AWS BLOG

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.

 

The Fastest Growing Cancer in the USA

By Anya Costeloe, DO

In honor of thyroid cancer awareness month just wrapping up, I will give a brief overview of the epidemiology, diagnosis and treatment of thyroid cancer.

In terms of incidence, thyroid cancer is the fastest increasing cancer in the USA. The number of cases has tripled over the last 30 years. Women have a significantly higher incidence of thyroid cancer than men; about 75% of thyroid cancers occur in women. Other risk factors for thyroid cancer include increasing age, history of radiation exposure (especially if at a young age), iodine deficiency and family history. Approximately 5-10% of thyroid cancers are hereditary. The four main types of thyroid cancer are papillary (60-70% of all thyroid cancers), follicular (10%), medullary (3%) and anaplastic (<1%).

The US Preventative Medicine Task force recommended against routine screening for thyroid cancer starting in May 2017. However, physical examination of the neck is still an important part of a yearly wellness exam and any palpable thyroid nodules should be further investigated with a thyroid ultrasound.

How does thyroid cancer present?

Thyroid cancer most commonly presents as a painless, palpable solitary nodule. It is typically asymptomatic but patients may present with a feeling of fullness in the neck, hoarseness, a change in voice quality, difficulty swallowing and tightness in the lower neck.

Thyroid stimulating hormone (TSH) level is a sensitive measure of hyperthyroidism or hypothyroidism, however, thyroid malignancy cannot be diagnosed or ruled out based on it. Hyperthyroidism can be caused by a “hot” nodule, meaning it is producing thyroid hormones and usually hot nodules are benign.

How is it diagnosed?

When a patients has a suspicious nodule, the first step in the diagnosis is a fine needle aspiration biopsy (FNA). A pathologist will look at the cells from the FNA to determine whether the nodule is malignant and determine what type of cancer is it. It is not uncommon for the FNA to be inconclusive, which means that cancer can’t be ruled out. Previously, these patients would have a total thyroidectomy. However, in 2011 a new test called the Afirma Thyroid FNA Analysis was created. This test reduces the diagnostic uncertainty in patients with inconclusive FNA results.

How do you treat thyroid cancer?

In almost all types of thyroid cancer except for thyroid lymphoma,the main treatment for is surgery . Usually a thyroidectomy is performed, but in some cases a thyroid lobectomy may be done, in which only half of the thyroid is taken out. If the cancer has spread to any lymph nodes, then a neck dissection will be done to remove those nodes.

After the thyroid is removed, patients need to take thyroid hormone replacement tablets because they no longer have the cells that make this hormone. In papillary and follicular types of thyroid cancer, replacement hormones are important because they tell your body that there are sufficient thyroid hormone levels. This prevents the re-growth of cancer cells.

Another form of treatment is radioactive iodine, which is taken up by thyroid cells after being swallowed in pill form. It is toxic to the thyroid cells. It is used in papillary and follicular types of cancer and it is usually used in addition to surgery.

What’s the prognosis for patients with thyroid cancer?

The prognosis for different kinds of thyroid cancer varies, however, thyroid cancer has a good prognosis overall, 98.2% survival at 5-years.

  • For follicular and papillary cancers age is the most important prognostic factor and patients younger than 45 have a better prognosis.
  • Age is not as important in medullary cancer. Patients with medullary cancer that has not spread beyond the thyroid have a 95% 10-year survival.
  • Patients with medullary cancer that has spread to the lymph nodes have a 75% 10-year survival.
  • Survival decreases dramatically if there are metastases, which is why early detection and treatment are so important.

Check out the following websites for more information about thyroid cancer:

https://www.thyroid.org/thyroid-cancer

https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq

http://www.thyca.org/how-to-help/awareness/

https://www.veracyte.com/our-products/afirma

References

Haugen, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. Jan 2016, 26(1): 1-133.

 

Anya Costeloe, DO is a first year otolaryngology resident at St. John Providence in Michigan. She was born in Russia and immigrated to the US when she was seven years old. Dr. Costeloe received a bachelor’s degree at University of Colorado, Boulder in molecular, cellular and developmental biology and in Spanish. She attended medical school at Western University of Health Sciences College of Osteopathic Medicine in California. Outside of medicine, Dr. Costeloe enjoys traveling, snowboarding, hiking and yoga.

