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 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...