AWS BLOG

Golden August

By Camila R. Guetter

Created in 1992 by the World Alliance for Breastfeeding Action (WABA), the World Breastfeeding Week completed its 25th edition this year. During the first week of August, campaigns and partnerships take place in order to support and raise awareness on the importance of breastfeeding. It is an international effort that currently involves 150 countries.

This year, to celebrate World Breastfeeding Week’s 25th anniversary, the Brazilian government announced the expansion of this campaign from a single week to a whole month dedicated to the cause, the Golden August. Initiatives include public talks and events, community meetings, advertising on the media, and illuminating monuments and buildings with golden lights. All in an effort to spread even more knowledge and awareness about breastfeeding in Brazil.

The name “Golden August” relates to the fact that breastfeeding is the gold standard for newborn feeding. Compared to Pink October initiatives for Breast Cancer, it intends to make society aware that breastfeeding is a primary preventive measure for many diseases, for both mom and child.

As I  go through my OB/GYN rotation in medical school, I now understand the extent and importance of the benefits of breastfeeding. For mothers, breastfeeding contributes to postpartum weight loss [2,3]. It has also demonstrated risk reduction on ovarian cancer [4], endometrial cancer [5,6], and aggressive inflammatory and invasive forms of breast cancer [7,8].

When it comes to the newborn, breastfeeding plays an important role in the development of the dental arches [9,10], speech, and breathing. It is also a protective factor for allergies [11], infections [12,13,14], gastrointestinal illnesses [13] such as gluten intolerance, obesity [15], and reduces neonatal mortality [16]. Last but not least, it contributes to the effective bond between mother and child. Another recent blog by Nickey Jafari highlights more the benefits of breastfeeding.

Given all the well-known benefits of breastfeeding to both mother and newborn, the WHO recommends exclusive breastfeeding for at least the first six months after the birth of the newborn. Nevertheless, this practice still encounters many barriers worldwide, mainly due to lack of information. Globally, only 38% of newborns receive breast milk until six months of age. The goal set by WHO is to increase this number to 50% by 2025.

Discrimination and criticism over breastfeeding in public is still a major issue in Brazil. In this regard, the Golden August has partnered with public and private companies to empower their employees who are new mothers. Some companies now offer special rooms for breastfeeding, showing recognition of its importance. They offer private and adequate environments for mother-infant interactions and bonding as well as for pumping breast milk, if needed, during work hours. These conditions may lead to less work absenteeism as they improve the ability for women to return to their work routine more easily. They also maintain breastfeeding as a unique and special experience, as it should be.

Happy Golden August to all parents out there!


Camila Guetter is a fifth year medical student at Universidade Federal do Paraná, Brazil. In her third year, Camila received a scholarship to study at UCLA. Subsequently she became a research student at Beth Israel Deaconess Medical Center (Boston, MA) on pancreatic cancer, HPB surgery outcomes, and patient education materials. Camila is passionate about pursuing a career in academic surgery and is currently a Teaching Assistant for Principles and Practice of Clinical Research, a Harvard T.H. Chan School of Public Health course. She currently serves as International Representative for the 2017/2018 AWS Medical Student Committee. Outside of medicine, Camila enjoys playing tennis, playing the piano, and traveling.

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.

 

 

Breast is Best, Supporting Mothers Is Better

By Nickey Jafari

My rotation in obstetrics & gynecology (OB/GYN) was full of emotional moments, and the first time I witnessed a mom breastfeed her baby was one of my favorites; in a culture that so overtly sexualizes women’s bodies, it reminded me that breasts had evolved for the purpose of nurturing a new human life. Of course, breastfeeding is not always easy, and the decision to breastfeed is a deeply personal one for a woman. Mothers who are unable or unwilling to breastfeed should never be shamed for it. However, the health benefits for both mom and baby are plentiful. We should seek to strike a balance between educating people on the myriad of reasons to breastfeed, while not making women feel pressured to do so.

The World Health Organization recommends exclusive breastfeeding for at least 6 months and reiterates well-known benefits, such as reduction in gastrointestinal illnesses for baby, increased neonatal immunity to infections, and reduced newborn mortality. For mothers, the WHO states the reduction in risks of both breast and ovarian cancers as other reasons to breastfeed. Some of the contraindications to breastfeeding can be found here, and include galactosemia and untreated, active tuberculosis.