Implicit Bias

By Doreen Agnese, MD

As the deadline approaches for this blog, I again wonder what topic will be interesting to discuss. I try to gather inspiration from prior blog posts, and as I scroll through the list of recent blogs, the one thing that I notice most acutely is how much older I am than all of the other contributors. Maybe this blogging is a young person’s game….but as I sit here thinking about what to say, I see a reminder about surgical grand rounds this week. The topic this week is “Unconscious Bias in Healthcare—A Primer and Strategies to Reduce the Impact of Unconscious Bias.” Included in the announcement is a link to the implicit association test, a well-validated web-based test to determine unconscious associations or preferences (https://implicit.harvard.edu/implicit/). I realize that we have come a long way with respect to explicit bias since I was a trainee, but women are still underrepresented in academic medicine. I took the gender-science IAT and was surprised to learn that I had a moderate unconscious preference for women in liberal arts and men in science. I did counter that with a moderate association with male with family and female with career. These results did surprise me, but point out the fact that implicit bias runs deep and it’s not something that we can really control. The times are changing, but how can we get at something unconscious? Is there hope? I think so.

Thinking of implicit bias made me think of 2 things that happened to me recently, one of which really fills me with hope for the future. The first was a pretty typical story. I had some time between cases and met a colleague in the café for lunch. She is also a female surgeon (urologist) and we were both in scrubs with our bouffant caps on. As we enjoyed our lunch, an elderly couple came in. The gentleman was in a wheelchair and his wife was trying to navigate between the tables. We came to her assistance clearing the tables out of the way so they could enjoy their lunch. She of course thanked us for our trouble and asked, as so often happens, if we were nurses. “No,” we replied, “we are surgeons here.” This situation is not a new one to anyone, and despite the widespread appearance on social medial of the “I look like a surgeon” campaign, all too often male nurses are confused for physicians and women in medicine are assumed to be nurses.

The second situation was a much more surprising one. I was leaving the hospital after a long day in the operating room on the same evening that there was a One Direction concert playing at the stadium. As you might imagine, campus was filled with quite young One Direction fans and my car was parked between the hospital and the stadium. As I left work in my scrubs (please don’t tell anyone—I know I’m not supposed to!), I saw some very cute kids, a boy and a girl who I assumed were siblings, who couldn’t have been more than 5 or 6. They were hurrying to the concert carrying their carefully crafted signs. As I walked up behind them the little boy turned around, saw me in my scrubs, and said to his sister “Look, a surgeon!” That was certainly a first for me! It renewed my faith that these stereotypes can be broken. We are not born with implicit bias. It is learned. And if we can adopt these biases, then I am sure we can employ strategies to address them. The first part is in recognizing the problem figuring out how to overcome our unconscious biases. The other key part is focusing on our young people, who have not yet developed these biases, and help them to keep an open mind.


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.

New Therapies for Childhood Cancer

By Madeline B. Torres M.D.

Arriving at the National Institute of Health (NIH) as a surgical oncology research fellow this summer felt like winning the golden ticket into Willy Wonka’s factory. I entered with high hopes to tackle one of the multiple roadblocks to the treatment of one of the many adult cancers. Little did I know that my path would lead me to investigate therapy options for the treatment of neuroblastoma. Neuroblastoma is the most common solid childhood cancer outside of the brain1, with an incidence of 9.5 cases per million children; that is approximately 700 new cases per year diagnosed in the U.S. alone. Standard of care includes surgery and adjuvant chemotherapy. Recent studies have shown a new promising target for neuroblastoma therapy, Glypican-2 (GPC2), a cell surface oncoprotein that may play a role in neuroblastoma growth and development. In studies by Li et. al. and Bosse et. al., neuroblastoma tissues showed high expression of GPC2 but it was not detectable in normal tissues, making it a promising therapeutic target.

