This recent NYT article describing the difficulties experienced by many women in surgical training, specifically what surgical residents who are also mothers, go through while pregnant as a resident, or juggling motherhood during training, and having a holistic “life” outside of work”. I can relate to this article well.
I was single and did not experience pregnancy, delivery, or face daily struggles with daycare/childcare issues during my residency training. Having my daughter, Claire, at almost 36 was not by choice but due to struggles with infertility, undoubtedly directly related to extremely long work hours, lack of proper sleep, nutrition, hydration, and what’s typically accepted as a reality and mandate for surgical training. The downside to having a miracle pregnancy in mid 30s was the increased risk of Down Syndrome and being categorized as “high risk”, while the upside was that I was an “attending” and made a decent salary so that we were able to afford an in-home nanny for the first couple of years after she was born.
Thankfully I didn’t have to struggle with daily stress of whether daycare was open early enough for me to drop Claire off, or if I would make it to pick her up on time and watch the clock in secrecy while in the operating room praying the case goes smoothly without delay. As I read this article, I do remember faintly the countless days in the operating room when I have had to ask the Operating Room nurse to call my husband when there was a change of plans for child pick up, or if I was going to be late to any special events despite my best planning.
But there are plenty of incredible, skilled, talented, women surgeons I work with that are faced with competing demands each and every day to fight for the surgical career they work so hard for, and the marriage and children they fought perhaps equally as hard for, investing in the most critical support they have in their significant other during the hardest years of their lives. That along with the evolutionary biological need to care for their child whom they probably carried and nursed while learning about disease, surgical complications, life, death, and so many experiences medical education simply doesn’t prepare you for.
While the same can be said for working moms in every industry, in medicine, one simply can’t walk out of the office from a patient encounter, leave a critical patient the Emergency Department or Intensive Care Unit, and, least of all, walk out when a patient is under anesthesia on the Operating Room table, until surgery is completed.
While at this point in my career, I only look at the clock during surgical days to ensure I am not too far behind as to not keep the next child and family waiting, I rarely have to look anymore for reasons of child care. Surgeons are trained to never compromise the outcome for our patients and they always come first, yet all the while we have been the spouse and mother who promised we would make it to the school play, holiday, choir, ballet, piano, or any music performance, soccer game, parent’s night, etc. My male colleagues may be equally susceptible to being late, but the world still has a double standard even as we approach 2020. When a male colleague is late, because he is a surgeon, there appears to be something noble and acceptable because of the prestige and respect one has for a male “surgeon”. When a woman is a surgeon is late, she is simply a mother who was absent.
Perhaps we women physician/surgeons are too warm, kind, hug too much, express more emotions than our male counterparts, and despite giving phenomenal care and achieving excellent surgical outcomes, we are more likely to be taken for granted. I don’t usually hear acknowledgement for myself or fellow women surgeons that there is empathy for them missing out on their child or family events due to long hours and job demands. For men, there is appears to be an unspoken forgiveness and understanding that women do not receive from patients or colleagues alike.
Even now, so many people I meet are surprised when they ask and I share what I do professionally. Conscious and unconscious bias usually allows me to introduce the element of surprise as a woman (and perhaps an Asian woman) that I am a surgeon, and for almost 3 years, the “Surgeon-In-Chief” of our Children’s Hospital.
When one outperforms as a woman, you don’t get extra credit. But when one reaches goals or targets slower, or on a different timeline due to child bearing years and natural desire to be a mother as well as work on a marriage or relationship, for those blessed enough to find a mate during our long journey in training to become a surgeon, we simply don’t get there and hence the disparity for the number of women in leadership positions such as “chairs” of academic departments, surgeon leadership roles, senior hospital administrative leadership roles, etc.
How is it that women are expected to have the same physical capacity as men and there can be no “special” accommodations for women? Biologically, women do not have as much muscle mass as men, and after being certified by Johnson and Johnson Human Performance Management in Energy Management, I know that physical energy capacity and the quantity of energy is definitely proportional to muscle mass, not to mention probably testosterone, and other biological differences.
Women also expend much more emotional energy than a man, hence our unique and amazing contributions to life and medicine, to our colleagues and organizations. When being criticized, or described as “too emotional”, it’s an inherent “fatal flaw” for my being a woman. When overachieving, there is no acknowledgement that we did it all the while cooking dinner most nights, doing the laundry, and planning most of the child’s activities and family schedule while financially supporting the family.
I don’t need people to be impressed, I don’t need anyone to tell me how great I am. I would like people, including my own family and friends, to acknowledge that I am different and experience my life differently, by choice. It would mean so much if people who know and care for you, even your patients and their families, show some empathy that doctors and surgeons are also human, and need to go home to be as good of a mother and spouse as possible, as someone who does her best to be present, contribute to household tasks, and creates a warm, loving home and “normalcy" for her family on as many nights and weekends as possible, when not on call.
