As the threats mounted, supporters of the organization wondered who would be capable of replacing its fiercest defender.

Should it be someone in the image of Richards, a political powerhouse who stared down lawmakers during congressional hearings? Or as some advocates urged, a leader of color who could understand the needs of the diverse communities Planned Parenthood serves? Later, the search committee added experience in health-care delivery to the list.

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On Sept. 12, Planned Parenthood dropped a video message introducing its new president — a woman who somewhat improbably checked all three boxes, and then some.

She’s Leana Wen, the wunderkind daughter of Chinese immigrants who grew up poor in Compton, Calif., at one point relying on Medicaid and Planned Parenthood services herself, and a fearless advocate for women and marginalized people who once sued the Trump administration — and won.

At 35, Wen is also an emergency room physician, an author, a Rhodes Scholar, a former Harvard Medical School clinical fellow and George Washington University professor. For the last four years, she’s been health commissioner for the city of Baltimore, a role she is leaving this week after earning national plaudits for her work in reducing health-care disparities.

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Her appointment marks the first time in nearly 50 years that Planned Parenthood has chosen a physician to lead the 102-year-old organization.

To Planned Parenthood’s supporters, that choice signals an emphasis on health care over politics, serving to highlight the full range of services the organization provides, including birth control, Pap smears and treatment for sexually transmitted diseases, in addition to abortions.

“She’s fundamentally a patient advocate,” said Wen’s good friend since medical school, Kao-Ping Chua. “That’s what drives everything.”

But Planned Parenthood’s critics view Wen’s appointment as an attempt by the organization to mask its focus on abortions under a guise of medical credibility — a “shell game,” as Carol Tobias, the president of the National Right to Life Committee, put it.

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“Putting a new face on the old game isn’t going to make anything different,” Tobias said in a phone interview. “They are abortion, that’s their goal.”

Wen is quick to assert that she is not, by nature, a politician.

“My identity, first and foremost, is always as a doctor,” she says as she sits in her office at the Baltimore City Health Department, surrounded by her academic degrees and medical accolades, coughing occasionally after catching a cold from her infant son.

She has a doctor’s calmly confident demeanor combined with a brisk sense of urgency. She’s fond of emergency room analogies, comparing a project in crisis to a patient in extremis. She often tells stories about her patients.

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Yet while Wen may not be a politician in the mold of Cecile Richards, her identity in some ways mirrors Planned Parenthood’s — that of a medical provider forced to become a political combatant in a war over reproductive health.

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And she is fully aware of what’s at stake. With the confirmation of Supreme Court Justice Brett M. Kavanaugh, Wen fears the possibility that Roe v. Wade could be overturned or further eroded. More than a dozen states have laws that could be used to restrict the legal status of abortion in the absence of Roe.

“Standard medical care should not be political,” Wen says. “The fact that it is political means that we as Planned Parenthood need to stand up and fight for it.”

Experience with stigma

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In many ways, Leana Wen’s decision to make her voice heard culminated four years ago when she stepped on a stage in Foggy Bottom.

For most of her life, the then-31-year-old physician and professor had been hiding something, she told the audience at the TEDx talk in February 2014.

She stuttered.

“My stutter was often so bad that I couldn’t get out any words at all,” she said.

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It began when she was very young, with specific letters such as W, N and L. To some members of Wen’s family, a stutter was a personal failure. She tried everything in her power to hide it.

Meanwhile, Wen and her family battled other stigmas as immigrants adjusting to life in America. Wen was 8 years old when she, her mother and her father, a political dissident in China, fled their hometown of Shanghai and received asylum in the United States. They arrived first in Utah and eventually settled in Los Angeles, living in Compton and East Los Angeles. Her parents worked menial jobs to pay the rent and relied on food stamps for groceries. They were, on multiple occasions, evicted from their home and forced to beg the landlord to let them stay. “Sometimes it worked and sometimes it didn’t,” she said. Sometimes they ended up at homeless shelters.

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Wen said she consciously avoids many memories from those years. But she still remembers the time in fourth grade when she stabbed herself in the leg with a pencil to get out of a lesson on the Roman Empire because she couldn’t pronounce the word “Roman.” The lead is still in her leg.

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Yet at age 13, Wen tested into college at California State University in Los Angeles, a commuter school, where she started taking classes with Don Paulson, then a chemistry professor who had never had a student so young in his research lab. Wen, who graduated at 18 with a major in biochemistry, ended up being among the top five best students he ever had in his 36 years at Cal State, he said in a phone interview.

“It was almost like I had a colleague rather than a student,” Paulson said. “I think back on it and I go, where did this person come from?”

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Looking back, Paulson never noticed that Wen had a stutter.

The whole time, the prodigious teenager was performing mental somersaults to skirt around words she couldn’t pronounce. She once chose not to register for a class in neuroscience, because the word started with an N. She avoided saying her own name. She became, she said, “a master of overcompensation,” doubling down on studies and camping out at libraries, but barely making friends.

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“I became so good at hiding that people rarely heard me stutter,” Wen told the audience at the TEDx talk, “but they also rarely heard me speak.”

She hid her stutter well into her 20s, even as she became president of the American Medical Student Association. When she started working with speech therapist Vivian Sisskin during medical school, Wen offered to do whatever it would take to rid herself of her stutter, even if it meant doing exercises for hours on end. But the speech therapist urged her to do what she dreaded most — show her stutter, “walk into the wall of shame,” Sisskin said.

