AWS BLOG

Defining the Resident Role in the Operating Room

By Heather Logghe, MD

In recent years, expectations and requirements for attending supervision of residents in the operating room has increased. This has led to ambiguity for both residents and attendings as to how and when operative autonomy is earned, appropriate, and safe. Another area of uncertainty is when, how, and by whom the resident’s role should be described and explained to the patient. Research in thoracic surgery by Meyerson et al. showed that while trainees’ and attendings’ expectations of resident autonomy did not differ, both groups expected higher levels of autonomy than were observed.
The January #AWSchat will explore these issues through facilitated questions led by three distinguished moderators:

  • Dr. Shari Meyerson (@lungteacher), thoracic surgeon and Program Director for the General and Thoracic Surgery Residency Programs at Northwestern, Feinberg School of Medicine
  • Dr. Nell Maloney Patel (@MaloneyNell), AWS member, colorectal surgeon, and General Surgery Residency Program Director at Rutgers Robert Wood Johnson Medical School
  • Dr. Rebecca Hoffman (@drbeckyhoffman), Vice Chair of the Resident and Associate Society of the American College of Surgeons Executive Committee as well as Research Fellow at the Center for Surgery and Health Economics and Chief General Surgery Resident at the University of Pennsylvania Perelman School of Medicine

In the chat, scheduled on January 15 @ 8PM EST using the hashtag #AWSchat, we will explore the following questions:

  1. As a resident, how much should I “do” in a case? Who gets to decide?
  2. As an attending, what metrics do I use to decide how much a resident does in a case?
  3. How should the discrepancies in expectations of autonomy in the operating room between resident and attending be resolved?
  4. How much transparency is owed to patients regarding the resident’s role in the OR?
  5. Who should discuss the #surgresident role in the #OR with the #patient?

Dr. Logghe is a longtime member of AWS and currently a Surgical Research Fellow at Thomas Jefferson University. She graduated medical school at the University of California, San Francisco and has completed two years of general surgery residency at the University of North Carolina, Chapel Hill. As founder of the #ILookLikeASurgeon social media movement, she is passionate about creating an inclusive and supportive environment for surgeons in training and practice. She believes that supporting physicians in optimizing their own physical and emotional health enables surgeons to take the best possible care of their patients.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

A New Year – A New You?

By Susan C. Pitt, MD, MPHS

Every year close to half of Americans make New Year’s Resolutions. They commit to losing weight, eating healthy, exercising more, going to bed earlier, and on and on. Many of these types of resolutions revolve around improving health and wellness. As surgeons and as women, we surely benefit from these types of resolutions. But we should also ask ourselves, what resolutions can I make at work? So you’re probably asking, “What do you mean, ‘work resolutions’?”

In my mind, work resolutions can come in many forms. Some work resolutions may lead to improved wellness by creating time for activities outside of work, like exercise or travel. Perhaps you could master a few shortcuts within the electronic health record to speed up orders and documentation. Maybe you could fully plan your week to take advantage of small periods of down time, thereby improving productivity. Or maybe you could finally master email management, so email doesn’t take over your life (ughh!).

Your work resolutions could also involve incorporating small efforts towards wellness into your daily activities that may increase your productivity. Could you meditate at lunch? Take the stairs every day? Or do push-ups and wall sits between cases? You could download an app with a short workout that you do once or twice a day between meetings. I’ve been enjoying my morning and afternoon 7-minute high-intensity interval training (HIIT) workouts so far. Can you say, “burpees and mountain climbers?”

Other types of work resolutions may involve patient care. You could resolve to improve patient communication or education by making any number of interventions, such as adding a new pamphlet in clinic or learning the teach back technique. You could even make a concerted effort to listen better. I know I’m frequently distracted by noises or other thoughts when I’m in clinic. Alternatively, you could resolve to trying make each of your patients laugh on rounds. After all, laughter is the best medicine.

Work resolutions could also involve learning or research. Perhaps you would like to read more or write more manuscripts. Maybe you would like to review articles in a timelier manner. Hopefully, by now, you can see the endless possibilities for resolutions in all facets of work and are encouraged to try incorporating one or several into your new year.

We all know that not all resolutions are successful, but we can help ourselves out. According to experts in the field, to help make your resolutions a reality, consider using these strategies:

  • Make the resolution specific (i.e., ‘I will finish my charts within 24 hours of clinic,’ instead of ‘I will finish my charting sooner.’)
  • Make the resolution realistic (i.e., Don’t resolve to read one surgical text each month when you only read one textbook last year.)
  • Have a strategy and a metric for evaluating your success (i.e., Keep track of every time your patient laughs on rounds and check your progress on Fridays.)

Ultimately, the resolution also needs to be important to you, your work, and/or your patients. Sharing the resolution with a friend or colleague may also keep you accountable and contribute to your success.

In this New Year, whether you pursue a resolution or not, consider incorporating strategies for building resilience and satisfaction at work, improving your wellness, and decreasing your risk for burnout.