However, neuroblastoma isn’t the only childhood cancer. The five most commonly diagnosed cancers in are: leukemia, brain and central nervous system tumors, neuroblastoma, Non-Hodgkin lymphoma and Wilm’s tumor. There are multiple subtypes of leukemia, the most common are Acute Lymphocytic Leukemia (ALL) and Acute Myelogenous Leukemia (AML), both have a high 5-year survival rate ranging from 80% for ALL and 60-70% for AML. Despite the high 5 year survival rate, some children are resistant to treatment needing more research to develop new treatments. Tisagenlecleucel, is a recent breakthrough in treatment for chemotherapy resistant acute lymphoblastic leukemia (ALL) recently approved by the FDA. Kymriah is a type of Chimeric Antigen Receptor (CAR) T cell therapy, a form of adoptive cell transfer, a type of immunotherapy. CAR T cell therapy is often called a “living drug,” it consists of giving patients genetically engineered T cells (cells are usually obtained from a donor) designed to recognize and kill tumor cells. CAR T-cells therapy unlike Tumor Infiltrating Lymphocyte (TIL) therapy does not require the use of the patient’s own cells to create the medication.

Despite all these advances, scientists continue to work tirelessly to find new therapies for childhood cancers. September is childhood cancer awareness month. This month, I ask that you consider contributing to developing new therapies for childhood cancer. You can call your state representative and ask them to continue to fund childhood cancer research. Over the next two years, I hope to make the best of my time at the NIH and make a small contribution to the treatment of neuroblastoma.


Madeline B. Torres, M.D. is a research fellow in surgical oncology at National Cancer Institute (NCI) in Bethesda, Maryland. She completed two years of general surgery residency at Penn State Milton S. Hershey Medical Center in Hershey, PA. Dr. Torres was born and raised in El Salvador. She immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her medical degree from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors. Her interests include: surgical education, surgical oncology, work-life balance and encouraging women and minorities to pursue surgery and careers in medicine.

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.

How to Maximize your CV in Medical School

By Faith Robertson

The curriculum vitae (loosely translated from Latin as “Course of life”) is a concise overview of your experiences and academic achievements over time. As a medical student, you will often be asked to provide a CV during applications for awards, grants, and scholarships, and on sub-internships for your specialty during 4th year rotations. Starting this document early on, and updating it periodically during your medical school journey, will not only help you prepare for those last minute grant opportunities, but also elucidate where you can continue to improve.
The rules for outline style and content are inexact, but we will briefly discuss pertinent points on how to Reorganize, Reevaluate, and Revive your CV.

1. Reorganize

Your CV should be easy to read. Period.

A study published by The Ladders (2012) tracked the eye movements of 30 professional recruiters as they reviewed job applicant’s resumes and online profiles. The results demonstrated the importance of how text organization dictates a reviewer’s course, that is, where and how long a person focuses when digesting information. Shockingly, this study revealed that while recruiters self-reported spending 4-5 minutes per resume, the study results demonstrated that most spent 6 seconds on their initial “fit/no fit” decision. Granted, this study’s credibility has been questioned due to method quality, but many agree, organization is key.

In general, your format should mirror the following:

• Education
• Honors/Awards
• Research Experience
• Service/Volunteer Activities (+/- Leadership within section or separate)
• Publications
• Submissions (for articles submitted but not yet published. Do not include articles in progress, as this work is covered under Research)
• Presentations (can divide into Oral and Poster)
• Professional Organizations
• Other Interests

If a category or heading does not apply to you, omit it; you can maintain a separate master version of your CV that contains these categories as placeholders for future updates. The AAMC has an excellent page on Preparing Your Curriculum Vitae that includes additional tips and templates, as does Vanderbilt School of Medicine.

2. Reevaluate

Now that you have augmented the aesthetics and organization of your CV, it is vital to assess the story you are telling. Yes, your CV represents the continuity and temporal accuracy of your current (and past) accomplishments, but it should also guide the reviewer in understanding your mission and vision. As mentioned above, maintaining a “Master CV document” can help you tailor your CV to the present goal/viewer to strengthen the impression you leave.

Request feedback from faculty or specialists in your desired field. Elicit whether or not they can clearly interpret your trajectory thus far, and envision where you are going. Where are your shortcomings, and how can you improve?
3. Revive

Taking feedback into consideration, it is time to reevaluate where you can spend time making your CV more robust. Perhaps there is a research project you can pursue to demonstrate your knowledge of and dedication to your desired specialty that can bridge your interests from college or pre-clinical years to the interests you hold now. Or if you notice that the majority of “Awards” listed were from high school and college, try surveying announcements for award opportunities; it might be worth sitting down to write for that essay contest you have seen advertised in the weekly student news.

