Elinore Kaufman, MD
Surgery has a rich culture, full of strengths that exceed and defy the stereotype of surgeons as privileged white men who believe they are gods. In surgery there is a shared commitment to a goal, to individual excellence but also to true teamwork, to honoring the privilege of our patients' trust, to finding problems and fixing them, to getting quickly to the heart of the matter, whatever it is. As a surgeon-in-training, I am learning how to perform operations, but I am mostly learning how to make high-stakes decisions in imperfect circumstances, and as an imperfect individual.
This is what makes being a surgeon the best job in the world, and it has been inspiring to see surgeons celebrating one another through #ILookLikeaSurgeon. The photos from around the world show a broad understanding of the people who bring diversity to surgery, but also of how our diverse backgrounds inform our work. As a queer woman and a surgeon, this conversation feels rich, inclusive and important.
As surgeons we have a lot in common, but we also bring our own unique experiences to the work. As I learn to operate, I draw on my attendings' teaching and expertise, my patients' generosity, but also on my background as an artist. Working with paint, fiber and clay has taught me the joy of working with my hands, learning new physical skills, and balancing speed and precision. I also bring my identity as a queer person to surgery. This can mean building a special bond with my lesbian, gay, bisexual, transgender and queer (LGBTQ) patients, making sure their partners, families, and identities are not only tolerated but welcomed. It can sometimes mean giving advice about anal sex after hemorrhoid surgery. It means always, always, always using the name, pronouns, and gender that a patient prefers.
Being queer in surgery means living in a world that assumes I am straight, and coming out over and over again. Although the reactions of my surgical colleagues are rarely hostile, they can be a bit awkward. Being queer in surgery also occasionally means pulling a colleague or student aside to tell them why I didn't laugh at a particular joke, or why they shouldn't assume that a married man has a wife. It also means letting some of these moments slide, wishing that it were someone else's turn to intervene.
I've been involved in LGBTQ organizing and activism in one way or another since middle school. I've been out since high school. It's a little bit about who I'm attracted to, and a lot about how I see the world. At the beginning of medical school I was one of two openly LGBTQ people in my class of 200, and I spent a lot of time not only explaining myself to my classmates and teachers, but also working for the inclusion of LGBTQ health issues into the curriculum.
For me, being queer in surgery means giving special attention to what alienation from healthcare feels like. Many of us from have experienced real discrimination at the individual or community level, leading us to present late or not at all; or to act in ways that perplex or annoy our doctors. Depending on our healthcare providers’ responses, this can lead to worse health outcomes. It also means being aware of health disparities that affect LGBTQ people beyond HIV: disparities in cancer, mental health and substance abuse, as well as insurance and access to care.
It means being aware of transgender-specific health care: transgender people are among the only individuals who often need surgery just to be themselves. Trans people, often with limited resources, save money for procedures that can be life-saving, but that insurance often doesn't cover. They frequently travel for services that are only available in a few places. Not every trans person wants or gets surgery, and gender confirmation surgery is not in the scope of all surgeons’ training. But still, our profession plays a critical role in transgender people's lives.
Thinking about the experiences of my LGBTQ friends and patients also gives me a special appreciation for surgeons just being surgeons. Surgeons like to get to the point, and we can be single-minded about it. We don't usually like endless debates or complications. While at times this might make us less sensitive to certain issues that affect our patients, it can also be a good way to approach everyone equally. For LGBTQ patients this can be an advantage. The average surgical history does not include a lot of invasive, personal questions. Being brisk can sometimes make us less judgmental, not more. So I was pleasantly surprised when, as part of a surgical team caring for a transgender woman with acute cholecystitis, the only person who cared about her genitalia was the person putting in the Foley.
I approached #ILookLikeaSurgeon with some suspicion. I am a woman and a surgery resident, and I know there are not enough of us, especially in leadership and mentorship positions. But as a white, upper middle class woman with an elite education, I come to surgery with an enormous amount of privilege already, and this disparity does not seem like the most urgent one. In addition, many discussions of women in surgery often seem to assume a uniform experience about life as a woman and a surgeon, and as a queer person, my life works differently. The assumption is often that all the women in the room date and marry men; have children at all or in the same way; and think about childcare as primarily their responsibility. I know many colleagues find solidarity in these conversations, but these are not my assumptions or my experience, and I have often felt invisible in these conversations. In its own way, invisibility is as exhausting as Q3 call.
Like many, I had a baby during my research years. Unlike my straight female colleagues, my partner got pregnant and gave birth. I did not operate pregnant or miss clinical time for prenatal visits or maternity leave. But more than that, my partner was not raised to believe that someone else would be the primary caregiver, so there's no pressure from reversing stereotypical gender roles. When I finish research in June, I know I am going to experience stress and sadness from not spending as much time with my kid as I wish I could. I know many of the fathers I work with feel this tension as much as the mothers, even if they are not expected to talk about it. On the other hand, I do need to make sure that my job offers partner benefits for health insurance that will cover us all. I'm only going to let my career take us to cities where we feel comfortable; where we have community; and where we are going to feel okay about raising our kid without her feeling like she's always the only one who has to explain her family. There are some family-friendly towns and institutions that might not be as friendly to my family.
So yes, #ILookLikeaSurgeon, I act like a surgeon, and I also look and act like myself. Our diversity matters to us, and it matters to our patients. We can bring our whole selves to their care, and they need us to.
Elinore Kaufman, MD@ElinoreJKaufman