Susan C. Pitt, MD, MPHS is an Assistant Professor of Endocrine Surgery at the University of Wisconsin. In addition to her clinical practice, Dr. Pitt is a health services researcher focused on reducing unnecessary surgical care and overtreatment. While she always strives to eat healthier, exercise more, and go to sleep earlier, Dr. Pitt’s “work resolutions” involve implementing strategies to make more space for her research and better manage her energy. She is looking forward to the challenge.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Building resilience in the wake of Sutherland Springs – How will we survive another mass casualty event?

By Lillian Liao, MD, MPH

For years now, our regional trauma system has performed scheduled drills of potential mass casualty events: an airplane crash, a stadium event, a nightclub shooting, etc. Our team is prepared to care for the injured patients “if” it ever hit us. Then came the dreaded text message on a beautiful Sunday morning: “Mass casualty incident – Sutherland Springs. Not a drill. More to come.” By Divine intervention or organized chaos, our trauma program had a meeting there that morning. In additional to the usual team of two trauma surgeons and the complement of residents, we had an additional five trauma surgeons in the building. Our most senior surgeon took the role of the triage officer. The teams of people required to care for the injured patients gathered like sections of a symphony orchestra. By the time the first patient came, everyone [the ER to the OR to the Adult and Pediatric Intensive Care Unit] was ready for what was to come.

Trauma clinical staff anticipating the arrival of patients.

A strong regional trauma system and a dedicated trauma program had prepared us to care for the injured patients. What it had not prepared us for is the sadness; the anger; and the helplessness felt when people die or become injured senselessly. These emotions are difficult to overcome. The nationwide outpouring of support from other healthcare providers certainly helped. Miami, Las Vegas, and Aurora all sent words of encouragement. How sad is it that we now belong to this sacred league of health care providers? However, surgeons are doers; we do not sit around and feel sorry for our plight. We find solutions! Moreover, we can recover from this tragedy by leaning on the resilience we have built up through years of surgical training to overcome all things difficult and seemingly impossible.

There are three major lessons I took away from the horrible tragedy. First, a strong trauma system is key to saving lives. Triage and transport of critically injured patients to the highest level of care is paramount, as there is really “no time to bleed!” Second, tourniquets save lives. When I look at the survivors and focus on the adults and children who came in with tourniquets in place, tourniquets saved their lives and limb! This should re-energize our commitment for regional STOP THE BLEED efforts. We must work to convert every bystander into a first responder. We must get our community leaders involved and help them to see that tourniquets and bleeding control supplies must be available in all public spaces because if this could happen in a church, it really can happen in just about anywhere. Lastly, we must also not shy away from dialogue about firearm availability and firearm safety. Our nation must build a consensus on how the need for freedom and liberty can coexist with the imminent need to reduce firearm related injuries. A good starting point is the ACS bulletin put forth by Dr. Deborah Kuhls and the Committee on Trauma Injury Prevention Team.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.

 

Dr. Liao completed her undergraduate training in Economics with Honors from the University of Texas Austin where she was a member of the Dean’s Scholars Program. Dr. Liao completed her medical training at the University of Texas Health Sciences Center in San Antonio in 2004 and her surgical residency in 2010. She pursued additional fellowship training in Trauma and Critical care and joined the Trauma Faculty at the Health Sciences Center in 2011. Dr. Liao is board certified in General Surgery and Surgical Critical Care. Her primary clinical and research interests are in vascular trauma, pediatric trauma and burn, and injury prevention/patient education. She is currently the Pediatric Trauma and Burn Director at University Hospital’s Level I Pediatric Trauma center. Follow Dr. Liao on Twitter.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

 

Clean Hands Deserve Two Thumbs Up

By Fatima S. Elgammal

The Hungarian obstetrician and a father of modern antiseptic techniques, Ignaz Semmelweis, risked his reputation when he took to stage at the Vienna Medical Society’s meeting on May 15, 1850. He was beseeching his colleagues to participate in a simple but a provably effective method of diminishing disease transmission: hand washing. The rates of puerperal fevers on wards covered by medical students, whose morning autopsies on women who died from the fever preceded examinations on the day’s laboring women, far outnumbered the rates on wards monitored by midwives, whose responsibilities did not include autopsies. Semmelweis attributed rates of the former group to poor hand hygiene. Ever the scientist-at-heart, he implemented a protocol whereby students and physicians washed their hands with a chlorinated lime solution after dissection. The results were groundbreaking: mortality rates of mothers seen on those wards covered by students and junior physicians plunged. Despite the evidence, Semmelweis’s conclusions were not as readily accepted, and would not be so for years to come.

Hand hygiene is one of the most important methods of preventing transmission of healthcare-associated infections. The Centers for Disease Control and Prevention asserts that hand washing prevents diarrheal illnesses by 30% and respiratory infections by 20%, for which antibiotics are, consequentially, overprescribed and overused, lending to a rise of antibiotic resistance. Rubbing alcohol-based solutions and washing with soap and water are the most popular and widely used techniques for hand hygiene.