Overall, continuous improvement and innovation are requirements for success in today’s hyper-competitive environment. At the 2016 AWS New England Exchange, Dr. Sandra Wong, Chief of Surgery at Dartmouth Hitchcock, discussed “What got you here won’t get you there.” This concept of continuous improvement is central to our journey as surgeons, and I hope this brief discussion about relaying your “course of life” will help you along the way.


Faith Robertson is a 4th year at Harvard Medical School, was the previous Vice Chair of the AWS National Medical Student Committee, and currently serves as an International Representative while taking a year-off to get an MSc in Global Surgery at King’s College London. Faith plans to pursue a career in Neurosurgery and Health Systems Improvement.

Twitter: @FaithCRobertson
LinkedIn: https://www.linkedin.com/in/faithrobertson/

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.

#DearIntern: Social Media Mentorship to the Max

By Marissa A. Boeck

In April 2015, Dr. Amalia Cochran had an idea. The United States Match Day had come and gone, and while most fourth year medical students were enjoying their last moments of unbridled freedom before the oft feared start of intern year, Dr. Cochran was thinking ahead. As a burn surgeon and Vice Chair of Education & Professionalism at the University of Utah, she was well-versed in the significance and misperceptions surrounding July 1st, and knew it would come sooner than most would imagine. To ease this seemingly overnight transition from student to doctor, she reached out to gather intel on how to prepare for the big day from one of the best (and arguably still untapped) resources in medicine: Twitter. The initial message asked:

 

Dr. Cochran’s followers and interconnected community took it from there, and #DearIntern was born.

Since the first post and subsequent blog, the hashtag has re-appeared annually as the new year approaches. Although typically surgery participants predominate, the advice applies broadly. Related messages have used #DearNewIntern and #WelcomeToMS3, among others. This also includes #TipsForNewDocs, started back in August 2011 in the United Kingdom as an advice hashtag for rising junior doctors across specialties, which has successfully maintained a nearly year-round presence since.

Upon reviewing expert posts from the past couple of years, broad themes emerge that can be organized into a Top 12 #DearIntern List of Advice:

  1. Medicine is a team sport: Be open to and respectful about input from others; this applies to nurses, physician assistants, colleagues (both in your specialty and others), superiors, and students. Sometimes you know more, sometimes others do, but diversity of input is always valuable. Show appreciation when and where it is due. Also, if someone calls for help, help them, don’t ridicule.
  2. Golden rule: treat others as you would like to be treated…or as you would want your grandma/important person in your life to be treated. It is almost always better to be working in the hospital than to be admitted to it; try to keep this perspective in mind during hard times. After all, we do this for the love of patients.
  3. Load the boat: Find help from senior staff members early and don’t be afraid to ask, this is not a sign of weakness. It is better to call for help when not required, than to not call when required or when a rescue opportunity is lost. Also always have a plan…and a back up plan.
  4. When in doubt, look at the patient: Electronic medical records have replaced a significant proportion of physician interactions with patients. An assessment for potentially acute changes in status requires actual facetime with your patient. Know them well and listen to them, they can teach you invaluable lessons. Keep a running list of interesting cases and patients you learned something new from; it’ll come in handy later.
  5. First impressions can be lasting: Guard your reputation with your life, but also know there will be chances for clarification and/or redemption.
  6. Immerse yourself in your craft: Scrub when the opportunity arises and be prepared (diagnosis, indication, anatomy, procedure, skills). Remember that you can learn a lot by observing an operation; never underestimate your opportunities.
  7. Show up (early) and do your best everyday: Work hard, as there is no substitute for due diligence. Be affable and available.
  8. The truth shall set you free…or at least keep you out of trouble. Be humble and admit when you don’t know something. We all make mistakes; and then learn from them to avoid making them again. You’re going to be yelled at. Don’t try not to be yelled at, just try to do the right thing for your patients. Trust but verify, never assume.
  9. Write down everything: Trust us.
  10. Ask questions and be curious: Read everyday, even if just for 10 mins, and learn a new fact. Be flexible, as medicine is always changing.
  11. Take care of yourself so you can take care of others: Keep a hobby and do it. Your wellness is important; eat sensibly, exercise, and find support in your family and friends.
  12. Have fun: Surgery is an awesome privilege. You’ll have good days and bad days, but the best moments in your professional life are ahead of you. Always try to keep your head up. Remember you are a valuable asset to the team.

