"The other faculty members don't think that you are aggressive enough to train with us." This is what my mentor shared with me in confidence when I did not match at my first-choice residency program. I was crushed. I could not understand how aggressive behavior in surgery is considered a positive personality trait. Moreover, as a champion athlete in college and medical school, I knew that I could be aggressive in appropriate settings. I had never considered that a hospital or operating room was a place where I should be aggressive. The term aggressive means ready to attack or confront, and it is synonymous with hostile, belligerent, and antagonistic. How, I wondered, could being aggressive be a desirable trait for a surgical resident? Reflecting on my journey so far, I think that the answer to this question lies in the culture that has been created by—as Joan Cassell states in "Doing Gender, Doing Surgery: Women Surgeons in a Man's Profession"—the 'adrenalized vocation' of surgery that values arrogance, courage and decisiveness.
When I rotated at my first-choice hospital, it was everything I'd dreamed of in a surgical training program: intense cases, prestigious research, and teaching rounds with rapid-fire questions that ranged from surgical history to postoperative care. What I didn't notice at the time were the toxicities I'd been conditioned to see as normal. Abrasive, tough surgeons ruled the program. Their hierarchical culture left little room for collegiality. Attending surgeons reigned over the operating rooms, where they had permission to behave how they saw fit: verbally assaulting nurses, scrub technicians, anesthesiologists, and residents. Broken or undesired instruments were thrown to the OR floor for any reason. This behavior was not universal, but far too prevalent and obvious to excuse as one or two bad actors. The operating room culture accepted unprofessional, unkind, and unbelievable behavior as the norm. While my rejection was devastating, not matching at my first-choice program turned out to be the best thing that could have happened to me. The residency program that I did match into valued and promoted attending surgeons and surgical residents who were entirely different. The administrative chief resident's orientation lecture entitled "This is how we roll" outlined the first two rules of surgical residency: Be Nice and Respect Others. We were informed that the annual Emergency Room Consultation Award was a coveted honor for surgical residents. The emergency room residents selected the surgical resident who they determined performed the most timely, respectful, and helpful consultations. Beyond expecting me to become a competent clinical and technical surgeon, my residency taught me that I must also embrace collegiality and kindness. Being confrontational in the OR, ER, and wards was a detriment to patients and not an essential ingredient in excellent care to patients. Such care is best achieved when we work together with respect and lift each other up.
When I left residency for transplant fellowship, I had grown accustomed to the collegial teamcentered culture of residency. I thought that I had chosen a place that had a similar culture, and I was so excited to spend two years gathering amazing technical training with staff who would build my surgical career. There were smooth cases, and I made some good relationships, but I can't ignore the fact that parts of the experience were unnecessarily abusive. There was a superficial collegial relationship among the staff and toward the fellows, but in the blink of an eye, attitudes would shift, and normal interactions would turn into confrontations on the wards, in the ER, or in the OR. Artificial or real disasters loomed all around, and an unsuspecting [End Page 209] nurse, circulator, anesthesiologist, or I would become the target of a rampage. If these situations had happened daily, I would have known what to expect. But the whims of any particular surgeon felt random, and, early on, I was entirely unprepared. I had so many positive interactions, but the negative ones were so powerful that I still get chest pain when I think back to my fellowship.
By my second year of fellowship, I was getting more accustomed to the culture...