An Open Letter to Young Women Considering a Career in Surgery

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Dear Young Woman Considering a Career in Surgery,

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

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

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

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

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

 

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

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

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

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

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

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

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

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

 

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

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

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

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

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

 

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

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

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

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

 

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

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

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

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

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

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

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Who am I?

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Long time followers of this blog know that we started it based upon a shared quest to be better to ourselves, our bodies, our families in the midst of very demanding careers as trauma surgeons. As the one who started the blog, I must admit that my initial intention was to focus on what made us whole outside of work. And so, much of the content, especially early on, was about our shared interests in hot heels and all things fashion, our efforts to stay healthy donning our cool kicks or our ballet socks, and our challenges as wives and mothers whose day jobs require a scalpel.

But as time passed, we wrote more and more about our professional experiences, because it turns out a large part of our whole is what we go through at work. After all, with 4-10 nights per month on in-house call and standard 120 hour weeks on service in addition to research, service and society work to advance our academic careers, we spend many, many more hours on the work part of ourselves than the outside of work part of ourselves.

Since my hope had been to share the outside of work part of ourselves in this blog, as I found myself writing here more and more about work related issues, I recently created separate blog. I told @surgeoninkicks it would be my “professional blog” where I could share some of the darker stuff that affects us (i.e., someone interested in my Jimmy Choos may not want to be confronted by the sorrow that I feel when I lose a patient). It would be a blog where I would write about the experiences that help me maintain joy in the profession.

However, the reality is that the two sides of our worlds are not separable. Maintaining joy in the profession in inextricably linked to finding joy outside of work. @surgeoninkicks understood this but it took me longer to confront this reality of who I am.

I am a surgeon in a specialty with extraordinarily high rates of burnout, with hours that pose significant logistical challenges to self care, family life, and extracurricular activities, and with routine exposure to human pain and suffering. I do feel joy in doing my best to care for patients and their families. I did choose a career path where I would be balancing non-clinical and clinical work. I do have a husband, two children, a dog, many friends, and interests outside of work. I do feel stress in juggling it all and routinely engage in retail therapy as an elixir. I am not nearly as fit and healthy as I want to be. This is who I am. 

So, this week I will migrate the few posts from my other blog into this venue. I will continue to write about all the facets of who I am in this blog, a blog I am so lucky to have shared with a true soul mate in @surgeoninkicks.  She has seen me through this crisis of online identities and I am ready to share completely. Thank you for the continued readership. Your enthusiastic support of our work is greatly appreciated.

Allowing myself to just be deserves accolades, not guilt

I am always telling myself to not be one of those bloggers who gives a play by play of his or her day. I prefer to blog about fun things or things from which I derive meaning and I hardly think that anyone gives a rat’s ass about what I did and when so fair warning:

THIS IS A POST ABOUT WHAT I DID YESTERDAY.

I woke up even earlier that I do when I feigning to be morning exercise person to get my daughter to a 6:30am arrival for a field hockey tournament 70 miles away. 4am is brutal for mom, for the tween player who now routinely sleeps until 10 or 11am on weekends, and for the sad sap of an 8 year old brother who needs to tag along since dad is away on a much needed and well deserved guys’ weekend. Of course I am chronically fatigued and it’s nice now that the kids are older that I can use the weekends to catch up on sleep. So to have this privilege stolen from me for a sporting event deeply hurt me but parenting wins so there I was driving 1 hour and 20 minutes each way. The kids both slept in the car both ways. I jacked myself up with caffeine hoping not to become a statistic we trauma surgeons like to study on driving and fatigue.

When we got finally got home at midday I was exhausted. Despite the caffeine coursing through my veins I could not keep my eyes open so I stumbled into a sleep on our ever so cozy sectional. But it was a broken sleep. I refused to simply go up to the bedroom and just give in completely to the tiredness. Nope, I kept hoping that I would soon rise and have a productive day. You see, after several years of working on work-life integration, I am still having a hard time with simply relaxing. I am so trained to think of it as lazy and unproductive that when I do nothing in particular (or choose to sleep rather than doing) I feel an enormous sense of guilt and failure.

In between my fits and spurts of sleep I was thinking:

The house is a mess. (I should be tidying up!)