Given all its benefits, breastfeeding is a public health priority. The CDC Breastfeeding Report Card 2016 shows that most mothers do want to breastfeed, but rates of exclusive breastfeeding through 6 months are as low as 22.3% throughout the U.S. Barriers to Breastfeeding in the United States frames the issue of expectations on breastfeeding very well – “even though breastfeeding is often described as “natural,” it is also an art that has to be learned by both the mother and the newborn”. Thus, education on breastfeeding techniques, such as the best way to achieve a proper latch, should be provided to moms. Empathy and encouragement go a long way, too. I remember on my pediatrics rotation, when we would check in on our new babies, a lot of moms would get frustrated if the process was not going smoothly because of this societal expectation that breastfeeding is an easy and innate process from the get-go. I noticed some moms who gave up because they felt like, since it was not going well, they were failing at being a mom, and others who switched to formula soon after because they were worried about their baby getting enough nutrition. Their decision did not come from any selfishness, but genuine concern for what is best for their child, and thus I always get upset, as someone who does enthusiastically promote breastfeeding and its benefits, when I see someone judge a woman who does not; we have no idea what her journey was. A little encouragement from clinicians to new moms that it is also “natural” for it to take some work, that they are doing a great job and should keep trying, that their milk amount will continue to increase after the first few days of colostrum, can make a world of difference.

Overall, there are far too many impediments to breastfeeding to address in a single blog post, but in addition to better education to new moms by their clinicians, they include changing societal norms and expectations, increasing social and family support, and creating work policies that allow women to breastfeed. Grace DeHoff wrote about her journey into motherhood as a medical student and touches on breast feeding time commitments. A great post about experiences pumping as a surgeon mom can be found here. The fact of the matter is that “many women face barriers to breastfeeding; poor breastfeeding environments where women work, live, and obtain health care are among the biggest barriers” (read more here). One critical policy area where the U.S. lags far behind other developed nations is the issue of maternity leave. The Family and Medical Leave Act only allows for up to 12 weeks of unpaid leave. The AWS maternity policy for surgeons in practice can be found here.

We can and should promote breastfeeding while not making women feel less than as mothers if it is not the best choice for them. We should be especially careful about promoting “breast is best” if we are not simultaneously working to create more flexible work policies, change societal expectations for new moms, and provide the tools that can allow women the chance to successfully breastfeed!


Nickey Jafari finished her third year of medical school at the University of Kansas this past spring and is currently pursuing her Master of Public Health at the Johns Hopkins Bloomberg School of Public Health.

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.

The Greenberg Spike: How speaking out on implicit bias and gender equity in surgery continues to trend

By Marissa A. Boeck

When #ILookLikeASurgeon went viral in August 2015, many expected a short lived hashtag. Yet Dr. Caprice Greenberg, the president of the Association for Academic Surgery (AAS), has shown the conversation on diversity, inclusion, and equity in surgery is far from over. During the recent AAS and Society of University Surgeons (SUS) 12th annual conference in Las Vegas, Nevada around 2,000 medical students, residents, fellows, and attendings gathered to network, mentor, collaborate, and discuss academic surgery. Despite the abundance of stiff competition, the AAS Presidential Address “Sticky Floors and Glass Ceilings” by Dr. Greenberg stole the show.

All those packed into the large event hall immediately knew the focus: women in surgery. This subject continues to be pertinent and necessary to discuss despite many notable advances, such as both the current and incoming presidents of the AAS and SUS being female. Yet Dr. Greenberg steered the conversation away from traditional topics of “women in surgery” as she asked us to rethink what issues actual female surgeons face. She argued the challenges do not boil down to only those associated with parenting. This is especially true since 40.5% of female surgeons do not have children, while 91.8% of male surgeons do, which is why we need to talk about parental challenges and leave versus simply maternity. She then spoke about widespread biases and discriminations against women seen throughout society that also resonate in medicine and surgery, using the Audi #DriveProgess 2017 Super Bowl ad, Huffington Post Pinksourcing video, and The Daily Show’s American Soccer’s Gender Wage Gap video as poignant examples. She showed data from a study of academic science faculty exemplifying hiring gender biases for lab managers based solely on applicant names.