Newer hospital wards are especially equipped with sinks and sanitizer dispensers inside and outside patient rooms, while older wards, especially emergency departments (ED) and intensive care units (ICU), are being similarly retrofitted. Still, low hand hygiene compliance plagues healthcare workers. Surprisingly, the World Health Organization (WHO) 2009 Guidelines on Hand Hygiene in Health Care lists physician status as a leading risk factor for poor adherence. The same set of WHO guidelines studied predictive factors for good adherence to hand hygiene, and cited peer pressure and the awareness of being watched as leading determinants. Another positive determinant for good adherence: being a woman. Few of us can objectively contest anything less than 100% compliance, especially when Infectious Control personnel are making their rounds, but consistent efforts to wash in, wash out, and wash in between encounters (for the double-occupancy rooms) can be more difficult to achieve. The five critical moments of a patient encounter during which hand sanitation must be attained are:

  1. Before touching a patient (e.g., prior to examination, or assisting patients to move or walk)
  2. Before a clean/antiseptic/sterile procedure
  3. After body fluid exposure risk (e.g., handling Foley bag, IV sites)
  4. After touching a patient
  5. After touching a patient’s surroundings (e.g., bed rails)

The above measures not only prevent exogenous germs on your hands from colonizing the patient or their room, but prevents us from carrying infectious particles to other patients or healthcare professionals. Cold weather and large crowds makes the holiday season an especially vulnerable time for germ spread, even just by walking through a hospital lobby, cafeteria, or the ED; pocket-sized sanitizer bottle come in handy when no wall mounts are available or should we become the unsuspecting victim of a wet sneeze, ours or someone else’s. The busyness of a surgeon’s day is on par with the delicate state of our patients’ health. The sense of criticality with which we adopt sterile techniques in the operating room should be translated just as readily in the clinics, inpatient wards, ED, and the ICUs, and beyond the weeks of Infection Control monitoring our movements. We do not think twice about it in the OR, we should not think twice about it outside it.

This National Handwashing Awareness Week (December 3-9), spread the word, not the germs. Alert those who walk in without washing into a patient’s room.


Fatima S. Elgammal is a fourth-year medical student from St. George’s University School of Medicine. She developed an interest in critical care and trauma/acute care surgery following four years of studying neuronal changes in traumatic brain injury models of epilepsy and her time at Hackensack University medical Center as an emergency physician scribe then later as student completing clerkship. An alumna of New Jersey Institute of Technology, she enjoys illustrating, baking, reading, and boxing.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Hurricane Season: A Family Affair

By Dr Christine Laronga

My nephew helping rescue people from floods caused by Hurricane Harvey.

News of hurricane Irma came on the heels of witnessing the heroism and devastation of hurricane Harvey in Texas. Yes heroism. Natural disasters do not discriminate and we have witnessed people of all walks of life coming together to help one another in the face of tragedy. 2017 has certainly had its share of devastation. Even though I wasn’t in Houston, I lived it through my family and social media who live just outside of Houston. I watched people, like my own nephew, rescuing stranded men and women in areas of flooding and delivering food & water to those unable to get out of their houses.

So when word came from the hurricane center that Irma was headed to Florida, Floridians prepared. Food, water, and supplies disappeared from grocery store shelves days before the storm hit. Gas lines became long as people filled up everything they could for car travel and backup generators. College students were evacuated and sent home two days before the storm arrived and were told not to return for a week. Schools and offices closed to make ready. The government sprung into action and orchestrated the largest evacuation plan in the state’s history.

Now Floridians are used to hurricanes. We have Miami Dade grade windows, hurricane shutters, back-up generators, and sandbags galore. This time was different. Floridians found themselves in an arcade pinball machine. The eye of the hurricane and where it would hit landfall kept moving.  People would evacuate from one area only to learn that new area was now in the path of the hurricane. Some managed to get out of the state via jam-packed highways or airplanes until roads and airports closed. Shelters opened at a fierce pace for those fearful to stay home alone whilst other joined forces and supplies in the safest house in the neighborhood.

Mine was one of those houses with Miami Dade grade windows, extra hurricane curtains, a household generator running off the public gas line, and a walk in closet that was emptied to convert to a safe room. Outpouring of texts and emails from concerned friends and colleagues across the nation keeping me connected with the outside world. Newscasters kept us abreast moment by moment of the storm’s progress. The entire state of Florida was hit by hurricane Irma without exception. Some lost their houses, many lost power for days (some for over a week), and many had no drinking water or usable water as their house supply comes from a well. Grocery store shelves lacked refrigerated products and water for days after the storm. Gas stations remained closed as the ports took days to re-open to receive tankers of gas. The government and public servants worked tirelessly to get the state up and running.  Like hurricane Harvey and the other tragedies, Floridians banded together. Households with water and power opened their doors to those without (Florida this time of year is still hot and humid). Cleanup and repairs are still under way.