There are multiple loads of laundry to be done. (I should be washing and folding!)

The kids are somewhere in this house fighting boredom. (I should be playing with them!)

The work to-do list is out of control. (I should be tackling whatever I can remotely!)

There are thank you cards to write. (I should be putting pen to Crane’s paper!)

The Kindle is filled with newly downloaded e-books. (I should be reading!)

My ass is getting fatter as I lay here and the sun is shining. (I should go out for a run!)

I woke up at dusk. I felt like kicking myself for these myriad failed opportunities to get stuff done, to be a better wife (who helps around the house every so often), to be a more engaged mother, to utilize any one of the 7 habits of highly effective people, to take care of myself.

Argh! The self-loathing was quick and sharp.

Later on, once the kids had made sure I ate and stayed hydrated (their dad has trained them well) and had headed to bed (after showering and reading to themselves)* I took the dog for a nice long walk feeling the need to pad the mere 1k steps I had accumulated up to that point since my daily target is 10k. It was a serene and beautiful night. There were no cars zipping by. No sound of Lifeflight that is frequently overhead. No other dog walkers even. Most lights in the neighborhood were off on the eve of returning to school after winter break.

As I was retelling myself all the failures of my day and tryinng to forgive myself, the peace and calm of the night got to me. It occurred to me that I surely deserved some peace and calm with all that I do day in and day out, at home and at work (okay, fine mostly at work!). It turns out that a perfectly calm and peaceful night was a fitting ending to a day of rest that I unintentionally engineered for myself despite all of my intentions (including with this blog) to take better care of myself. I deserved accolades and not self-flagellation. And so I tacked on 4k steps dropping a little more guilt with each stride, congratulating myself on a job well done, not for being lazy but for successfully allowing myself to just be. 

Today, I can see that it helped recharge me for the household chores, unending work obligations, needy family, and self-care that are still there today waiting for type A, get-the-job-done, me.

[*NB: It gets better as they age, I promise. I miss the cooing and burps and smiles of my babies but I sure do appreciate their self-sufficiency on these lazy, ummmmm restful, days.]

 

Here’s to 2 years and another half marathon in the books

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Two years ago today, I wrote my first blog post. It was on running a half marathon in my hometown. It was my third half marathon. Writing about the experience and it’s reflection on my past was a great way to start blogging, something I had been contemplating for at least a year by that point. You see, my zeal to run was borne from following the musings of others who felt similarly challenged with regards to their personal wellness.

And so, Hot Heels, Cool Kicks, & a Scalpel came to be. It’s a blog about what a traumamama does to get through the days and still be whole–a whole surgeon to her patients and their families, a whole researcher to the university and funding agencies, a whole teacher to her trainees and students, a whole peer to her colleagues, a whole friend, a whole sibling, a whole daughter, a whole spouse, a whole parent, a whole person who takes care of herself.

I was lucky to have hoodwinked my fabulously witty and sarcastic fellow traumamama @surgeoninkicks into this whole blogging thing soon after this first post. Our original connection was that we were both trying to make running part of our lives at a time when life and work was overwhelming and causing us to neglect ourselves. I had no idea how compelling her writing would be but I knew I needed to do this with her lacking the time to keep the content flowing on my own. Working on the blog together (it’s our form of joint therapy) has help our friendship grow in ways that I don’t think either of us imagined and we have also run together on many an occasion since then.

Finding time to run is still the hardest thing I do and running is my biggest physical challenge. Since my first real run without stopping at a whopping 15min/mi pace in August 2011, I have logged just about 1100 outdoor miles (and very few on treadmills). But I consistently run at an 11-11:45 pace these days (depending on hills and whether or not I have done a recent barre class!) and have finished 4 half marathons and a Ragnar Relay just this past year alone. Four days ago I ran that same hometown half marathon again. It was my third time. I posted this photo at the corrals with the caption “Suck it high school self-esteem issues.” It was a hit with my Facebook friends. (PS. if you hit Old Navy’s clearance rack in the summer you will have lots of $5 throw away fleece that comes in handy when the temperature at the start line is 29F)


With the 2 year anniversary of this blog, I want to say a continued suck it to self-neglect and thank you for continuing to read the random, somewhat disjointed, musings of two traumamamas who engage daily in the push and pull between their families, their patients, and their own well-being (fueled through food, fashion, fitness, humor, and sentimentality). Together we have written 195 blogs that have been viewed more than 1.2 million times and we now have 787 followers.