Dr. Greenberg then honed in on specific items most relevant to surgeons: differences in salaries, promotions, and grant funding. The fact that in 2017, based solely on gender, with all other factors held equal or superior in females, women still earn less, fill fewer leadership roles, and have lower grant funding than men is unacceptable.

The impact of Dr. Greenberg’s talk was palpable. From individual goosebumps and frequent murmurs, to occasional outbursts of disbelief and, finally, tears. No one in the room appeared unaffected, women and men alike. An objective measure could be visualized on social media, where metrics for the conference hashtag showed a large spike of almost 750 tweets during the 45-minute talk, greatly overshadowing the other subjects of the day (Figure 1). The diversity-championing hashtag #ILookLikeASurgeon showed a similar increase during the same period (Figure 2), disseminating Dr. Greenberg’s important message to a global community that has likely faced similar challenges in their careers.

Figure 1.


Source: Symplur

Figure 2.

Source: Symplur

Besides firing everyone up for action, the most important part of Dr. Greenberg’s talk was the discussion of potential solutions. The global social media community agreed, as this appeared to be the most shared slide from a quick glance of the Twitter feed. Her suggested systemic interventions for surgery included:

  • Transparent, objective compensation plans
  • Blinded manuscript, grant, hiring, and promotion practices
  • Explicit, purposeful, and fair distribution of uncompensated teaching and service workload
  • Equal leave policies and tenure clock extensions
  • Objective measures of success and milestones for promotion that are defined a priori so everyone knows the rules
  • Institute educational programs on implicit bias and its impact

Only through the wide adoption of targeted actions that aim to recognize and address surgical workforce inequities, such as those listed above, can we actually hope to erase them. This includes organizations speaking up, such as the Association of Women Surgeons’ Statement on Gender Equality. Although frequently labeled as women in surgery problems, these issues cast a wider net, encompassing all those affected by implicit bias; in other words, potentially anyone. Yet together we can make surgery a field that accepts and promotes anybody who has the passion, stamina, and drive to succeed within a challenging but rewarding profession, irrespective of personal characteristics that have no bearing on one’s potential or worth.

Photo credit: Dr. Danielle Sutzko @LoupesLoveMD

Dr. Greenberg’s final slide starkly projected #ILookLikeASurgeon and #HeForShe in large white font on a black background, inviting the audience to continue the conversation, both on social media and in real life, until we all receive equal compensation and consideration for opportunities for professional and personal success.

From left: Nelly-Ange Kontchou, Heather Logghe, Caprice Greenberg, Marissa Boeck. Photo credit: Dr. Susan Pitt

Resources:
2017 AAS Presidential Address By Dr. Caprice Greenberg, Introduction by Dr. Rebecca Sippel
Ladies Get Paid (@ladiesgetpaid) – Helping women advocate for themselves to get recognized and rewarded
He For She (@HeforShe) – United Nations Women’s mission for gender equality
Why So Slow? The Advancement of Women by Virginia Valian
Carnes, Devine, Baier Manwell, Byars-Winston, et al. “The Effect of an Intervention to Break the Gender Bias Habit for Faculty at One Institution: A Cluster Randomized, Controlled Trial.” Academic Medicine 2015; 90(2): 221-230. Link


Marissa A. Boeck MD, MPH is a general surgery resident at New York Presbyterian Hospital – Columbia. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings.

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.

To Look in the Mirror and Not See Further than My Neck

By: Natalie Tully

January is Thyroid Cancer Awareness Month. As you may have read in an earlier blog post, thyroid cancer is the most prevalent cancer in young women under 25. This is the story of one of those young women.

It was June of 2011, and I had just come home to Pennsylvania for summer vacation after completing my sophomore year at the University of Texas (and finally passing organic chemistry). In an effort to get back in shape for our family beach vacation (and after six months of eating like a nineteen-year-old college student does), I went out for a bike ride. Naturally, I was drenched in sweat when I got home and decided to give my mom a sweaty hug-a move she wasn’t exactly keen on. As we play-fought, I turned my head to the side and instantaneously, she went from mom to nurse. She saw a lump protruding from my neck and rapidly went about evaluating it. She decided that the Otolaryngologist I was scheduled to see later that week (nothing says summer vacation like getting your nose cauterized) would need to examine it as well.