As for me, eventually I will unpack my house and take down the hurricane curtains. In the grand scheme of things, it is just not a priority. What is a priority are efforts to help our Puerto Rican neighbors (many of which have family members in Florida). Our schools are taking on their students. Our hospitals are taking their sick. I am proud of how we all put our differences aside, rose to the occasion, and are helping one another. We have seen such resolve time and again this year for other tragedies.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.

Christine Laronga is a Senior Member at Moffitt Cancer Center and a Professor of Surgery at the University of South Florida and specializes in disease of the breast. She joined the Association of Women Surgeons as a resident and has been an active member for over a decade. She is also the Immediate Past President. Follow her on Twitter @clarongamd.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

When the Storm Clears: A New Perspective

By Dr. Ainhoa Costas-Chavarri

For 14 days after Hurricane Maria hit Puerto Rico, I had no way of knowing if my parents were dead or alive. They’re fine, I told myself. Our house is not in a flood-prone area. The roof and walls are solid, and won’t blow away. I’m sure they’re ok, I replied to the rising tide of emails, texts, and phone calls from concerned friends and colleagues – there’s just no lines of communication. I’m sure they’re fine, they have to be, I reassured myself, resting my hand on my second trimester and growing belly.

I grew up in Puerto Rico. Every summer my mother would unearth the free NOAA hurricane tracking map and place it on the bulletin board we had hanging in our kitchen. She’d catch the coordinates on TV or the radio and my brother and I would fight over who got to place the pushpins on the map. Pin by pin, every morning we followed the hurricane’s trajectory, and then went about our school day.

As surgeons, we live with similar daily acknowledgements of looming potential complications. We learn anatomical variations and control for risk factors, following the steps that will hopefully see the twin storms of morbidity and mortality veer off course. When I last heard my mother’s voice, we were going down a checklist: batteries? Check. Electronics charged? Check. Radio? Canned food? Water? Check. Candles? Mama? Mama?

For the next two weeks the only things I could pretend to control were the news and my Facebook feed. It was devastating to watch: 3.4 million Americans living on the island without water, electricity, and telecommunications. The images of massive destruction and flooding filtering through unable to fully capture the scale of this humanitarian disaster. Even after 40 days, the statistics are mind-numbing: less than 30% of all people have electricity and ~70% have access to drinking water. More heartbreaking, however, is the reality down at the individual level –  stories of families that are still without food, of people washing their clothes in and drinking from polluted water sources, and in hospitals, surgeries compromised as the power goes out in the OR. On Facebook, there was a new-found sense of community: my Puerto Rican friends and I ranted over government officials placing politics above human lives, commiserated over losses, and celebrated whenever any of us had good news.

Finally, it was my turn: 14 days after we’d lost contact, my mother called to say she was in the hospital. A small inflamed area had morphed into an angry abscess, necessitating an I&D and IV antibiotics. “It’s like being at a spa,” she proclaimed, ecstatic, “they have light here and clean water and wifi…that’s how I was able to call you.” She had been seriously considering, she also revealed, traveling to Colombia. Colombia? Para que? Well, she explained, I’ve always wanted to go – and your father and I, we have worked so hard, we did all these things to prepare for the hurricane, for the worst, and still we suffered all these unforeseen problems. Y sabes que? I think we need to put in just as much effort into living.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.


Dr. Ainhoa Costas Chavarri is a General Surgeon and Hand Surgeon who does full-time academic #globalsurgery. She has been living and working in Rwanda for the past four and half years, teaching Rwandan surgery residents and medical students as part of the Human Resources for Health Program. Her focus is on surgical oncology, especially breast and gastric cancer. She enjoys foreign films, modern art, poetry and now more than ever, the beaches of her home island of Puerto Rico. You can follow her on twitter: @ainhoac63

 

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

 

United We Are Stronger

By Dr. Rocio Carrera

#FuerzaMéxico  #19S

Thirty-two years ago, Mexico City was hit by a devastating earthquake that left thousands dead, hundreds of buildings collapsed and became uninhabitable. It was an event that united us as a society and helped to implement a culture of prevention. The regulations for the construction of buildings in the city were modified and since childhood we were taught how to act and protect ourselves during an earthquake. Earthquakes cannot be predicted, but we can prevent many of their terrible consequences.

On September 19th, a new earthquake struck the country on the anniversary of the 1985 earthquake. Two weeks after another strong earthquake shook the coasts of Chiapas and Oaxaca. What a terrible coincidence! That morning the City had participated in acts that commemorate the events of 1985. At the time of the earthquake (13:14 CMT), I was in the emergency room with several surgery residents when we felt a strong shake. Just at that moment the seismic alarm sounded and we tried to quickly go to the security areas together with some patients and their families. It was a matter of seconds but it felt like an eternity.

