able to do that. There was no other option. I mean, you have to live on campus. Of course, I understand that now. And I understand also in the U.S., my mother was studying for a Ph.D. while also working multiple jobs. Then when we moved to Los Angeles, she was earning a teaching certificate while working multiple jobs. Of course, I never saw her, but I also resented her not being there. And as a result of us just not knowing each other well, we fought a lot when we did spend time together. And it wasn't until she got ill and I started going with her to her chemotherapy appointments and going to her doctor's visits that we really got to know one another.

GROSS: You know, I'm trying to think about this from your mother's point of view, that she'd sacrificed so much for you and you were just so impatient and angry with her. So I know that must have been really hard for her, though it sounds like she wasn't exactly the huggy (ph), touchy-feely type of mother.

WEN: No. And, I mean, I said so many terrible things to my mother. And I had blocked it all out until I wrote this book, right? Because who wants to think about the terrible things that you said to your parents when you were young? But I remember saying to my mother - and I cannot believe this because this is so horrible, and it's just such a - it's - I regret this forever. If my mother's listening somewhere, I hope she'll forgive me for this. But I was saying to her, when I'm a mother one day, I want to be nothing like you.

And I have tears in my eyes saying this because it's so horrible. I cannot imagine what my mother must have been thinking when she heard this because she was trying to do her best as a working mom under very difficult circumstances. She was trying to keep our family together. I wish for nothing more than for her to somehow know that she has grandchildren who would have loved her very much.

GROSS: Well, Dr. Leana Wen, thank you so much for talking with us. And stay healthy.

WEN: Thank you. You too, Terry.

GROSS: Thank you very much. Dr. Leana Wen is the author of the new memoir "Lifelines: A Doctor's Journey In The Fight For Public Health." After we take a short break, Maureen Corrigan will review Dana Spiotta's new novel, set in 2017, about a woman who's kind of falling apart at the same time the country appears to be coming apart. This is FRESH AIR.

(SOUNDBITE OF CHARLES MINGUS' "SELF-PORTRAIT IN THREE COLORS") Transcript provided by NPR, Copyright NPR.