Fast forward through that appointment, an ultrasound, and an FNA-all of which lent increasing evidence to suggest the mass might be malignant. A few weeks later, I found myself in pre-op (with a wicked sunburn I got to protest the ordeal) about to go in for either a lobectomy if the mass was benign, or a total thyroidectomy if it was concerning for cancer. I awoke afterwards to a drain coming out of my neck, and spent the next day in my room, trying to digest that the mass was malignant and they’d taken the whole gland. My oncologist (also my neighbor) came in to tell me that the pathology report indicated that the tumor had been papillary thyroid cancer, follicular variant. That meant that when I got released that afternoon to go back to the beach for family vacation, I’d need to start a low iodine diet. Missing out on my favorite foods made the diet seem nothing short of exasperating. Eventually, I got through the diet and took the I-131 dose-followed by five days of isolation (during which I became addicted to How I Met Your Mother, and my mom served me meals on a silver platter at my bedroom door). At the end of the week, my whole body scan was clear indicating the radioactive iodine treatment was complete. Two days later, I found myself on a flight back to Austin to start my junior year of college.

My whole experience of being a cancer patient lasted about 5 weeks from discovery to completion of treatment, which had some pros and cons. On the plus side, I had early-stage disease that was treated quickly and without complications, but the rapid timeline didn’t leave me much time to process what was going on. There were some lingering issues, not having an established endocrinologist being one of them (hypothyroidism + college classes + job=not good). By and large, I was able to return to my life mostly uninterrupted with not much more than a scar on my neck as a reminder. I feel profoundly fortunate for my cancer experience-I was surrounded by people who cared enough about me to let me be angry at them, because they knew far better than I did what was at stake.

So there it is, my mostly tame cancer story. Today, I’m a (mostly) normal 25 year old who takes a pill every morning and has to get bloodwork/scans every so often-really not a bad setup in comparison to a lot of medical conditions. In conclusion, I’d like to share a few thoughts about thyroid cancer that may be helpful to providers:

  1. There is not a simple way to ‘prevent’ Thyroid Cancer- Exposure to ionizing radiation is a known risk factor-but very hard to modify for most patients.There are common-sense steps to improve detection of early disease. Not everyone is lucky enough to have an observant and persistent mother to find their lump for them. Whether it’s breast awareness, thyroid awareness, or anything else-be aware of your body and act when it something doesn’t feel right.
  2. Atkins and Paleo ain’t got nothin on Low Iodine-Thanks to salt being in everything, and most of that salt being iodized, almost anything in a package is off-limits. In time, I’ve come to appreciate what being on the diet did for my awareness of eating whole foods, but at the time, it was the bane of my existence. Take time to read up on the diet to understand (and help counsel) your patients when you prescribe it.
  3. Yes, Thyroid Cancer is a ‘good cancer’ to haveBut you still have cancer. Look at this post-almost six years later and I can remember details down to the scrubs that my nurses were wearing. It’s an emotional event, even if the long-term prognosis is very good. Be mindful of this when diagnosing and treating all of your patients-any diagnosis is a big deal for them.

 

Natalie Tully is an headshotMD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. Before starting medical school, she received her bachelors of science degree at the University of Texas at Austin followed by two years working in basic science research at Baylor College of Medicine. Natalie hopes to pursue a career in surgery, and has particular interest in applying her dual degree in Pediatric or Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her dog, 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.

Dressing Your Best, Inside Out

By: Natalie Tully

Every year after the post-midnight New Year’s celebrations wind down, we each start the all-too familiar process of declaring resolutions for the coming twelve months. In that spirit, I hope to explore ideas (most old, but perhaps a few you haven’t heard) and encourage some of you to put on your best self in 2017- mind, body, and wardrobe.
Dressing your best-literally
Fair warning: most of my clothing is sportswear and I prefer the DMV and the Dentist to going clothes shopping. That said, this is something I struggle with but have found strategies that result in me feeling more confident in professional situations without excessive strain.