Rescuers search for survivors and victims in a home destroyed by the earthquake.
Photograph by Yuri Cortez, AFP/Getty

When it was over, and after the initial shock, we all tried to get in touch with our families. Internet and telephone lines had collapsed. When the communication lines were reestablished, the terrible news began to arrive. Offices, buildings, houses, schools had collapsed all over the city, people trapped in the rubble, children lost. What to do, what to think in those moments of despair? During those first hours of fear and uncertainty, when we all tried to know if our loved ones were safe, if our homes were ok, I witnessed the vocation and professionalism of the hospital staff, especially the surgery service, to which I am proud to belong to. Those who were in the operating room at the time of the quake only left during the tremor and returned to finish the procedures and put the patients in safe areas despite the risk of damage or gas leaks. Some could not step away. The residents voluntarily stayed to see what they could help with, organizing tasks, relocating patients who had to be evacuated from certain areas. Many of them, like hundreds of people in the country could not return to their homes for days, and many basic services failed. In these instances I saw how, despite the shortcomings, people kept going on.

Volunteers picked up rubble from a building that collapsed in Condesa. Credit Rebecca Blackwell/Associated Press

The people of Mexico City responded by taking to the streets to help. Young people raising debris to rescue trapped people, doctors organizing brigades, people preparing food for those affected, and volunteers, donations in unexpected quantities. Help came from everywhere and in all forms. The solidarity, strength and unity that the country showed in those days will be something I will remember forever. In the midst of chaos, despair and death, I confirmed that Mexico is still one of the most friendly, vibrant, and resilient countries in the world. The reconstruction work and help for those affected will continue for months and years to come. The important thing is that we do not allow us to forget that even during those terrible days there was hope and that all of Mexico was one.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.

Dr. Rocío E. Carrera Cerón is a thoracoscopic surgery fellow at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City, where she also  completed her residency in general surgery. She received her medical degree from Universidad Nacional Autónoma de México (UNAM) in 2012. Her interests include general thoracic surgery, particularly tracheal surgery, and lung transplantation. She is engaged in clinical research studies and actively participates in several local associations of women surgeons trying to establish mentorship and sponsorship programs for young residents. A native of Mexico City, she is passionate about sports, cinema, and historical novels.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

AWS 2017: A Few Ships By The Bay

By Natalie Tully

The AWS Conference on October 21st was a full day with a scientific session, professional development panels, and a broad range of networking opportunities that originated as a simple sign for a breakfast with women surgeons 36 years ago.

This year we took mindfulness and self-care from the abstract into practice with a yoga session and run along the San Diego Embarcadero. With the excitement buzzing around the day’s events, I deeply appreciated having a moment to appreciate the sunrise and to sync breaths with other attendees.

This past year we accomplished new milestones and new trends on social media. We had the opportunity to realize how much better we truly are together. The conference made broad use of multimedia, including an introductory video by student member Emily Chen.

 

Members’ academic endeavors were highlighted in the Starr Research forum, AWS/AJS Best Manuscript Session, and a presentation from AWS Foundation Fellowship Awardee, Dr. Nasreen Vohra. Projects from a broad range of topics were presented, including “SOX9 in irradiated rectal cancer: a potential marker for tumor regression?, and Evaluation of TRB-N0224”, by Lindsay Nowak, “Improving Outcomes with Minimally Invasive Aortic Valve Replacements” by Anna Olds, and “A Chemically Modified Curcumin for Osteoarthritis Treatment” by Josephine Coury. Likewise, the resident forum featured excellent projects from a variety of surgical research areas. To complete the scientific session, Dr. Nasreen Vohra spoke about the project she’ll be working on with the AWSF Ethicon Fellowship “Relationship between the transcriptional profile of the sentinel lymph node and outcomes in triple negative breast cancer”.

The keynote speaker, Lara Hogan, Vice President of Engineering at Kickstarter, challenged us to “Be a Mentor, Find a Sponsor”. She encouraged all in attendance to critically evaluate how we seek out and provide professional guidance and support. She spoke to the value and crucial need for senior surgeons to sponsor their trainees and more junior surgeons for leadership positions. While the seat women earn at often unfriendly tables, she underscored She highlighted that for surgery to move toward gender equity, there must be increased sponsorship but also self-assertion that women belong at the table based on merit.

There is a reason why we are the Association of Women Surgeons, why we are not tied to a country or geographic region. It is because our international collective of members experience the same themes globally as women in medicine. The global panel on women in surgery highlighted the social exclusion, implicit bias, challenges in mentorship, and pathways to promotion we all inevitably encounter in the spectrum of medical training. Featured speakers included: Dr. Suad Abdul (Kuwait), Dr. Ainhoa Costas-Chavarri (Rwanda), Dr. Vikisha Fripp (USA), Dr. Avril Hutch (Ireland), Dr. Kazumi Kawase (Japan), Dr. Sherry Wren (USA), and Dr. Cheng Har Yi (Malaysia).

The official conference activities ended with a networking event in the new-for-2017 “Surgeon’s Lounge”- with a ribbon cutting ceremony by AWS President Celeste Hollands. The event offered a unique opportunity for all attendees to relax and network with each other and with our generous corporate sponsors. Following the conclusion of the conference, residents and medical students headed to a local restaurant for a taco-infused mixer. Medical Student and Resident Committee Chairs Shree Agrawal and Andrea Merrill spoke to the group to welcome all to San Diego and to encourage anyone interested in becoming more involved with AWS to take take the leap in becoming a member and make their mark on AWS.