Wen gradually stopped substituting words. She started stuttering to strangers in grocery stores, and even to her family. She challenged herself to stutter in her interview for the Rhodes Scholarship, Sisskin recalled. And by embracing her stutter, it gradually improved. She started speaking out more professionally, both in writing and in public speeches. After her mother’s death from breast cancer in 2010, when she was 27, she wrote a best-selling book and launched a nationwide medical transparency campaign.

Even as Wen’s career skyrocketed, she never publicly discussed her experience with stuttering. She was terrified of what her students and peers would think. But in February 2014, on that stage in Foggy Bottom, Wen publicly came out about her identity as a person who stutters.

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“Each person that I stuttered to became a success, because it meant that I finally got to say what I wanted to say,” Wen said.

It took Wen years to see that the biggest source of her shame was also a major part of her identity. Living this stigma informs so much of what she does every day, and what she will do at Planned Parenthood, she says. Whether it’s a patient struggling with opioid addiction, or a woman seeking an abortion, Wen said she understands the stigma they face — and how to fight against it.

“What is the worst that will happen if you go for it?” she asked.

Heeding the call

The same year, a job opened up for Baltimore’s health commissioner. Wen at first questioned whether she should apply for it. She had no experience with city politics. She’d be running a staff of more than 1,000 employees tackling public health crises in a poverty-stricken city she barely knew — and have to take a huge pay cut.

But Wen felt limited by simply treating sick patients once they were already in the emergency room, instead of tackling the disparities in the system that prevented them from getting the care they needed.

“She felt like she wasn’t being tested,” recalled her longtime mentor, Josh Sharfstein, who formerly held the role. He urged her to apply. Her only limit in the job, he told her, would be her ability to stay awake.

He was right. Months into the role, Baltimore erupted in riots. Freddie Gray had died after suffering a spinal injury in police custody. When pharmacies were looted and burned, Wen personally delivered prescription medicine to elderly residents who couldn’t otherwise access them. She seized on the news coverage of the city, quickly churning out op-eds arguing that Baltimore’s underlying problems were rooted in substance use, mental health problems, and historical policies of mass arrest and incarceration.

To Wen, there’s no societal problem — poverty, violence, drug abuse, racism — that can’t be confronted through public health. To combat Baltimore’s opioid epidemic, she issued a standing order for naloxone, allowing her to prescribe the overdose-reversing drug for all of Baltimore’s 620,000 residents. She helped launch Maryland’s first 24-hour stabilization center, a place where drug addicts can go to get medical treatment and social services, as an alternative to the emergency room — or jail.

She’s also taken her fight to Washington. She’s testified to Congress about the opioid epidemic. She’s protested the Trump administration’s proposed nationwide “gag rule,” which would ban providers from referring patients to centers that perform abortions. She sued the Trump administration for cutting off $5 million in funding for two Baltimore-based teen pregnancy prevention programs — and won.

Wen had no intention of leaving the Baltimore health department. But then she gave birth to her first son, Eli, now 13 months old and named after her one of her heroes, Rep. Elijah E. Cummings (D-Md.), a man she hopes her son can “model his life around.”

Her pregnancy turned out to be high-risk, and required her to meet with her doctor for a physical exam every two weeks. It also coincided with Republican efforts to repeal the Affordable Care Act and gut Medicaid. She thought about what her pregnancy would be like without access to stable health insurance, a job, a partner, a car. She thought about the privilege she has now that her family didn’t have growing up, “and what that means in terms of my responsibility.”

After the search committee approached her, she couldn’t think of anything more important than serving at the helm of Planned Parenthood.

It’s an organization her mother had relied on for health care. Wen herself had depended on Planned Parenthood as a teenager to learn about birth control.

Becoming the face of an organization vilified by many Americans would place a target on Wen and on her family, including her husband of almost six years, Sebastian Walker, an information technology consultant, and 13-month-old Eli.

In her first meeting with Cecile Richards, in New York over the summer, the two mothers talked about what the job would mean for Wen’s family. Richards urged her to trust her gut, she recalled.

“For a lot of women, it’s what we need to do,” Richards said. “Focus on what you believe is the most important, and just don’t let up.”

Making it personal

On a Monday morning during her last few days as Baltimore’s health commissioner, Wen was straddling two worlds. She would be traveling to New York later that week for meetings with Planned Parenthood. The country was in the midst of a debate over a Supreme Court nominee who could someday cause millions of women to lose access to abortion.

But in meetings with her health department staff, Wen was still the most energetic, enthusiastic person at the table.

She moved quickly from one item to the next, constantly jotting down bullet points on her multiple to-do lists, but still taking the time to ask a colleague about his wife, who was expecting a baby. Wen was formal and focused, yet sincere and self-deprecating, calling herself out for rambling, and for using a metaphor that didn’t quite connect. She spoke with her hands, occasionally pausing a train of thought to say things like, “This is why we do what we do!”

In an afternoon meeting, Wen planned what would be one of her last acts as health commissioner — responding to a Trump administration rule, proposed this week, that would make it more difficult for immigrants to stay in the country permanently if they use Medicaid, housing vouchers or food stamps.

Wen, as she often does, made it personal.

She told the story of how her mother, as a new immigrant in the U.S., had to rely on Medicaid while she was pregnant with Wen’s sister. If faced with a trade-off like this one — medical care or legal status — what kind of choice would she have had to make?