Through posts associated with the hashtag, additional valuable resources and commentary have come to light, which include:

How to be the Best Intern in the Hospital by Dr. Mary L. Brandt (June 5th, 2010)
Hints For New Residents by Skeptic Scalpel (June 20th, 2011)
Internship: Ready, Set, Go! By Dr. Callie Thompson (2013)
What Every Resident Should Know on Day 1 (July 7th, 2014)
Stuff Surgery Interns Should Know, Behind The Knife podcast (June 23rd, 2015)
The “July Effect” and Tips for New Doctors by P.F. Anderson (July 1st, 2016)
#JulyOpportunity by Drs. Kevin Sexton & Julie Duke (July 28th, 2016)
You’ll mess up but save the day: advice to new doctors as they start work as interns by Dr. Ilana Yurkiewicz (June 29th, 2017)

Overall, this crowd-sourcing exercise highlights one of the many strengths of Twitter and social media: to generate global conversations connecting experts to those just starting out, and everyone in between. You’re able to shed the limits of location, time constraints, and hierarchies, and have the opportunity to connect with anyone, anywhere. Unlike published works, which retain their value for certain uses, these platforms uniquely enable a free flow of information that is constantly being revised and expanded, maintaining relevance to the here and now. On the flipside, the seemingly no-holds-barred rules to participation reinforces the need for discernment by the receiver, which is a useful skill to cultivate throughout one’s career both on and offline.

So what’s stopping you? Join the conversation, add your voice and knowledge, and impact the #NextGen of surgical leaders across the globe!

Acknowledgements: Thank you to Dr. Amalia Cochran for her original idea and blog post input, and to the dozens of #SurgTweeting community members who contributed to the #DearIntern hashtag over the past few years. This post would not have been possible without your contributions and wisdom!


Marissa A. Boeck MD, MPH is a chief general surgery resident at New York Presbyterian Hospital – Columbia, after which she will pursue a fellowship in trauma/critical care. 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.

A Medical Student’s Perspective: Reflections and Lessons from Rural Surgery

By Kaylynn Purdy

I am, as far as anybody is aware, the first person from my small mining town in British Columbia to go to medical school. Growing up, my town was often in a state of physician shortage.We relied on a few long-term physicians who spent their entire careers there, but the rest seemed to come and go like the seasons. Whenever we lacked physicians, the suffering and frustrations in my community was evident.The rural doctor shortage in Canada is part of what motivated me to pursue a career in medicine. I wanted to serve the often-forgotten rural/remote communities, much like my hometown in Canada.

Early in my second year of medical school, I felt like I had won the medical student lottery. I had gotten my top choice for my first month-long “Integrated Community Experience” in a rural town in Northern Ontario with a population of about 10,000 people. I chose this town because it was one of the few rural Northern communities that had a fully functional operating room (OR) staffed by GP anesthetists, one general surgeon and another general surgeon with a specialization in vascular surgery. Students were expected to spend at least one day per week in the OR, and often, as first assistant. As a newly minted MS2, the prospect of being a first assist was both exciting and terrifying. It was during this month that I discovered my love for surgery. Yet, it wasn’t until well into my third year of medical school that I began to appreciate what it truly means to be a rural surgeon.

It was a Saturday night when I got a call for an emergency appendectomy that was to happen in about 20 minutes. My only regret that night was not eating dinner sooner. As I rushed out the door of the retirement apartment complex I was assigned to live in for the month, I stuffed a granola bar in my mouth and waved hello and goodbye to an elderly woman walking outside with her dog. It was Halloween weekend and I frantically scraped frost off my car, worried that I would be too late to scrub in.