  1. Err on the Conservative-Yes, you’ve heard this ad nauseum, but no matter your career stage or if it’s an interview, clinic, or social event, you never want your clothing to distract from you. If you question your outfit’s appropriateness, either change or double check with someone else. You don’t have to wear a Muumuu, but do focus on well-fitting clothes that present a great you.
  2. Comfort adds to Confidence- Feeling comfortable in your clothes can help you feel comfortable in your own skin and contribute to your overall confidence. Finding clothes that fit you and your style comfortably can help you to feel at ease. If you’re not the type to define ‘your style’ (I call mine Gym Clothes Chic), finding a few pieces that you love can be a great way to dip your toes in the water.
  3. Form, but Function- Whether it’s shoes, a skirt, or any other piece of clothing, you should like the way it looks, and looks on you. One caveat to that, however, is that it’s important to balance that form with functionality- probably most notably with shoes.

These are some themes that help me to feel professional and confident without sacrificing my femininity. If you’re looking for more specific fashion advice, particularly for interview apparel there is a great blog post at Love and The Sky covering this topic.
Putting your best foot forward
Putting on your best self goes much deeper than your clothing-and one important facet of dressing your best is taking care of the body wearing the clothes. The demanding schedule of this field can make it challenging and sometimes impossible to maintain a diet and exercise routine-but giving your body a leg up where possible can have wide-ranging benefits.

  1. Small Steps to Bigger Change-Whether it’s taking the stairs in the hospital, adding an extra block to your evening walk, or playing tag with your kids or pets-exercise does not have to take place in the gym or on the running trail. What is most important is not the duration, intensity or frequency of your exercise-but simply doing it.
  2. Fuel your Success-3am graham cracker and peanut butter sandwiches washed down with coffee or juice are a reality of this field. Eating better can range from meal prepping on a day off, having one whole-food-only day a week, or even just replacing one candy bar with an apple-little changes add up. Find the modifications that fit in with your life and needs, and you will likely find them more palatable to maintain.
  3. The Pizza and Couch Cleanse-This is the part where you forget those two previous points briefly. When your body needs a break, listen. Everyone gets sick, has sleepless nights, or can even be injured- give your body a chance to heal before making it worse. Additionally, enjoy the foods you love, and when you honestly don’t have the energy to cook, don’t-forcing healthy food and cooking on yourself will make you hate them.

Our bodies are the machines that we use to make our work and lives happen, so it only makes sense to keep them in the best working order possible. This is a time of year when many people are looking to change their bodies, but shooting for improved wellness over a dress size or scale number is a far more important goal.
Your most important look is your outlook
The start of the year is always a little bittersweet for me-it represents the return to work/school and the stress that it and the tasks ahead in the year bring. Battling stress and negativity is a constant challenge-one I struggle with mightily-but the way you see into the mirror is the foundation of how others see everything on the outside.

  1. Breathe, just breathe- Taking even a few seconds at the beginning of the day, during stressful moments, or in the car at home can be profoundly beneficial in dealing with acutely stressful situations as well as dampening general stress. Building this habit into your daily routine is a great change by itself or as part of building a meditation practice.
  2. Check your boxes, fill your buckets-All of us have seemingly endless to-do lists-it’s so important not to feel enslaved or entrapped by them. Give yourself credit for accomplishing each task, and use it to build toward successive tasks in your day (H/T to this speech). Use this momentum to get through your day, but keep track of your mental ‘buckets’ so that you can find ways to replenish your stores.
  3. Small bricks build big buildings-It’s so easy to let little failures chip away at our confidence and spirit, forcing us to put on a defensive front simply to survive. Allow yourself infinitesimally small victories, and use them to reassure yourself in times of doubt and to build a stronger foundation for your own sense of well-being.

A very wise person once told me never to give rent-free space in your head to anyone or anything. Working toward a more positive outlook and sense of self are critical steps to creating a stable framework on which to build a healthy body and perch clothes that add to your positive image and confidence, and contribute to putting on your best, most well self for this new year.

headshotNatalie is a 2nd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. Before starting medical school, she received her bachelors of science degree at the University of Texas at Austin followed by two years working in basic science research at Baylor College of Medicine. Natalie hopes to pursue a career in surgery, and has particular interest in applying her dual degree in Pediatric or Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her dog, 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.

The Road to Wellness

By Jaime Lewis

The road to wellness is often less than straight and narrow. Some stretches are full of potholes and construction barriers, causing delays, requiring tolls and taxes for passage, while other sections are smoothly paved, wide open, and headed straight into the sunset.

