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A Female Attending

In the brief time between finishing step 1 and starting my third year, I thought about my first clerkship a lot. My father had bought me a book called “Surgery Clerkship: The 150 Biggest Mistakes and How to Avoid Them” and in my free time I committed it to memory. I spent the days of my last summer imagining how long it would take me to conquer the learning curve, how much more I’d learn rounding in a hospital than sitting behind a desk, and how deftly I’d interact with residents and attendings.

Orientation day arrived and my classmates and I found ourselves sitting around a large table with the site director, who delved into the existential nature of our rotation quickly: “The drop out rate from surgical residency programs is one of the highest in the country. My goal for you is not to just learn as much about surgery as possible…. I want you to know, at the end of August, if you can see yourself doing this for the rest of your life.”

The first two weeks were hell. Everything I did was wrong: presenting patients, talking to residents, answering questions. Whenever I walked into the O.R. it seemed like every single nurse, tech, and resident was purposefully ignoring me–two weeks into my surgery rotation and I had scrubbed in on exactly two cases. But after grief, denial, bargaining, and anger comes acceptance: I wasn’t going to stop making mistakes, and I wasn’t going to get an A or any letters of recommendation. Things got better.

I left my comfort zone and forcibly befriended a large number of the ancillary staff, nurses, scrub techs, and anesthesiologists so that I could escape to the O.R. whenever possible. Surgeries became more fun. I began seriously wondering if I could become a surgeon. Evaluating patients who really needed help, cutting them open, analyzing their anatomy, watching them post-operatively, sending them home healthier and happier than when they arrived… it made sense to me. And then one day, my aspirations were nullified.

It was my first time scrubbing in with a particular attending but I was excited because I had read up on the indications for arteriovenous fistula creation and it seemed pretty interesting. I had “glossed” over the anatomy, and when the surgeon asked me to name all the arteries from the heart to the hand, I kept saying whatever came to mind until he put his scalpel and Debakey pick ups down on the surgical field, crossed his hands over his chest, and yelled at me: “Just stop talking!” An understanding glance from the scrub tech was the only thing that kept me from tearing up, but thirty minutes later when the surgeon let me reach inside the patient’s forearm to palpate a radial pulse, I was still shaking so badly I couldn’t differentiate my sympathetic muscle tone from the patient’s pulsatile artery.

The surgeon, of course, was right–I should have known my anatomy better–but I was still angry, conjecturing on how much better I would be as a teacher than this guy: “If I was a surgeon…” I kept telling myself. And then I realized something: there were no surgeons who reminded me of myself, either in personality or in principle–so there was no way to know, really, how I’d react to a student in a similar situation. There were no female surgery attendings at my hospital.

I had stumbled upon a troubling realization: I would spend eight weeks mimicking the behaviors of surgery interns and yet I would never be able to see myself as a surgeon realistically. What I had imagined for myself was an idealistic abstraction crafted piecemeal from surgery themed television shows and the few female surgeons I had met, but never worked with or scrubbed under. My disadvantage wasn’t just that I lacked female surgeons to model my behavior after, I also had no one to ask the tough, women-centric questions: is it hard to work with mostly men? Do people take you seriously? Why did you–what about your life made you–choose surgery? What do you feel like you lost by choosing to go into surgery? Do you regret anything? I was able to get some answers from the female chief surgery resident, and while I found her mere existence comforting and her instruction invaluable, I can’t help thinking something was lost by not seeing more women leading operations.

On our drive to the subject exam, my good friend, also a women, also a medical student, and also on her surgical rotation, was ecstatic when she told me that she was getting a letter of recommendation written by an attending–a female attending. I was happy for her. Ultimately, we would learn similar facts concerning the management of surgical patients, but she had gained a lot more from me. Not just a letter of recommendation, but a more resilient emotional attachment to surgery, a stronger conviction to become a surgeon.

Great teachers can easily be male or female. Some of my best teachers have been men. Role models don’t have to be your gender to make a strong impression. But I would argue that the strongest impressions are made by people who you can see yourself in, and as much as I respect many of the physicians I have worked under, I can’t see myself living their lives because many of them haven’t lived mine. Their biggest challenges, their greatest fears, what drives them… these are fundamental attributes that I would like any possible mentor or role model to share with me, and I presume that in these areas, women in the medical field have more overlap with each other than with men.

At our exit interview, the site director asked us what we thought of surgery, and if we wanted to go into it. I said maybe, and then I said yes. “Ah yes,” he asked, “but can you see yourself doing this for the rest of your life?” I shrugged my shoulders.


Author, Elora Apantaku 

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