I sprinted up the 4 flights of stairs to the OR, feeling the grooves worn into each step by the catholic nurses, who ran the hospital in a bygone era, under my feet. One of the scrub nurses was setting up- she let me know that the surgeon was waiting in the doctor’s lounge and that the patient would be coming up from the ER soon. Being an old hospital and modeled after a more male-dominated medical profession, the doctor’s lounge was also the men’s changing room. I cautiously opened the door, fearing I might see something I didn’t want to see, and saw the surgeon sitting on the couch eating baby carrots. He gestured for me to sit, and offered me a carrot. Given that he was known to rarely acknowledge the presence of medical students, I felt as though this gesture was a sign of appreciation for coming in when the rest of my colleagues had gone home for the weekend. We chatted about cycling, and doping in le Tour until the patient was in the OR. As we walked out of the lounge he looked at one of the scrub nurses and said “Kaylynn is going to drive the camera tonight.” I didn’t even know what that meant at the time as this was the first laparoscopic surgery that I had scrubbed in for.

In true rural medicine form, I also had the opportunity to learn how to administer anesthetic, put in the patient’s Foley catheter and then shave his abdomen before it was finally time to scrub. Since that day, I have come to see scrubbing as a moment of calm and meditation, a moment to collect myself before walking into the OR. It is my three minutes of tranquility to calm my nerves.

I focused on controlling the camera like it was the only thing that mattered in the world. Soon my nervousness dissolved and I was fully engrossed in what was unfolding on the screen before me. It was like being absorbed into a Netter’s textbook. Time stood still. As the appendix was removed, I was asked to take a “sweep” look at the rest of the abdomen. The gallbladder was massive, inflamed and angry looking. The patient was just a teenage boy and of course being Canadian, also a hockey player. That night he had both his gallbladder and appendix removed. I felt simultaneously devastated for him, but in awe of what I had just witnessed and had been a part of at 11pm on a Saturday night.

At the time, I was on a high from the surgery itself. As I reflect on that night more than a year later, however, the awe of the surgery is less, but a different kind of amazement has replaced it. To me, it is almost magical that a surgery team can be called in from home and ready to operate in 20 minutes.With one surgeon on holidays, the other was at the beck and call of the people of his community 24/7. During my month-long placement, this single surgeon was the keeper and protector of health for an entire community. The respect that that the community has for its surgeons was incredible, because without them they would have to travel to a regional centre hours away for a surgical consultation, to have a wound checked, or to take care of a sick child.

No matter the size or centre that a surgeon practices in, there are uniting features of surgeons across the world. These include being able to quickly gain the confidence of your patients, trusting your gut and your training, knowing when to push the boundaries in a “Hail Mary” situation and knowing your limits. In rural surgery, these characteristics seem to be even more important, as there is often no back-up, nobody to call in for help. In rural surgery and rural medicine, often it is just you, your small team of people who are also your friends, and your patient who just might be your neighbor or an old high school teacher. There is simultaneous isolation and profound intimacy in rural surgery.

Some people might consider rural surgeons the “Cowboys” (and Cowgirls) of medicine because of how they try to save a life with limited resources. These surgeons feel compelled to try to reduce the suffering and burden that is imposed when patients are forced to seek care far from home. After living and breathing rural surgery for a month, then spending eight months of my clerkship in a semi-remote city, I see these surgeons as the quiet heroes of medicine. Nobody tweets about them, they didn’t just publish the latest research about cancer or develop a new technique to improve healing after bowel resections. They don’t work at prestigious university hospitals, but they are on call often for weeks at a time, ready to operate and ready to serve. They are often the hearts of the hospital and the lifeblood of a community. They are what allows people to retire and grow old in their communities knowing that they will have reliable essential medical/surgical care at home when they need it.

I might not be a rural surgeon “when I grow up,” but I hope to one day be a pillar in my own hospital and community. I hope that my surgical team are also my friends and that I think of each patient like my neighbor and not just as a case. I still have the picture of the gallbladder from that Saturday night surgery. I kept it because it is a reminder of who and what I want to be one day: A surgeon who places her community before all else.


Kaylynn Purdy is now a 4th year medical student at the Northern Ontario School of Medicine in Thunder Bay, Canada. She hopes to pursue a career in Neurosurgery with a focus on timely access to surgical services. When not in the OR, she can be found skiing in the winter or out riding her bike in the warmer months.

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.

