- Championing A Surgical Career:Success in a World of a Thousand Cuts
During my seven years of training in general and cardiothoracic surgery, 1977-1984, women were beginning to graduate from medical school in significant numbers. Few women surgeons had yet to complete training, however, and I knew no role models in practice. My experience in a progressive medical school was that hard work and strong clinical skills speak for themselves, so initially, I was confident I could establish my credibility.
My first realization that this premise was naïve came during my 1977–1978 general surgery internship at a large pyramidal university-based training program in south Texas. The program had never graduated a woman, but they did have two women out of about 35 general surgery residents, one in the 2nd year and one in the 4th. My first internship [End Page 186] rotation was months on Urology at an affiliated hospital, effectively rendering me invisible to the general surgery program attending staff. When I tried to address this disadvantage directly by seeking supplemental visible work, I was told there wasn't room, and the system didn't work that way.
The deadline came and went for identifying interns who would be promoted to the second year. I had received no feedback on my performance to date, although I had not been invited duck hunting at the Chief of Surgery's hutch, rumored to be a prime endorsement that a resident had a job the next year.
So, it seemed natural to me that I speak with the training program director and figure out what was the situation. The first thing he said was that, obviously, having asked to meet with him, I must be aware I was not doing well. He went on, stating I was "not competitive enough" to be a surgeon.
With the die cast, almost more furious than disappointed at this teaching vacuum, I was no longer biddable and compliant. I started confronting OR staff directly when I overheard my nickname, "the whore." I stopped accepting extra call nights—an ongoing hazing test to see if I was a "real" team player. I explicitly pressed for my fair share of operative cases and ICU experience. And I found a senior resident willing to teach me, who I still regard with gratitude. My campaign to raise visibility and speak out on my own behalf became crucial to a gradual recovery of my self-esteem and my future surgical education.
The internship turned out to be a scam. I was accepted under the ruse of participating in a teaching program solely to meet temporary staffing needs while a male resident was on leave. Perhaps this also contributed to the aloofness of the other 2 women in the program from me, although they carefully kept a distance from each other as well. I later came to see this as a pattern—pioneer women are often wary, and often treated with caution, in turn, creating an isolation that limits mentoring opportunities.
For years after, I always sought out this dishonest program director at professional meetings to re-introduce myself and update him as I competed successfully to become a cardiac surgeon. I wanted to remind him that he failed to erode my spirit.
The Chief of Surgery at my medical school helped me find a new surgical training program, and in the course of my rotations, I became seriously interested in cardiac surgery. Some troublesome characteristics of this field are that the work is relatively high-risk and, being high-profile, it is often politically complex. In addition, there is the personality profile of many cardiac surgeons themselves. "You're killing my patient!" does not provide a lot of educational insight, and it is hard to learn from surgeons that are both self-absorbed and non-verbal and whose work entails frequent clinical crises. But it is very interesting and very rewarding to be part of a high-performing team. The anatomy is beautiful, the feedback about success or failure immediate, and the decision-making intellectually just as challenging as the technical craft.
I applied to a string of cardiothoracic residencies with strong letters from...