AWS BLOG

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.

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.

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.

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.

When Disaster Strikes

By Dr. Minerva Romero Arenas

#HoustonStrong #HurricaneIrma #FuerzaMéxico #PRstrong #VegasStrong

Our world has been in the midst of what seems like an endless series of tragedies. This blog started out as an idea to write about how I was inspired and proud of the goodwill shown by my fellow Houstonians (and other Texans and neighbors) in the aftermath of hurricane Harvey. Much like this love letter. Much like my colleague’s reminder to look for the helpers when disaster strikes. However, it quickly became a seemingly insurmountable task. Just as I was trying to pen a few lines, another disaster was brewing in the Atlantic. Then the earthquakes hit México. Another set of hurricanes. Yet another mass shooting.

Staying safe. Trying to help. Then trying to keep up with everyone’s safety and figuring out how to help in the aftermath. Donate. Volunteer. Meteorological maps seemed like something that could only have come out of a Hollywood blockbuster. I can’t imagine that I would find it essential to follow @NWSNHC, @SismologicoMX, or @weatherchannel? And if I never have to sleep with an eye open for flash flood warnings or tornado warnings… it may be too soon.

To be quite honest, there were a lot of days the past 6 weeks that seem like a blur.

Thankfully, I had my work to help keep my mind (and hands) occupied! I am thankful for the teamwork shown at our hospital, where 1 in 3 employees were affected. Colleagues swam to work, camped out for days unable to assess the safety of their own families or homes, and everyone who boldly came back to offer relief as soon as it was reasonable to do so. It was amazing to see the “good neighbor” spirit that was showcased from Houston to the world – an example to be seen again in tragedy after tragedy.

On a personal note, I have found a way to turn these events into a positive by taking time to reflect on everything. I have made more time than before to actually consider important questions like, am I okay? Am I putting my best effort to live a meaningful life? How can I be part of the solution? Have I done everything I can to help others?

I am thankful for the human spirit and solidarity that continues to shine through disaster after disaster. I am thankful more of our ACS leadership continues to engage in meaningful discussion about firearm injuries. Most of all I am thankful for my colleagues, friends, and *my family* – their compassion, determination, and strength is truly inspiring and figuratively and literally helped me “weather the storm.”

A message from the AWS Blog Team: This is the first in a series of blogs 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.

Minerva A. Romero Arenas is an Endocrine & General Surgeon joining the faculty at the University of Texas Rio Grande Valley. She completed a fellowship in Oncologic Surgical Endocrinology at the UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.
Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.
She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.


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.

 

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.

 

 

BLOG for FINDING FRIENDS

By Beth Shaughnessy

This lifestyle we have chosen seems to come in 4-5 year runs, Each new phase of training means we may have to pick up and move somewhere else, again. At least until we get that first real job. And with that comes a little loneliness. What if we have never lived there before? What do I do to find a friend?

Before I left for my fellowship in Los Angeles, I had lived in Illinois nearly my entire life – and was lucky enough to complete medical school and residency training close to home. I knew NO ONE in California except for my husband. As I started fellowship, he appointed me his social secretary! What to do? The social culture was a bit different in L.A. as compared to Chicago, as compared to Cincinnati where I now live. In California, people tend to live farther away, commuting long distances. Gone were the days of spontaneous get-togethers with co-workers. Locating friends nearby was not so easy. People kept to themselves more. Obviously, this was one of those times I would have to take matters into my own hands and be proactive. So, how did I find like-minded individuals? The easiest way for me was to find some common ground. These are some of the ways I was able to make new friends as an busy professional in a new city:

  • Take a class: My yoga friends have been around 12 years now. We support each other, we network, celebrate weddings, suggest restaurants, etc. No one else in this group is in medicine, and it is refreshing to get a different perspective. Find something that you are interested in, such as yoga, spinning, cooking, photography, painting/art, bee-keeping.
  • Volunteer: I helped to organize the Susan G. Komen Affiliate in L.A., then contributed to the new one in Cincinnati. Met lots of people through this organization.There are many ways to donate your time, such as putting on a running race or bicycle race, or help with the handicapped, or be a big sister through the “Y”.
  • Join a club for running, hiking, bicycling, book club, or an organization like Sierra Club, a club for a cause.
  • Neighborhood meet-ups.
  • Network with existing friends to find names of people they know in this new city. You are more likely to meet a potential new friend in someone who knows a friend of yours.
  • Become active in an alumni organization or chapter. In Los Angeles, I met up with women who had been members of my same sorority in college. They came from a wide variety of ages and backgrounds, from many parts of the country.
  • Get a dog and walk that dog. They don’t call it a people magnet for nothing.
  • Go to a fund-raiser that is meaningful to you, and introduce yourself to a lot of people, and/or volunteer to do something for that charity.