However the journey proceeds I have found it is peppered with choices and opportunities to make myself a little happier, a bit healthier, and perhaps a little more “well”. Some moments it’s a choice of how to respond or react, how to understand my own emotions, or how to interpret the actions of another. Other days it’s making the choice to eat the healthier meal, to run the extra mile, to play with my children, or in my professional sphere- to finish up my charts, respond to a committee request, or spend a few extra moments with a resident.

Recently I have worked to formulate goals which I believe will help me progress on my journey to wellness. While I may stumble along the way, I will strive to:

  1. Understand my place in this world in the many roles I play. I will be true to myself and not pretend that I can be everything to everyone.
  2. Focus my efforts where I believe I can make a difference and work to understand the opportunities and limitations as they exist. I will not try to change the world overnight.
  3. Align my actions with my core values and central beliefs while allowing them to evolve. I will attempt to act in ways that are expressions of who I am rather than who I am expected to be.
  4. Be physically active on a regular basis, eat a healthy diet of real food, and enjoy the benefits of relaxation and regeneration. I will relish my time running rather than regretting what I’m not otherwise doing. I will be mindful about the nourishment I choose. I will make time to rest.
  5. Understand my own value and worth without comparing it to others. I will work to accept that my path is different and uniquely mine. It’s all about the journey.
  6. Challenge myself when I need to grow and forgive myself when I have failed. I will not be satisfied with stagnancy and will give my heart time and space to heal when necessary.

And I will remind myself that in order to care for others, I must be well myself. And the lessons I learn will be used to help my family, friends, and patients care for themselves and others.

As we head into this holiday season and the New Year is upon us, I wish that all of you may find a little wellness each day in the hustle and bustle of it all.

Namaste.

 

jaimelewisJaime Lewis practices breast surgery at the University of Cincinnati where she also completed her general surgery residency. After residency, she also completed a one-year fellowship in breast surgical oncology at the Moffitt Cancer Center. Outside of the hospital, she enjoys running, cooking, and 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.

Coming soon! AWS on Facebook

By Cornelia Griggs

Like most surgical residents, I used to think of social media as an easy way to connect with friends, to discover interesting articles, and a way to occupy my hands during the (few) idle moments of my day. Whether it was scrolling through Instagram while waiting for an elevator or checking out articles on Facebook before I fell asleep at night, social media was just a casual time filler. Over the past year, however, social media has played an increasingly important role in my professional world. Shortly after I had my daughter in October, one of my attendings added me to a secret group on Facebook for surgeon mothers. The group is an offshoot of a hugely popular community that many of you may have heard about- the Physician Moms Group, which now has over 60,000 members. As Dr. Stephanie Bonne described in her blog post last week, these communities have created a (semi) protected space where physician and surgeon mothers can go to vent, seek advice, share tips and find other amusing and useful information about navigating life as a physician/surgeon mother.

At first I was just a lurker in these groups, casually scanning through pages and posts while I was up nursing my daughter in the middle of the night. But as my maternity leave drew to a close, my anxieties about returning to the operating room loomed large. Pumping at work and in between cases seemed overwhelming if not impossible. The idea of being away from my daughter for twelve or more hours a day made me want to bawl. But suddenly I had found a group of women who had done it.

These women had not only survived but appeared to have built happy families despite the demands of being surgeon. So I reached out. I sent a few Facebook messages and posted asking for tips on breastfeeding while in surgical residency. Within minutes, multiple women had written back to me and shared their stories. A resident from another program in Boston sent me her number and we bonded for over an hour about surgery, residency, motherhood, and the juggling act it takes to manage it all. She assured me that there would be days when I would miss my daughter so much that I would question my career choice. She also assured me that a few weeks back into residency I would find a new normal — that making it home to give my daughter her bath and put her to bed would feel like a little victory, just enough to keep me going. We comforted each other by reminding ourselves that residency is temporary and one day we would have a modicum of control over our schedules. Suddenly, the whole endeavor seemed not only possible but manageable.