As the day ended and American College of Surgeons Clinical Congress (ACSCC) began, AWS members continued to show the incredible work they are doing in advancing the surgical field, having myriad presentations, panel discussions, and leadership positions given by members. To highlight this and make use of the “Amplification” strategy used by other groups of women, appearances by AWS members were posted with #AWSatACS. This allowed for an extra level of visibility of the number of women speaking at ACSCC, and as a result, greater visibility both of each individual’s message and of women as leaders in surgery overall. Another trend that began during the Congress was a surgical #HeForShe– which started by Tom Varghese joining AWS subsequently followed by many other male surgical colleagues. The AWS conference’s close temporal and spatial relationship to ACSCC provided opportunities to engage with our biggest allies in our plans moving forward.

As the Clinical Congress continued on, there were myriad wonderful moments for women in surgery-Dr. Barbara Bass being installed as the 3rd female President of the College, Dr. Eileen Bulger installed as the first female chair of the Committee on Trauma, and Drs. Leigh Neumayer and Diana Farmer installed as the Chairs of the Board of Regents and the Board of Governors, respectively, just to name a few. On the evening of October 23rd, AWS held it’s AWS Foundation awards dinner, recognizing remarkable accomplishments by members at the medical student, resident, and attending level, as well as non-member allies. It was a truly spectacular evening celebrating how far we’ve come as women in surgery and reaffirming our commitment to the AWS mission. The next morning, AWS activities wrapped up with our annual Stryker Networking Breakfast, in honor of the origins of AWS and Dr. Pat Numann’s original breakfast meetings. The morning gave those still in town one last chance to come together in an informal setting and network…or be gently encouraged to take on one more AWS committee project.

This was my second ACSCC and my first of what I hope to be many AWS conferences, and for all of the things I imagined the experience would be, somehow it exceeded them. AWS seeks to inspire, encourage and enable women to realize their professional and personal goals. For at least this n=1, I left San Diego inspired by the accomplishments and ongoing work of #Sheroes I was surrounded by, encouraged by friends new and old, and enabled by new opportunities to lead and to pursue a career in this field, so that someday I may have the joy and privilege of being a surgeon.


Natalie Tully is a 3rd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. She plans to pursue a career in surgery, and has particular interest in applying her dual degree in Surgical Research, Pediatric, and Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her 4-legged study buddy, Sadie.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.

Lessons About Healing After Hurricane Harvey

By Jackie Olive

I hail from the foothills of Los Angeles County, where natural disaster comes in the form of forest fires and droughts. Having lived in Houston for over four years for college and now medical school, I’ve learned that disaster here comes in practically the opposite form. Hurricane Harvey was the first significant tropical storm that I have experienced.

Initially, my colleagues and I hadn’t predicted the magnitude of the devastation that our city and neighboring Texas coastline would ultimately face. I remember we first became worried when we heard of friends who were leaving town and grocery stores that had completely empty shelves. We later became shocked when we couldn’t leave our homes because the water levels had dangerously risen and cars had been deserted in the middle of streets.

The immediate aftermath of the hurricane was devastating, as homes were destroyed, families relocated, and stress levels rose high. However, the road to recovery appeared bright, as the volunteer response was overwhelming, even to the point of being in excess at times. Temporary shelters at George R. Brown Convention Center and NRG Stadium actually had to send potential volunteers away. The positive energy and generous spirit of the Houston community were palpable, and it was absolutely vital to cultivate such camaraderie in these most trying of circumstances.

We may think that the biggest hurdle has been overcome. After all, months have passed since the hurricane wreaked immense physical damage on our city. Yet, I’ve learned to appreciate that healing is a dynamic and lengthy process. Sustainable recovery of this kind requires months, even years.

As members of a service-oriented profession like medicine, we anticipate the days when we can discharge our patients after witnessing their labs return to normal or wounds fade. And as surgeons and surgical trainees, we, in particular, feel encouraged when the procedure goes well and we are able to acknowledge the immediate fix and patient’s relief of symptoms. Subsequently, however, what happens after he or she is discharged? Where is home? How will he get there? Who will take care of her if there is a complication? I observe a parallel between post-operative care at some public hospitals and post-Harvey relief efforts: those with fewer resources, including various indigent groups, have a longer road to recovery. Houston’s diversity is one of its strengths, but we must also recognize that it comes with a heightened responsibility to maintain the health of this community.

We are continuing to rebuild homes on the ground in Houston, but I would like to offer the opportunity for others to help in a variety of ways. Most charities prefer monetary donations, as these are more flexible to accommodate changing needs. Please visit this site for specific references to organizations that are supporting the post-Harvey relief effort. I am personally also raising funds for the hurricane relief efforts as I train for the Houston Marathon in January 2018. Any form of support is dearly appreciated and will make a positive long-term impact on our community!