 

#AWSEASTChat Wrapup

By Lillian Erdahl, MD

The Association of Women Surgeons hosted its first joint tweetchat this week joined by the Eastern Association for the Surgery of Trauma. Paula Ferrada, chair of the EAST Mentoring Committee hosted the chat joined by guests and EAST past-presidents Nicole Stassen and Kimberly Nagy. If you missed the chat, you can read this #storify for a recap of the #AWSEASTchat: https://storify.com/lillianerdahl/awseastchat-5937c42b5f3db4ab638f6bab#publicize

As highlighted in Heather Yeo’s recent blog post1, the topic chosen was mentorship which is an integral part of the missions of both professional organizations. We know that mentorship and sponsorship are important to professional success for all surgeons. According to a research letter published in JAMA Internal Medicine, women in academic medicine appear to receive less sponsorship from mentors then their male colleagues2.

Partnering with another professional organization to discuss such mentorship in a surgical career provides a broader perspective on how mentors and mentees can contribute to successful relationships. Working with EAST is a natural fit for AWS which has ongoing partnerships with other surgical organizations to promote equity in surgery. I am excited to see that our social media engagement continues to increase with each chat that we host. If you are looking to participate as a mentor or mentee for EAST or AWS, please visit their websites to learn more.3,4

  1. https://www.womensurgeons.org/may-is-mentorship-month/
  2. Patton EW, Griffith KA, Jones RD, et al. Differences in Mentor-Mentee Sponsorship in Male vs Female Recipients of National Institutes of Health Grants. JAMA Intern Med. 2017;177(4):580-582.
  3. https://www.east.org/news-and-events/news-details/76/east-mentoring-program-call-for-mentors-mentees
  4. https://www.womensurgeons.org/in-practice/mentorship/

May is Mentorship Month!

By Heather Yeo

One of the most important factors in surgical training and a foundation along which much of our profession has grown is mentorship. Mentorship has many definitions, and a long historical tradition dating back to ancient Greece. The word Mentor was taken from the character of the same name in Homer’s Odyssey. Although it’s slightly a misnomer (as anyone who has worked with Dr. Murray Brennan knows), because Mentor himself was a bit of a fool, and it was actually the goddess Athena who took on the appearance of Mentor who guided the young Telemachus in his struggles.

To me, mentorship is a relationship where one person shares their experience and knowledge with another person and helps to guide their career. The focus is on the career development of the mentee. Mentors can help with clinical, educational, research or personal growth.

So how do you get started?

Finding a Mentor
Formal: Many surgery programs and professional societies have mechanisms that support mentorship (for example, through AWS, ACS, AAS), these are best if there are shared interests and not assigned blindly. It is good to apply for one of these programs-tell them what kind of mentorship would be helpful for you.
Informal: Look around you, who is doing work that interests you, who has a career that interests you. One of the best things about academic medicine is that there are mentors everywhere. You don’t have to only choose one mentor. You can have a research mentor, a personal mentor, a career mentor. Having more than one mentor gives you different perspectives and can be good because you don’t overburden one person.

Setting up rules to the relationship
Like any relationship, both the mentor and mentee must be committed. To have a good relationship it needs to be balanced, meaning if your mentor is teaching you, you should be willing to learn and to take their advice. If you promise to do something, do it, and in a timely manner. I find that when I am working with good mentees they communicate their timeline and get things done. I find I am a better mentee myself when I set timelines and expectations.
Talk about what each person is going to put into and get out of the relationship.

Here with my Mentor Dr. Julie Sosa and some of our surgical residents, in particular Dr. Jon Abelson who I have been mentoring for the past 2 years.

Sticking with or separating from a mentor
Not all mentor-mentee relationships work. It is important to try to fix them early. If you do not align with your mentor or mentee, it is important to communicate what you need and what you can give. Sometimes a relationship isn’t working, this then lead to a formal separation, maybe asking the current mentor for other potential mentors on different interests (if yours have evolved for example), or sometimes the relationship just slows down. Always be polite, and always think about how you can learn from your mentor-mentee relationship to improve on the next one. Even if you are no longer close with a particular mentor, you never know when that relationship may sprout again as a new project comes up or in a different environment.
Much of my success has been directly a result of supportive and generous mentorship, but I’ve also had mentor-mentee relationships that were not so good. In fact, I know I haven’t always been the best mentee. But every time I enter into a new mentor mentee relationship, I try to think about what I need and what I bring to the table and how to make this relationship even better than the next.