In reading articles on new websites, meetup is supposed to have notices of multiple meetings that you could possible go to. Bumble is supposed to be a new way to find your next BFF. I haven’t tried it, mostly because they are new.

Finding new friends as we get older becomes more challenging as we age. This is well-documented, but not impossible. Think about it; making a friend takes time and emotional investment. It takes a certain level of commitment, albeit as small or as large as you are willing to commit. And it usually starts with finding common ground. As the demands on our time grow, and we might get a career, get married and might start a family, the extra time shrinks. So does theirs. Friendships through classes or activities help to serve you in participating in an activity, but also having a friend with whom you have something in common. You can keep the commitment at the level of the activity only, or you can expand beyond it, depending on your time constraints.

But take heart; remember you have made friends before, and you will make friends again. They don’t come prepackaged. Try to remain loose, flexible, and open to conversations and meeting new people. One lasting friendship I made casually through a discussion in a grocery store, commenting on the person’s sweatshirt design, and the individual became like family in time.


Beth Shaughnessy was born and raised in the Chicago area, leaving to go downstate for college at the University of Illinois at Urbana-Champaign, but returning for medical school at the University of Illinois at Chicago. After residency at the University of Illinois’ program, she felt she became too inbred, so she left for Los Angeles to complete a fellowship in surgical oncology at the City of Hope National Cancer Center. She is currently a professor of surgery at the University of Cincinnati, in Cincinnati where she lives with her husband and son. She enjoys cooking, yoga, the arts, choral singing, and gardening.

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.

Perception of Personal Success in Burnout

By Shree Agrawal

In the preclinical years of medical school, the idea of burnout among healthcare workers is more of an abstract concept. The unique environment of healthcare, regardless of specialty or academic/private practice settings, has been shown to make all healthcare providers vulnerable to burnout.(1)(2) In my observations on clinical rotations, it seems highly successful peers, trainees, and faculty, who may have multiple publications, excellent clinical skills, and a strong work ethic, can also be the same individuals who unexpectedly experience burnout. Interactions with someone who does not realize they may actually be experiencing burnout are challenging, even for individuals who are at the fray of most clinical situations.

Some of the key manifestations of burnout include emotional exhaustion, cynicism, depersonalization or isolation, feelings of ineffectiveness, and lack of accomplishment, as shown in Figure 1.(3) Some of these features are difficult to fully notice in brief professional interactions with peers and superiors. Instead, common outward defining behaviors in burnout may be a focus on professional survival, fewer reflective practices, reduced desire to be at work, and/or a diminishing appeal of clinical and non-clinical activities.(4)

Figure 1: Factors contributing to and subsequent manifestations of burnout

For all the successes visible to the outsider, the relevance of personal and professional accomplishments to the person, who may be burned out, appear less significant. A component of this perception could be individual focus on future goals and milestones. Regardless, I am curious. Does the perception of personal success change in the process of burnout? Do achievements seem less worthy in the face of factors contributing to burnout?

Even though I would posit my observations are a multifactorial outcome, studies would imply this is not an uncommon phenomenon. Research within healthcare settings demonstrated insufficient recognition of employee contributions corresponded to healthcare providers feeling less respected and valuable to their organizations. This belief alone can cause providers to experience higher levels of emotional exhaustion, feelings of ineffectiveness, and subsequent burnout.(5) Another study suggests individuals who identify as a minority in society may receive less recognition and credibility for their accomplishments/capabilities when compared to their counterparts. Many minority participants in this study expressed already feeling burned out in their training. They stated their role on the team was not viewed as meaningful, or worse, unsatisfactory. Alarmingly, some minority participants not only revealed their feelings of inferiority to their peers but also doubted their own accomplishments, abilities, and personalities.(6) The infrequency or lack of recognition in healthcare both contributes to burnout and reduces individual perceptions of professional competencies and capabilities.

On the blog, we have talked about practicing gratitude and cultivating resilience in the face of burnout.(7,8,9,10) While these are important tools, I wonder if we should also encourage the practice of acknowledging both our own success ladders and those of the people working alongside us.

Outward recognition, while not common within medicine, is crucial to defining individual success. It facilitates finding value in our professional responsibilities, validates personal efforts for growth, and positively changes the perception of personal success. Recognition ultimately nurtures essential skills, traits, and resilience required in the practice of medicine.


Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, 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.

June is National Safety Month

By Doreen Agnese

I have always been a woman of few words. Always a good student who got A’s on exams, but when my classmates were filling blue book after blue book with elaborate prose, I struggled to fill a single one. While many of my colleagues document patient encounters with lengthy notes, my notes are very brief- but I do believe just as thorough. Despite all of that I find myself here composing a blog. So what do I say? What do I discuss? It turns out that June is National Safety Month. It seems to me as though every month should be a safety month, so I think that this is as good a topic to blog about as any other. We are surrounded by the culture of safety at work, but what else should I be thinking about? Just what is a “National Safety Month?”

Google is a useful tool, and it brought me to the National Safety Council website. It probably comes as no surprise that many deaths are preventable. But what is shocking to me is that there are 140,000 preventable deaths in the United States every year. That’s a death every 4 minutes caused by things like car crashes, poisonings, and falls. What can we do to keep each other and our loved ones safe?

Poisoning? I had no idea that this was the leading cause of unintentional injury and death over motor vehicle accidents! I guess it’s not surprising with the current opioid crisis. Every day, 52 people die from opiods. Perhaps I can be more observant of how many Percocets we provide patients after relatively minor, or even major, surgery. On one occasion before leaving for home after breast surgery, my patient requested a prescription for FEWER Percocets, as the resident had written a script for 90! Ninety! After a lumpectomy and sentinel lymph node biopsy! Most of my patients tell me that they have only taken a few Percocets after their surgeries and have adequate pain relief with Tylenol of Ibuprofen. Rather than leave the mundane tasks of providing scripts for post-operative pain relief to the resident, I can do a better job of providing education so making sure that they provide adequate pain relief to patients without and don’t over-prescribing narcotics. That won’t solve the opioid problem, but at least we can have fewer pills circulating out there.

Every day about 100 people die in motor vehicle crashes and more than 1,000 suffer life-changing injuries. Motor vehicle crashes are the #1 cause of death for children and young adults ages 5 to 24, and the #2 cause of death for adults 25 and older and for toddlers, according to the ​Centers for Disease Control. What steps can I take to prevent car accidents? The first thing that comes to mind is reducing distracted driving. We have to remember that nothing is so important that we need to check our phones while driving. I can avoid it and encourage my friends and family to not text and drive. What else? I can also remember that it’s better to be late to an appointment than to not make it at all. We are always in such a hurry, which may contribute to aggressive driving and road rage. Maybe it’s OK to slow down (OK, honestly one of my partners often ends up driving behind me on the way into the hospital and often makes fun of how slow I am—driving the speed limit. This one won’t be much of a stretch for me!).

OK! Next…falls. Apparently, more than 30,000 people died in falls in 2015. This is the third leading cause of unintentional-injury-related deaths for all age groups, but number one in those 65 and older. I think that I sometimes lose sight of this, since everyone on the entire surgical floor seems to be at high risk of falls! I already do a few things in the clinic to try to prevent falls. We always have a team member to help the patients on/off the exam tables. Hate to hear a crashing sound when I leave the room. What else can I do? I could encourage my patients to practice Tai Chi. Several studies have shown that Tai Chi can significantly decrease the risk of falls in inactive older adults. One study demonstrated that a three-times-per-week, 6-month Tai Chi program was effective in decreasing the number of falls, the risk for falling, and the fear of falling, and improved functional balance and physical performance in physically inactive persons aged 70 years or older (J Gerontol A Biol Sci Med Sci. 2005 Feb;60(2):187-94).

There are so many other causes of preventable deaths to consider: choking and suffocation, drowning, fires and burns, natural and environmental incidents and so many others. I can’t possibly address them all. I can spend some additional time considering how to keep myself, my family and friends, my colleagues and my patients safe. So as a woman of few words, please consider these. Don’t use your phone while driving, be mindful of overprescribing narcotics, and spend a few extra moments figuring out how you can contribute to a culture of safety, this month and every month.


Doreen Agnese, MD is Associate Professor of Clinical Surgery in the Division of Surgical Oncology at The Ohio State University.  She was born and raised in New Jersey.  She attended Drew University in Madison, NJ, and completed medical school and surgical residency training at Rutgers Medical School in Piscataway/New Brunswick, NJ.  Dr. Agnese completed a surgical oncology fellowship and training in clinical cancer genetics at The Ohio State University.  Her clinical practices focuses on care of patients with breast cancer and melanoma and those with significant personal or family history of cancer.  She cycles in Pelotonia every year to raise money for cancer research.

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.