The Making of a Woman Surgeon by Elizabeth Morgan MD

Trawling through the internet one day I came across this little book published in 1981 (when KBW was playing doctors and nurses at Playgroup) by one Elizabeth Morgan, a plastic surgeon who as well as being the medical columnist for Cosmopolitan under Helen Gurley Brown’s editorship, was one of very few women to become a surgeon in the late seventies. It’s a rather clumsy title but well worth the ridiculous price of 97 pence that amazon had it listed for.

“Any woman is strong enough to do any surgery except surgery on the shoulder, hip and knee joints of an adult. Then she needs two or three men to help her.”

Hmmm. Not sure that I agree with everything she says in her book but it is an interesting account of her training, written from contemporaneous diaries she had made in the two seconds each day she wasn’t working.

“I felt betrayed when another woman surgeon, just as capable as I was, wept and complained when things got tough”. Now we are all a little bit guilty of this, I have no patience with crying (do it alone in the toilet or in the car, but never at work) and have been a bit scornful of the pathetically pregnant who waddle from 12 weeks and are too tired to operate, but I am working on being more sympathetic. Not everyone has easy pregnancies. Dr Morgan is not a crier and does not show weakness or doubt to colleagues.

I love how americans have people they “dated” it sounds much less significant than ex-boyfriend. “Do you know so and so? Yes I dated him years ago”: way less dramatic than “Yes, we went out for a year and then he dumped me and I cried for six weeks and gained a stone”. Anyway, there is a psychiatry ex boyfriend who is the only one who comes close to the inner Lizzie, in suggesting she is closed, defensive and exhausted and that surgery has changed her.

She is (like me) weight obsessed: “I was beginning to feel fat, because I had gained five pounds since coming to Boston and I was now 135 pounds..A diet I thought masochistically, would be the perfect compliment to all my suffering”.

She weighs the same as me! The mad eating disordered competitive monster that lurks inside me now wants to find out how tall she is. What she doesn’t touch on much are the issues that bother me on a regular basis: leading a team, handling conflict with men, endlessly having to assert my authority as people assume I am not in charge and that a (more junior) man is. Telling nurses (usually women) what to do, dealing with not being popular when you do have to point out mistakes, being a crap mum the days I work and being a girl (heels, skirts, wearing pink) at work. Even the practicalities of being a girl, bleeding every month,can turn a 10 hour operation into even more of a stress wondering if blood is slowly seeping through your scrubs*.

Anyway, I read this book with great interest, an account of her training as it happened. Light on any deep and meaningful observations, heavy on “this one time I…” In some ways the world has changed completely since she wrote this and women doctors are soon to be in the majority (by 2017 over half of UK doctors will be female) but we are still under represented in surgery. I suspect Dr Morgan was too busy being a surgeon to think to much about being a woman. Certainly when she wrote this book she was unmarried and childless, so had none of the guilt and pressures that I have. Working late on birthdays and missing first days of school and failing to sew in name labels and not making swimming galas and not being the wife you might be if you were only at home a bit longer each day..

I have waited a long time to publish this post, mainly as after reading and researching this book I realised that she is still in practice as a plastic surgeon in the US and I didn’t want this to impact on her in any way. If you wiki her you can read all about her subsequent career and life and she also has a website for her private practice. I suspect it would be more interesting to read about her thoughts on being a woman surgeon now she is well established in her career and has 30 years to look back on. The copy of the book I bought from a second hand book seller is from the Paw Paw Public Library in Michigan and has never been checked out by anyone. It’s found a home with me now though.

*reasonable people will wonder why we don’t excuse ourselves to go to the bathroom for 2 minutes. You wouldn’t dare, you wouldn’t want to seem so weak, you would lose your position at the table and be told not to scrub back in. It’s a test.

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Wingmanless

Modernising medical careers has done many awful things to surgical training, which has had little impact on me personally as I am a post Calmanisation trainee. However, the little impact it has had is of great importance; I have lost my wingman, I’m like Maverick without Goose.

Ward rounds, that are left to me to do, occur with 2 or 3 junior doctors (F1, maybe an F2 and maybe a core trainee which is meant to be like an SHO) instead of the old team of senior registrar, registrar, senior SHO, SHO, JHO. Almost all of whom, in a big a hospital like Bighospital would have been career general surgeons.

Now of the 2 to 3 of us, only I am a surgeon and the rest hate surgery. My core trainee is a GP trainee and the F1 and F2 are similarly psychiatrically or internal medically inclined. In the olden days on this professorial unit people (including me) fought with each other for the honour of being Prof’s JHO and it was a job that went to the keenest and most desperate wannabe surgeon.

Nowadays, a computer nationally allocates them to Bighospital and they rotate through each unit every month. Dreadful for them, dreadful for us.

Back to how this has meant I am Batman without Robin. Everybody needs a wingman, especially on a ward round.