Ultimately, while donations of this kind are always welcomed and productive, it is also important to care for one another on a daily basis. It shouldn’t take a tragedy to build compassion and empower generous acts. I’m humbled by what’s already been done to rebuild our amazing city, and I hope that we may all stay engaged in the future stages of healing from Harvey and other natural disasters throughout the world.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.

 

Jackie K. Olive is a first-year medical student at Baylor College of Medicine. She graduated from Rice University in May 2017 with degrees in biological sciences and policy studies. Jackie is an aspiring surgeon and researches surgical outcomes and therapies in cardiac regeneration. She is also passionate about healthcare and public health advocacy initiatives.

Twitter: @JackieKOlive

Blog: jackiekolive.com


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Hand ties & Heartbreak: My Experiences as a Puerto Rican Surgical Residency Applicant during Hurricane Maria

By Mariela Martinez

News channels have been flooded with images of the devastation caused by hurricane María in Puerto Rico. There are numerous stories about the damages to the health system, infrastructure and economy of the Island. Yet, have you wondered what it was like for Puerto Ricans who experienced this devastating storm? I am a medical student from Puerto Rico and this is my story.

NASA Earth Observatory, Image by Joshua Stevens

Hurricane Maria made Landfall in Puerto Rico

It was 4:00am and I was wide awake for the fourth day in a row. My mind filled with despair as images of the beautiful island I call home  were replaced with destruction. I made another frantic attempt to call them one more time. No success. Calling my loved ones had become a stubborn attempt to restore some normalcy in my life and to re-establish a sense of balance, to pretend this disaster never happened.

I was completing surgical “away rotations” in mainland US when on September 20, 2017, my life changed completely. Hurricane Maria, a category V storm plowed through Puerto Rico causing massive destruction. The delicate power and communications systems in the Island could not withstand the harsh winds and collapsed. Puerto Rico became silent and dark during the aftermath, and I watched in horror from afar as images of the Island showed my home in a state of destruction. I saw buildings collapse and families lose their homes. Places that were all too familiar to me become unrecognizable. The green scenery that characterizes the Isla del Encanto was substituted by murky brown as trees were stripped of their leaves and mud replaced grass.

Power lines scattered across the streets of Humacao, PR on September 20th, 2017. Photo by Carlos Giusti/AP CNN

No communication

In the midst of all this destruction I could not communicate with my loves ones to know if they were safe. I kept calling frantically in an effort to somehow get a response from their phones. When I finally heard their voice in the answering machine,  I was transported back to a state of calm and completeness, and for a split second I forgot that it had been more than 4 days without knowing if they were safe.

While I am safe in the continental US, the destruction of my home breaks my heart while I watch all that I know be torn to the ground. I watch in horror as supplies begin to dwindle and basic needs such as water become scarce. In the midst of all this uncertainty, all I have from my loved ones is silence… no familiar voices, no reassurance. There is no worse feeling of helplessness than knowing that your loved ones are going through the worse moment in their lives and you can’t help. There is no greater sorrow than the uncertainty of not knowing what is needed by those you love in moments of disaster.

Damaged road in Toa Alta, west of San Juan after hurricane Maria. Image by Ricardo Arduengo/Getty Images

Shifting my focus

As I  undergo this painful process of uncertainty for the future of my home and those I love, I suddenly become more aware of others’ misfortunes. Suddenly the cystectomy patient in room 1425 becomes the mother of two who is struggling with depression. I begin to develop a greater sense of what is needed from me as student and I begin to focus my energy on helping patients recuperate. I follow their progress as if they were my own family members, I speak with them as if I was speaking to those I miss dearly back home. They open up their greatest fears and concerns as I also share my own. During the time I spent without being able to confirm the wellbeing of my loved ones I was able to witness hope being restored in the life of a cancer patient who underwent major surgery and the devotion of loved ones during her challenging moments. This terrible experience taught me that sorrow unites people and that we can make a positive impact in the lives of patients despite our own personal struggles.

I  learned that a good stress relief technique was practicing my hand ties. When I felt the sense of despair taking over me, surgeon hand ties helped my mind focus on a different activity and refocused my energy on the task at hand. I devoted my time and energy to learning as much as I could, to keep my mind occupied. I was having excellent days in the operating room and great interactions with my patients, yet at night I stayed up and cried.  My mind was ridden with guilt, with being too tired to answer those late night calls, for being “too busy” to call and hear my family’s voice when I had the chance. The pain of knowing that once I returned home, it wouldn’t be the same beautiful place that I was born and raised in was truly devastating.

My parent’s apartment in Rincon, PR after hurricane Maria. The deck and pool were torn down by the strong swell caused by the storm. The water levels rose and dug under the base of the apartment complex.