With this new community at my fingertips, I became motivated to get involved with the AWS and signed up to join the Communications Committee led by Dr. Stephanie Bonne and Dr. Heather Yeo. I co-hosted a mixer at my home for women medical students interested in surgery. When some of the students asked me how I was managing the transition back to residency with an infant at home, I was brutally honest. I was scared, overwhelmed and knew that the first few weeks away from my daughter would probably be torture. Now, almost three months into PGY-4, there are definitely days that I ache for the long, lazy days I spent with my daughter on maternity leave. When cases run late and I come home after she’s already asleep, I feel defeated. I open up Instagram and feel sorry for myself when I see posts from the “mom friends” I made on maternity leave. Many of them have more flexible jobs where they can take off days during the week. I’m overcome with “FOMO” (fear of missing out) when I see posts of them at the Boston Children’s museum or the sprinkler playground on a sunny day. given everything I’m missing out on at home, social media can sometimes make me question whether the path I’ve chosen is really worth it .

But then I dream of the woman I hope my daughter will become some day. I know that I must lead by example if I want her to believe that she can set ambitious goals for herself and follow through with them. When I’m reaching hour 80 of my week and the fatigue makes me doubt my choices, I open up our Facebook group and look at pictures of all the women surgeons who have come before me. Surely if they can do it, I can do it too. These women are posting tips for passing the boards, the best shoes or music to have in the OR, or even just sharing little successes from their day. In this community I have found a small tribe of women who have walked in my clogs. While there are great women role models at my residency, somehow this online community feels more accessible.

Our hope on the AWS communications committee is to create another group  where all women surgeons and trainees, not just mothers, can come to find friendship, advice, support, and even a daily dose of humor from like-minded women across the country.. Be on the lookout on our Facebook page in the next month or two. If you have interest  in joining our group, you can also reach out to me on Facebook, Instagram or Twitter (@cornelialg for Instagram and Twitter). I look forward to connecting with many of you!
C briggsCornelia Griggs, MD is a PGY-4 General Surgery resident at the Massachusetts General Hospital (MGH) in Boston, MA. She completed a surgical critical care fellowship at MGH from 2014-2015.

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.

An Open Letter to Young Women Considering a Career in Surgery

This post originally appeared in Hot Heels, Cool Kicks, & a Scalpel

 

Dear Young Woman Considering a Career in Surgery,

It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself  if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday,  remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with  your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required,  you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for  you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters,we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers.https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee

dg-strappysAbout @surgeoninheels: I am an acute care surgeon specializing in trauma, emergency general surgery, and surgical critical care. I am married to an incredibly supportive husband who is the primary childcare provider, homemaker, and diy’er in our home. I began running with him two years ago and we plan to run many half marathons together. While navigating the abyss between work and our two children and small dog, I also do as much Zumba, Stott Pilates reformer, and shopping as I can.


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.

 

#AWSfood4thought : Here’s to the Dads

By Heather Logghe

This Father’s Day I would like to give special thanks to the dads who lovingly support their women surgeon partners. My husband, Chris, has been one of them.

I embarked on my intern year when my daughter, Sierra, was only three months old. The journey never would have been possible without Chris, who left his “dream job” to fulfill the role of lead parent. Notably, three of my fellow female residents also had children cared for by stay-at-home dads. Just as their husbands had done for them, Chris’s love and support made the emotional and logistical challenges of residency surmountable. During orientation week when I was still nursing, requiring me to“pump” away from home for the first time, I found I had forgotten an essential part for the process; Chris brought it in without hesitation. He also delivered homemade meals when I was on call, while picking up a warm bottle for Sierra’s “dinner.” He kept our home life organized, while regularly texting messages of encouragement and adorable pictures of special moments with Sierra to help me feel connected despite being away at work. His efforts as a father and partner were and continue to be invaluable to my career.

Beyond the immediate benefits to their partners’ careers, the sacrifices made by dads partnered with surgeons may have more far-reaching benefit. A study by Alyssa Croft showed the strongest predictor of girls wanting to go into less traditional, potentially higher-paying careers was having fathers who helped with the housework. “Even when fathers publicly endorsed gender equality, if they retained a traditional division of labor at home, their daughters were more likely to envision themselves in traditionally female-dominant jobs, such as nurse, teacher, librarian or stay-at-home-mom.” Thus, male spouses of surgeons who “walk the walk” by contributing equally to domestic responsibilities (or even more than 50%, as is often the case), are likely to have a longer-lasting and more significant impact than dads who simply “talk the talk.”

These brave and engaged fathers who dare to “break the mold” are role models for the next generation. I’ll never forget a comment my 8 year old niece made as she watched her two year old brother carefully hold a bottle for Sierra. She said, “You better learn how to do that Johny, because there’s a 50% chance you’ll marry a doctor some day and have to help at home.” While I’m not sure where she got her statistics, I was impressed by her 50/50 mindset.