Let’s pretend you are an emergency admission with right sided abdominal
pain. Your GP has sent you in as query appendicitis and so you also suspect that you have appendicitis. The male F1 examines you and says “yes probably it is appendicitis ” the male F2 is too busy to see you. The nurse reads the F1’s notes and discusses with you all about appendicitis and theatre and even starts getting you ready for theatre. They’ve fasted you for the 8 hours you’ve been in hospital.

I appear, a young(ish) girl, I spend 2 mins listening to the (appalling presentation) that the F1 gives. I ask a few questions, I look at X-rays and bloods and urinalysis results. I examine you, I conclude that as you are hungry, have normal obs, have no peritonism, normal bloods and haven’t done a shit for 4 days you are likely just constipated. My plan is: eat and drink, pain killers, something to move your bowels, observe and reassess in 8 hours. You will be feeling better by the next morning, when you will want to go home, and will be pleased with the outcome.

It is at this moment some patients look to the male junior for confirmation of this change of plan. Male junior is so inept and so inexperienced I wouldn’t let him decide what day of the week it is never mind anything else. He looks glum, chastened that he is wrong. It’s at this moment your wingman steps in, just nodding in agreement with what you’ve said. Some good nurses play wingman, they know the score. Some good F’s can play wingman but they can’t be relied on.

I miss that friend with a nodding head at my elbow. Maybe I should get a puppet to pull out of my pocket when necessary to nod in agreement.

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what mummy does at work

The prize comment in BMA news this week is accompanied by this cartoon which made me smile, and then feel sad.

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My upsetting sexist comments this week came from the same consultant whilst I was performing a very high anastomosis of the CBD into a loop of jejunum, Mr HPB turned to the fourth year student and said “just think in a few years you could be doing this too, how would you like that?”. I was seething; a few years? How about 15 years. This was swiftly followed by “you’ve got to be mad to do this job (it was by now 8pm, we had started at 10am) KBW is a bit mad because she wants to be a surgeon” this was again said in front of the student, scrub nurse, more junior colleague and another consultant.

I was livid, thousands of operations, hundreds of hours of independent operating, I AM A SURGEON I shouted in my head. A man would not have taken it, one of my colleagues famously retorted “not fucking really” after 10 hours with this person when he had let him do nothing and was asked if he wanted to put in the skin staples. I need to grow some balls. The good news is that there is no bile in the drains: want to be a surgeon my ass.

Thanks for that interesting observation BMJ Careers.

In a recent edition of the BMJ (yes reader, I have caught up eventually) there is an article about men’s dominance of surgery, they are commenting on a survey that I in fact took part in, about UK surgical trainees perceptions of how well they fit the “surgical prototype”. They used statements such as “Generally, I feel good when I think about myself as a surgeon” and unsurprisingly the boys came out on top, hilariously assuming that they performed better than all their peers, a perception that increased with seniority.

No offence to Tom Moberly, the editor of BMJ Careers, but his article is a wee bit boring. Men don’t “dominate” surgery, even that word is sexually aggressive, there’s just more of them. The big question is what is it that puts women off? why do they drop out, why do they leave? I know I am a strange creature in some respects (part time mummy surgeon) but I wasn’t always like this, I used to be just a girl and I wanted to be a surgeon more than anything else.

Role models get banged on about a lot, I have a few of them and they are mostly men. Why I have to identify myself only with women is a strange one, I identify more with someone who likes what I like (food, clothes, travel, exercise) or uses the same sort of language (frequent expletives) or has the same sense of humour than someone who is female.

I am very aware of my responsibility to other junior doctors and get at times (application season) overwhelmed with requests from eager beaver juniors who want some advice and to ask me all about being a surgeon. I realise that as one of the few young female surgeons who wears makeup, high heels and doesn’t fit anyone’s idea of a “surgical prototype”, I am the go to girl for the careers chat.

I am not a member of WIST (the Royal College of Surgeons of England’s women’s group; aargh) as I can’t bear the idea that we need a special group to look out for us. There isn’t one called PIST for presbyopics or GIST for the red haired so why is there one for us? I suspect they do marvellous things and I am probably missing out on something great, but I think as I have got this far without them I can probably carry on in ignorance. (Annoyingly the author of this article calls the Royal College of Surgeons of England “the royal college” when of course, there is more than one.) The president of the RCSEngland, Norman Williams urges that “it is up to us as a profession and medicine as a whole to look at why women may be deterred from becoming surgeons….and find ways to overcome any barriers they face”

I’m the only girl in my university year doing surgery, most are GP’s and the vast sums of money earned and ease at which part time working could be accommodated was what lured many of them. Unfortunately, they now have school age children who need them less and they are realising that they quit a job they loved (Anaesthetics, surgery, medicine) and are now stuck for 30 years in GP jobs they hate. A role model is someone who is happy doing what they do, not someone who has 4 kids in private school and a range rover and never works weekends or night shifts. I hope that it is the fact I love my job that makes me the careers chat girl, rather than the fact I am a girl.

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Nobody dominated her at work.