I hope you will continue to read, and subscribe, and share and I will continue trying to run as much as a I can.

 

1 (usually growing) reason why every single man in America should care about maternity leave

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You all have prostates.

Seriously.  But let me explain further to those people who simply can not fathom as to how a woman could dare ask for maternity leave and expect her other team members to “pick up her slack, because she chose to get pregnant”.  (yep, check the comments section on my last post here, pretty entertaining, in fact!)

Life happens to everyone.

If my profession as a trauma surgeon has taught me nothing else, it has taught me this.

“Life happens to everyone,” and unfortunately, a lot of “life” isn’t pleasant.  Car accidents, strokes, heart attacks, broken legs, and ill family members are just a few examples of life situations that happen to everyone, whether or not you have a uterus.  And guess what they all have in common?  A need for time off of work.

Now, the distinct disadvantage here is that women usually need a set block of time off for maternity leave that seems relatively long (to some, at least) and at an age where they are usually young and healthy, but let me tell you gentlemen, people are going to be covering for YOU when your prostates need to come out and your coronary artery needs a stent.  No, you may not need 12 weeks all at once, but, between doctor’s appointments, procedures, recovery, and complications, or at some other point in time in your life, you are going to need significant time off of work, with your partners/coworkers/etc. chipping in and helping out.  And, oftentimes without the 6 month’s notice that your pregnant colleague is able to give.  And guess what else?  That is OKAY.  That is what life is about – building relationships and working in teams to get the job done, even if someone is having a bad day, a stroke, or a baby.

Oh, and just as an FYI, let’s just say you break your leg while skiing and you need at least 6 weeks off of work… I don’t think people will judge you and say that went skiing and break your leg – accidents happen.  So being judgmental and saying that every woman chooses to get pregnant is pretty inane.  You chose to go skiing, she chose to have sex. Get over it.

Maternity leave = family leave. (Or, hopefully will equal family leave at some point soon in the future.)

I have to admit, I was blown away by the responses I received on our blog, through FaceBook, Twitter, and even my own personal email from my last post.  Women from all walks of life shared their stories, and overall, as Americans, and as humans, we should both be encouraged and appalled.  Some female physicians wrote how supportive their partners were, but as a group, would have to sneak around HR to get her time off.  Some women went back to work in less than one week to preserve their family’s income and sometimes their job.  Office administrators refusing to allow 15 minutes breaks for new moms to pump breastmilk.  A new mom, forced to use a surrogate, being allowed zero time off because she wasn’t actually birthing the baby herself.  The stories unfortunately go on and on.

Yet, the stories of finding support from male coworkers was encouraging.  And, I do think most men and women without children also, absolutely see the value in family leave – whether it is paternity, maternity, sick leave for themselves or to care for an ailing family member.  Bottom line, every single one of us is going to need time off of work, expected or unexpected, and we are all are going to have to rely on each other, and a system to help us out.  Unfortunately, for most of us, that system does not yet exist… and at the end of the day, we can do this better – for ourselves, and each other.

Avoiding a Vacation Set Back: Day #8

Today was filled with packing and errands before heading to the airport. I didn’t manage a formal workout but logged >14k steps.

I was also overjoyed to return to Panera after many months because they listened to our protests and brought back the BBQ chicken salad.

After finally arriving at Disney for the family half of my vacation, I satisfied my snack craving by paring Stacy’s Naked Pita Chips with Justin’s Unsweetened Almond Butter. It really hit the spot after a long day without the guilt of the red velvet cake or carrot cake that I successfully ignored.

Avoiding a Vacation Set Back: Day #7

Busy day today between two trips. Exhausted yet energized from my girls’ weekend, I had to efficiently transition to my family trip to Disney that starts tomorrow. I still managed to squeeze in a barre class at my local studio and then logged 14,000* steps before midnight. Now I just need to purge 12lbs from my suitcase….