I am nearing the end of my training at one of the top surgical fellowships in the country. I chose this fellowship not just for the name, but also because the surgeons all seemed like genuine and altruistically motivated individuals. It was two-thirds of the way through fellowship when I found myself in conversation with two male trainees. We were discussing the younger trainee and his girlfriend; he would be moving away soon for fellowship, and they had decided to stay together. He mentioned that he had been operating with our program director earlier, and the topic had come up. When he told our program director that he was staying with his girlfriend, the surgeon stopped operating, looked at him, and said: “Come on man, don’t you want to go to [insert generic city name] and just pound some p#$$y.” As I heard the words, I recoiled inside from the sheer lewdness of the comment. I have always had male friends, and I was used to quickly brushing off immature male commentary. But as I walked away and started my day in the OR, the comment kept bubbling to the surface of my brain.
Each time I thought of it, I became more sickened and infuriated. Hadn’t there been female nurses or anesthesia docs in the room? Were they offended? Was I allowed to be offended if I wasn’t there? Was that really how my program director, literally the person responsible for making sure that I felt safe at work, thought about women? What kind of fellowship had I really chosen, if surgeons felt comfortable making those comments so casually in public?
In seven years of surgical training leading up to that comment, I cannot remember ever feeling so degraded by a male attending. Now, I realize that the comment was not directed at me, that I was not even in the room, and that he may not feel that way about me in particular. However, because it was spoken so publicly and by a person in a position of authority, it contributes to a ‘locker room’ culture and cues the younger male trainee he was operating with that such comments, and even opinions, are acceptable.
It is possible that I have missed other moments like this before. As a resident, you often get so overwhelmed by patient care, acquiring new knowledge and impressing your attending that it can be easy to miss things that are happening right in front of you. I may not have had the freedom of mind to notice something like this until later in my training; it may just not have been the culture of my residency program. I honestly cannot say which of those two is true.
This event made me think about women in surgery. I admit that I have been a skeptical follower of what I’ll call the “women in surgery pride movement.” I use Twitter, I followed #Ilooklikeasurgeon, and I read about gender discrepancies in surgical leadership. I have always felt those were generational problems that would equilibrate as the rising proportion of female surgeons aged into these leadership positions. I looked at these posts and felt like the younger surgeons participating were taking credit for a overcoming a barrier that I had never encountered, and wasn’t sure really existed for my generation. I wanted credit for my hard work, not for my hard work with a bonus for my gender. I cannot say that the story I am telling has helped me reconcile these feelings, and I realize that not everyone shares my feelings. It has, however, made me think about what I consider to be a separate problem for women in surgery, but not unique to surgery.
Part of what initially attracted me to surgery was that it was a male-dominated field, not just in terms of numbers, but also in terms of culture. I enjoyed that surgeons were direct and task-oriented, I felt comfortable within the hierarchy of the system, I yearned for the confidence of my attendings, and I felt at home with the dark and sometimes crude sense of humor.
And that may be why the comment I am discussing made me so suddenly feel like an outsider in the field where I have spent almost 12 years immersing myself. It reminded me that there is a certain culture that lingers in fields that have been traditionally dominated by men. It reminded me of the comments I had pushed to the back of my mind in the name of career advancement: “Wear a skirt to clinic with Dr. X, he’ll be nicer to you,” and “She only got that chairman job because they needed a woman, Dr. X was more qualified.”
It reminded me of this article that had resonated with me earlier this year. It reminded me that, even when you think you are in a place where you feel valued for your contribution, you are still bobbing and weaving to avoid hitting that culture smack in the face. It made me worry that, with this political administration, and with ongoing cues from men in positions of authority, we are entering an era where these comments will become more common instead of less common.
I have four months left of training; I will spend many late nights with that surgeon. I will have days where we spend prolonged periods of time in the kind of close physical contact that challenging surgery requires. And I will spend that time trying to learn everything I can because I think he is an excellent surgeon, and I owe that to my future patients. But I will be uncomfortable for every second, I will never go to him for career advice again, I will veer away from him at national meetings, and I will worry about what might happen to make next fellows (all attractive, young women) as uncomfortable as I feel.
The author is an anonymous surgery fellow.
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