As co-workers, we don’t often have the chance to meet the partners who support our female or male colleagues behind the scenes. Rather, we tend to “feel” their presence and benefit from their support indirectly–such as when we enjoy the food they lovingly cook for their wives on call, or oogle over the cute kid pictures they text their wives. Most of the time, their job is thankless. And yet, they continue to do it anyway, 24 hours a day, 7 days a week, making it possible for their surgeon partners to be fully present with their patients.

Here’s to the dads.

HeatherLoggheHeather Logghe, MD has completed two years of general surgery at the University of North Carolina, Chapel Hill.

 

 

 

 

 

 

 

 


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.

 

Distracted Driving

By Stephanie Bonne

As a trauma surgeon, my main academic interest has been injury prevention.  It just makes sense to me – the easiest trauma to recover from is the one that never happened to begin with.  This takes on many forms, from violence prevention to safety, to addressing the problems at the intersection of poverty, education, and injury.

As part of this mission, I have occasional speaking engagements in the community.  Last year, I was asked to speak at my state’s highway safety coalition meeting about distracted driving.  I prepared a powerpoint full of statistics and videos, and stood in front of several hundred people, emphasizing the dangers of distracted driving and how important it was for everyone to spread the word.

But like most physicians, I was terrible about practicing what I was preaching.  It started with checking text messages at stop lights, but got worse from there.  A glance from the road to my screen when I was driving to see who just texted me, a quick check of my inbox to make sure it wasn’t anything urgent.  Pretty soon I was writing full emails while sitting in stopped, or sometimes not-so-stopped, traffic.

And then it happened.  I was about a mile from home, coming back from a quick run to the store.  Sitting at a stoplight, I was looking at an email my assistant had sent.  It seemed like something kind of important, like I might need to call her, and I was trying to finish reading when the light turned and I rolled into the intersection.  A block later, lights and sirens behind me.

“Officer, I’m not sure what I did.”  I rushed through the last 5 minutes in my mind.  I know I wasn’t speeding.  Was my taillight out?  Had the light turned from yellow to red as I was going through the intersection?  It occurred to me that I didn’t really know if the light had changed, because I wasn’t paying attention.  How terrifying.

“You were texting and driving.  I don’t usually pull people over for this, but you were not even looking at the road.  I’ll let you off with a warning.”  He glanced at the empty car seats in my back seat. “Don’t you dare do this with the kids in the car.”

Silence. 

Distracted driving, just don't do it!

Distracted driving, just don’t do it!

How embarrassing.  In one experience I was, sanctimoniously standing in front of hundreds of concerned citizens, and in another I was so distracted I actually got pulled over.  When I told the officer that I was a trauma surgeon, he commiserated.  Yes, he said.  Sometimes he texts and drives too.  And then he sees someone like me and is reminded how very dangerous it is, and stops for awhile.  But it creeps back in over time.

April is distracted driving awareness month, let’s all make the commitment to stop distracted driving. It can wait.  If you feel the urge to reach for your phone – stop.  Think of your family and your patients, or think of me and this ridiculous photo I’ve included below, with my ticket.  Put your phone out of reach when you get in the car, if it’s that hard for you.

If it’s an emergency, use your Bluetooth technology and call, don’t text.  While driving and talking on the phone is still dangerous, it’s not nearly as dangerous as texting.  And don’t do the worst thing of all – voice recognition technology.  Because proofreading the text you just recorded is the most dangerous form of texting and driving.

You are no good to your family or your patients if you are dead.  It’s serious.  Don’t do it.

BonneS_4095_72Dr. Bonne is a board-certified general surgeon with additional training and certification in Surgical Critical Care.  Her clinical interests are in trauma and injury prevention, trauma epidemiology, and infections in the surgical intensive care unit.  She participates in the American College of Surgeons, the Eastern Association for the Surgery of Trauma, and the Society of Critical Care Medicine. She leads the American Medical Women’s Association Gun Violence Prevention Task Force.  Dr. Bonne is the current Communications Chair for the AWS, and also serves as the faculty advisor for the Rutgers New Jersey Medical School chapter.  She is a wife and mother to three young children.

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.