DDr. Carole Jenny has had to be both tough and tender during her career as a pediatrician. She has made tough choices all along the way—for starters, entering medical school at a time when it was an uncommon path for women; then leaving medicine for several years to raise her two daughters at a time when that was frowned upon by the profession; and ultimately choosing the discipline of child abuse—a field that didn't exist when she began her training and that doctors still aren't flocking to enter because of the emotional challenge of working with severely abused children.

But while surmounting those and other hurdles, plus winning national and international acclaim for her work, she has managed to sustain a tender spirit. There's a lilt in her voice and a sparkle in her eye that belie the heartrending nature of her work.

She needed to hone a tough exterior early on. "Back then," she remembers, "men would come up to us [women] in our senior year in college and say, 'I didn't get into medical school. You took my place.' " At DMS, where she was one of just four women in her class, there were further indignities. For example, she was dismayed that the women in the class didn't get a chance to learn how to examine the male genitalia. She also recalls a visiting professor who looked down on the four women sitting in the front row and warned them that the next year, "one of you will not be here."

But complaining about the insults seemed out of the question. "We were very meek and not at all liberated," Jenny recalls. "You can't imagine how we worked to make sure we didn't make waves."

Yet her sense of justice was aroused again a few years later, when she arrived in Philadelphia for her residency. She was shocked at the state of primary care for children there. "It occurred to me at that point that maybe how health care is delivered affects children's health," she recalls. So, hoping it would help her address the health of the medical system and not just of individual patients, she earned an M.B.A. at Penn's Wharton School. Today, joint M.D.-M.B.A. programs are common (Dartmouth has had one since 1992). But Jenny was once

Photo by Karen Philippi

Carole Jenny lectures all over the world about child abuse, then seeks respite from the horrors of her work at home, including by caring for the dogs of vacationing friends.

again in the vanguard in acquiring both degrees in the 1970s.

Soon thereafter, she and her husband, Dr. Thomas Roesler, a child psychiatrist, moved to Seattle. There, Jenny took up a faculty post, practicing pediatrics and doing health-care research at the University of Washington. The academic career she had planned on was right on track—or so it seemed.

Her decision to quit 18 months later, "to stay home with my babies," almost sabotaged her hope for a life in academe. Back then, women in medicine were still cause for comment, and "if you did drop out, that was considered a betrayal," says Jenny. "It was a cop-out." Characterizing herself as someone who tends "to do things in a big way," Jenny says that the "big way" for her at that time was to stay home with her two daughters.

When she was ready to return to work seven years later, she was scared that she wouldn't be able to get back into academic medicine. But thanks to persistence and serendipity—and a job no one else wanted—a new career path opened up. After her younger daughter started kindergarten, Jenny applied for several jobs. She didn't even get as far as an interview for any of them. She did

some locum tenens work—filling in temporarily for doctors who were on vacation—but began to feel very discouraged.

Then I got a call from the University of Washington," she says. "Someone had written a grant for child abuse. He said that no one wanted the job so I could have it. I said, 'Who would want to work in child abuse? That's so depressing. I don't know anything about child abuse.' He said, 'That's okay. No one else does either.'

"He was right," Jenny continues. "It was a field that had no academic basis for what it did. My husband, the psychiatrist, said, 'Get your foot in the door, do a great job, then do a lateral move.' I've been doing child abuse ever since. It turned out to be a very exciting field because it was all brand new. There were tremendous amounts of things we had to learn and figure out."

She recalls an incident from her first week on the job, when she was called to court to testify in a sexual abuse case. The doctor who had examined the child in question observed that she had no hymen—implying that it had been broken during the sexual assault. But a defense attorney picked up on that comment and challenged Jenny, asking, "Isn't it true that some newborn females do not have hymens?"

"I said, 'I don't know,'" relates Jenny, "so I went back and organized a study with a nurse. . . . No one really knew what normal genitals were." She and her collaborator examined 1,131 female newborns, and she described their findings—that every single one of them had been born with a hymen—in a paper published in the journal Pediatrics.

Jenny also started Seattle's first hospital-based child protection program, then went on to run a similar program six years later in Denver and another one six more years later in Providence, R.I. The move to Providence came when she was offered the country's first endowed chair in child abuse pediatrics, at Hasbro Children's Hospital, and a faculty post at Brown's medical school.

Such child protection programs now exist