Editor’s Note: A major professional challenge and how it was addressed.
It is easy to say that it was the hardest case of my life. I was well along in the pregnancy of my first child and was on call at the worst trauma hospital in the city. The patient was a woman with metastatic breast cancer. She had a pathologic hip fracture and required a hemiarthroplasty.
The patient had no insurance, and this trauma hospital was the only one that would take her. I was the orthopaedic surgeon on call. The patient was a large woman who weighed 280 pounds. My body mechanics were altered due to my advanced pregnancy. This case was well outside of my subspecialty focus but I had, of course, been trained as a resident to do trauma. As the emergency medicine resident and I opened to expose the fracture site, we encountered a significant amount of extraosseous tumor tissue. It was so pronounced that the resident was shocked and passed out leaving me alone to do the case.
As I continued to operate, I had the OR staff make phone calls to solicit help. We called my colleagues, my friends and no one was available. I felt rising panic during the phone calling but eventually moved into “robot mode” where I simply did my job. There was a very experienced industry rep in the surgical suite so I kept talking to him during the case. I told him that I knew “he saw everything” in his OR work and encouraged him to make any suggestions he felt would help.
In the end, the case was completed successfully, and the patient lived another 12 years with her disease despite lack of ongoing cancer care. I know this because she came to my clinic for years to get free NSAID samples.
What did this experience teach me?
• I learned how valuable my training had been. Despite not planning to do adult orthopaedics, I still paid attention and took none of my rotations for granted. I conquered the material and that prepared me for this case.
• Don’t hesitate to admit to yourself when you are afraid.
• Rely on your skill set when forced into doing work you are called upon to do.
• Ask for help if you need it. You and the patient both benefit in the end.
• I was able to successfully perform the “hardest case of my life” and feel good about the outcome.
Would I redo my career in the same way? Yes, but I would try to structure the work requirements differently, particularly as it applies to subspecialty call.
My advice to those choosing to pursue a career in orthopaedic surgery is as follows:
• Make sure you love what you do and that is your primary motivator. A generous salary and a lavish lifestyle will not counterbalance the anguish of doing work you don’t enjoy over the span of a career.
• Understand that you may need to accept things out of your control such as how the business side of medicine impacts your individual practice. Medicine is evolving or perhaps, devolving.
• Try to define what brings you joy in your practice and focus on it as much as possible.
• Invest your funds wisely and early. Burnout may occur sooner than you expect. You may not make it to full retirement age.
• Accept that women and men may have different interests and talents. To acknowledge this is not a bad thing. Define your superpowers and utilize them boldly.
• In my opinion, women still must work 2 -3 times harder than men to succeed.
• Doing your best work as a clinician and as a surgeon gains you professional respect which can bring career satisfaction.
As a final anecdote, I was the second woman in my orthopaedic residency program. My male attendings appeared happy to have a more diverse residency group and I felt welcome. I worked very hard to secure my positive standing in the program. For me, my work ethic, high Inservice Training Exam scores, and extra effort such as writing a manual for students pursuing orthopaedics paid off.
On a required rotation at an affiliated hospital, I continued my extra effort. One day, I made a presentation in Morning Conference and was verbally praised by the attendings who were present. Later, a senior resident approached me in a stairwell, called me a fraud, and gestured like he wanted to put his hands around my throat to choke me. This was disturbing. Was he jealous or merely threatened? Why was anger his chosen response? This taught me how the success of others may threaten those with insecurities and that their responses are unpredictable.
Editor’s Note: This is one of six accounts to date describing committed or threatened violence against a seasoned female orthopaedic leader, practitioner, or trainee. See Accounts #7, 21, 22, 23 and 51.