Some additional resources on surgical mentorship opportunities:
http://www.surgicaloutcomesclub.com/fellowship-program
https://www.womensurgeons.org/in-practice/mentorship/
http://www.aasurg.org/meetings/fallcourses.php
https://www.facs.org/member-services/yfa/mentor
https://www.facs.org/member-services/ssc/mentoring
https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee/mentorship-call

A great longer piece from some of the amazing mentors at AWS
https://www.womensurgeons.org/in-practice/mentorship/strategies-for-building-an-effective-mentoring-relationship/


Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College and Assistant Attending Surgeon at New York-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. Dr. Yeo became involved with AWS after receiving the 2013 AWS-Ethicon Fellowship Grant and is currently a co-chair of the AWS Communications Committee.
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.

Taking Precautions for my Well-Being

By Beth Shaughnessy, MD, PhD

As the deadline approached for this blog, I found myself preparing to go to Las Vegas for a conference, my mind numb with encroaching burnout. I knew the signs—chronic fatigue, growing apathy, lack of alertness, decreased ability to organize and be efficient. I trained in the era of no restrictions on work hours; hospitals used residents to fill in the gaps when they lacked personnel in transportation and phlebotomy, especially at charity hospitals. Burnout used to be a state of being back then, but it didn’t have a label.

I love what I do. But I face intermittent burnout from being in a field that mandates high volume to meet the RVUs benchmark—breast surgery. This is usually manageable, but randomly cases may pile up as patients return from neoadjuvant chemotherapy and I must mesh these women into the operative schedule with the new ones referred and the emergency ones. There is a modicum of randomness to the referral intensity, although I can rely on certain times of the year to be more intense. This relative randomness of work intensity creates an intermittent discord in the general flow of our lives.

We can get so focused on providing the needed care to our patients that we begin to lose track of caring for ourselves. I just want to sleep; I calculate the years to retirement. I realized I was in a funk based on my husband’s behavior relative to discussions with him, or relative to my lack of discussion—I have come to recognize the disgruntled interaction from him, reflecting back on my own behavior. I guess the signs were there at the office as well.

Recognizing the situation is half the battle. Immediately, I start to examine my surroundings and my practice to reduce and simplify. In my homelife, what events can be canceled or missed? I make sure that I incorporate those activities from which I derive pleasure and renewal.

In my past life, I used to do Pilates in preparation for the dance season in high school and college. It was an easy choice to join a mat Pilates class following pregnancy, restoring so much energy and social interaction! And that morphed into yoga, which I still actively practice 17 years later.

Over the long run, I have learned from my husband and my son. When planning travel for a conference, I reacquaint myself with friends who live there, or friends that are going to the conference. Arrange for a dinner or an event to share stories, in order to remind yourself to enjoy your life. If it is a city I know well, maybe I will arrive a half day or full day before, order to reacquaint myself with the city and what it has to offer. Take the meeting in Las Vegas, for instance. I arranged for a hot stone massage—my favorite—and participated in a yoga class. Serendipitously, I met another AWS surgeon whom I follow on Twitter before yoga began. Little things like seeking out an art museum or strolling along a quaint shopping district (when there is time) can make my day.

Ultimately, do not forget to be kind to yourself and to those who are significant to you. Plan that special vacation to get away, shift gears, see the world from a different perspective! You will return, relaxed and refreshed, ready to tackle what the day may bring. So stop and catch your breath, recognize the signs and step back for a moment. It will make it so much easier to step forward.


Beth Shaughnessy, MD, PhD is a professor of surgery at the University of Cincinnati. She was born and raised in the Chicago area, spending her undergraduate years at the University of Illinois at Urbana-Champaign, and returning to the University of Illinois at Chicago for medical school and graduate studies. She completed residency at the University of Illinois Hospital and Clinics, with rotations at Cook County Hospital, the West Side VA Medical Center, and Michael Reese Medical Center. Dr. Shaughnessy also completed a fellowship in surgical oncology at the City of Hope National Medical Center. She enjos academic projects and writing, in addition to singing in a choir (first soprano), gardening, practicing yoga, and riding her bike, & being a wife and mother.

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.

 

 

 

 

 

 

With my sisters in County Kerry, Ireland.

 

 

 

With the family in Petra, Jordan