The Aftermath of Maria

When I finally heard from my loved ones their words were almost as painful as their silence. “We love you and we miss you, but don’t come back.” They went on to tell me how essentials like food and water had become scarce, how they had to spend the whole day in line for gas, how banks were limiting the amount of cash given per family, how overwhelming the darkness was at night and how difficult (if not impossible) it was to fly out of Puerto Rico after the hurricane. I heard that my best friend’s family lost their house after the hurricane, how supermarkets were empty, patients in the critical care unit were dying due to lack of electricity, and all these things seemed surreal to me. It almost felt like I left Puerto Rico in 2017 and was going to return to an island that was now in the 1900s.

Maria was called the fifth strongest storm to hit the United States and its landfall was described by Jeff Weber, a meteorologist from the National Center for Atmospheric Research, “as if a 50-to 60-mile- wide tornado raged across Puerto Rico, like a buzz saw”. If hurricane Maria was rough, the aftermath has been even more devastating. There were parts of Puerto Rico that saw 30 inches of rain in one day, the equivalent of the amount Houston received over three days during hurricane Harvey. A total of 48 people died during the storm and the death tolls continue to rise exponentially as power and water continue to dwindle.

Residents from Cayey, P.R. seeking water from a local spring. Photo by Carlos Garcia Rawlins, New York Times.

Three weeks after hurricane Maria hit the Island beverage shelves stand mostly empty. San Juan, Puerto Rico. Photo from Mario Tama/Getty Images. Source: ABC News

One month after hurricane Maria, more than one-third of Puerto Rico households (about one million people) still lack running water. This has caused communities to search for water at local streams and water wells exposing themselves to water-borne diseases such as Leptospirosis. At least seventy six cases of suspected Leptospirosis and two confirmed deaths have been reported by Dr. Carmen Deseda, state epidemiologist of Puerto Rico.

Meanwhile, hospitals are currently operating with back-up generators. Roughly three million Puerto Ricans still lack power because less than 20% of Puerto Rico’s power grid has been restored. Photos have surfaced of surgeons operating with cellphones as flashlights due to sudden malfunctions with the hospital generators.

Surgeons using cellphones as flashlights during surgery. The photo was taken by a surgery resident in Puerto Rico and was published at @agarciapadilla Twitter.

Communications continue to be challenging within and outside the Island as seventy five percent of cell phone antennas are still down. There are people still living in their houses without a roof fearing that they won’t receive the help they need if they abandon their homes. Physicians have had to discharge patients knowing that they will probably live on the street because they lost all of their belongings. As I learned more and more about the devastation and the aftermath of Maria, my desire to serve has become stronger and deeper.

The Road Ahead

After undergoing some of the worst moments in my life I am convinced that this has made me a stronger person and better surgical residency candidate. Now I know I have the resilience and the dedication to overcome any challenges thrown at me during my surgical training.

People walk in flooded waters next to damaged houses in Cataño, PR after hurricane Maria. Photo by Hector Retamal/Getty Images. WSJ

We have a long road to recovery but this experience has allowed us to remember we have the strength needed to overcome the challenges we are facing as a country. Our hearts are torn for the loss, the devastation, the catastrophe that is going on in our island. We encourage you to help us rebuild our country by supporting local organizations in Puerto Rico and by joining relief groups.

We will never forget that fateful week of September 20, 2017 and it will inevitably change the history of our island forever but I am optimistic that together we can restore the health of the Island. As a medical student trained in Puerto Rico during this critical time in our history, it will likely take time to emotionally recover from this experience, but I am confident that it has helped me become more sensitive, empathic, and more dedicated to my future patients. After all, like my brother said the first time I spoke with him after the hurricane, “después de la tormenta sale el sol (the sun will always come out after the storm).” For now, I keep my head up high and continue carrying my suitcase from one airport to another as I travel for interviews hoping for the light at the end of the tunnel, not only for me but for all of those back home who are suffering.

Puerto Rican woman with what is left of her home on September 27, 2017 in Corozal, PR. By Joe Raedle/Getty Images (Vox.com)

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.

 

Mariela R. Martinez Rivera is fourth year medical student at Ponce Health Sciences University (PHSU) in the city of Ponce, located in southern Puerto Rico. During her medical training, Mariela has become a recipient of the American Medical Association (AMA) Minority Scholar Award and has been inducted as Junior Member of the Alpha Omega Alpha and Gold Humanism Honor Society for her commitment to serve communities in Puerto Rico. She studied Biology at University of Puerto Rico Mayaguez where she conducted research in Genetics and Admixture of the Puerto Rican population. Mariela then completed a Masters Degree in Human Genetics at the University of California-Los Angeles where she received the prestigious Eugene Cota Robles Fellowship and the NSF Graduate Research Fellowship.

Her interests include urology, oncology, surgery, health disparities, health advocacy, non-profit leadership, genetics and molecular biology. A native from Puerto Rico, Mariela has spearheaded diverse initiatives to increase leadership and advocacy among Latinos throughout her involvement in the Latino Medical Student Association. She is also passionate about increasing the representation of women in medicine and in surgical fields.

She enjoys painting, photography, and singing. Mariela also loves going to the beach and spending time with her family.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.