Despite the challenges, faint memories of dragging the breast pump every day and pumping between surgical cases and patients in clinics, I have never regretted my choice to pursue surgery and spend my career gaining mastery and using the gift of my own hands to restore and improve health and quality of life for children. Women have unique qualities as surgeons: perhaps we can speak to patients and families from a parent perspective if we are a parent. Women physicians have been reported to spend more time speaking with and explaining to patients, thus increasing their comfort level and decreasing fear and anxiety.
Two or 3 years ago, I was a panelists for an evening program with female medical students discussing women and a career in surgery. I will never forget my strong and defensive reaction, when a beautiful young lady raised her hand and said, “I have always wanted to be an orthopedic surgeon, but I have been told if I can’t if I want a family.” The inner rage came on quickly as I asked who gave her such advice—it was her male “radiologist” uncle. I reminded this young medical student that women can choose to pursue whatever career they want, that no “easy” specialty guarantees fertility or a happy marriage, but that the profession itself sucks the life out of you and you need support, strong mentoring, and great advice. Not going to the moon, just need help and lots of it.
Day in and day out when I meet young students, male or female but particularly female, and discuss their career choices with them, my message is this: pursue what you are passionate about, and don’t make a decision based on how “hard” you think or hear it might be. Never choose a “specialty” because you heard it was “easier”. You will have to work hard and make many sacrifices no matter what, but once you finish training, you have more freedom and ability to make some choices to better support your personal life and hopefully allow you to enjoy marriage and motherhood as well. I would never mislead a medical student about how truly difficult surgical training is, but to choose a career because one perceives less work and easier ‘hours” is unlikely beneficial or fulfilling in the long term.
Last week, we as a family watched every video during Christmas time from the year Claire was born until 2018. I was moved to tears watching my beautiful little girl who brought awe and magic into the Christmas season and created so many beautiful memories. In one video when Claire was 5 or so, you can hear me asking her, "Claire, what did you ask Santa for? What is on your list?" to which she said, “I want presents, and I want more time with mommy.” This is a sentence that cuts like a knife.
Despite all that I have “achieved” and given to others, providing my family with all that we have from a financial standpoint, supporting my parents in part financially since the day I finished training, I know the cost and price I paid with every part of my being—my physical, emotional, mental, and spiritual domains of energy. My little girl just wanted her mommy and more time with mommy. I can only pray that Claire will not pursue medicine as a career, since people continue to be less accountable for their own health and the pressure on physicians to "perform" and "produce" do not seem to go away fast enough while burning out most of us in my generation. I am grateful for my husband, who was there whenever I was not. He got spend all the times with our daughter when I was caring for someone else’s child. Dave made it possible for me to focus on patients and families first and my career development so that I could become more than just a practicing physician but also have a leadership journey. He was robbed of a wife who could pay more attention to him, have energy left for him, and not resent having to do more when she got home. To him I owe the most.
To every female resident in surgical training, and fellows (additional training after residency for further sub-specialization): it WILL get better, so hang in there. Paint your face blue, get up again tomorrow. You CAN do this, you ARE tough enough, you are STRONG and you are beautiful. You are already good enough and you don’t have to be perfect. You will be able to have more control over your schedule once you are done with training, and then it gets better to be a mother because your child will also be getting older as well. Few will understand you, least of all your spouse if he or she is not in medicine. Don’t expect anyone to feel sorry for you because they won’t. Don’t expect others to take extra care of you because they won’t. Being a warrior is lonely, but find other warriors because together you will feel proud and see who you really are.
To all the medical and surgical physician leaders who are in a position to influence change for residents and fellows:
- Make sure there are “different” accommodations, not “special” ones, for your women trainees. Examples include access to lactation rooms, FMLA and maternity leave that’s reasonable, some flexibility if needed for work schedules, helping residents figure out childcare options and navigating sick care for their child, and most of all provide mental health support and a culture of support in your program.
- Be a great role model, make sure that priorities are set and schedules are made to allow and support reasonable time away from work to ensure strategic recovery and early career space and time to learn how to “balance” work and life as a mother and surgeon/researcher/physician.
- Provide constructive and positive feedback. Women tend to be overly critical of themselves and set unrealistic expectations, so for God’s sake- be a positive voice, and help women physician/surgeon look in the mirror and see wha she should see, someone who is sacrificing a great deal to give more of themselves to patients and families, day and night, holidays included.
- Teach them better self-care: hydrate, eat on schedule, sleep when able, and plan/take vacations.
- Acknowledge and celebrate women who become surgeons while still caring for children, spouses, parents, friends, etc, likely also navigating healthcare for everyone in that family, neighbors, and friends. Know that women in medicine advanced their careers by sacrificing their own sleep, hobbies, time to self, healing, and rest and got work done in a way that didn’t compromise motherhood and all other duties.
- Thank the women in your life who are doctors, surgeons, nurses, therapists, and anyone who provides health care to others. Without us, you and your loved ones may not get better sooner and likely experience “health” and “healthcare” very differently.