#ILookLikeASurgeon: The Hardest Part

by Chris Porter, MD
@PorterOnSurg

Watching the #ILookLikeASurgeon Twitter campaign has been a joy. I’ve long felt the old boys’ surgeon culture needed some shaking up.  (Facilitating cultural change was one of my goals in creating OnSurg.) May our new workplace culture recognize this: surgical practice was designed around men with few parenting obligations. That breed of surgeon is a rapidly-shrinking group. The growing demographic is female surgeons and new-age dads – people who parent.

Unlike most of the surgeon faces on #ILookLikeASurgeon, I’m privileged as it gets, race- and gender-wise. Even age-wise. Nobody calls me nurse or looks quizzical when I claim to be the surgeon. My scrub cap goes off to all who face workplace stereotype challenges. Being a surgeon is hard enough. Patients die who shouldn’t. You make mistakes you never imagined. You face questions you’re untrained to answer.

For me, the hardest part of being a surgeon though, is when the school nurse calls to say my daughter is sick while I’m up to my elbows in a patient’s belly. Sometimes a patient requires your full attention and you can’t give it.

In 2009, a colleague left our three-person practice. We struggled to replace her. I was getting worn out, but enjoyed being the go-to surgeon. My wife was also in a critical period of her career, so we outsourced parenting to a nanny. We could work day and night. I stayed late and routinely returned to the hospital for minor issues, on call or off. Long hours notwithstanding, work was the stable part of my life’s bigger picture.

My daughter was three when her mom and I separated. I rented the nearest apartment and left it unfurnished because I had no time and little idea how long I’d be there. We camped in sleeping bags and walked to the corner convenience store for bananas and cup-o-cereal. I set up a tent in the living room to complete the ruse of a planned adventure.

One morning I awoke anxious, well before my alarm, thinking about my upcoming operation. I took a long shower, rehearsing the steps of the abdominoperineal resection (APR) in my mind. My daughter woke up and, finding me absent from our nest, walked out the front door in search of me. My neighbor – a stranger to us – found my child, dressed only in flowered underwear, bawling in the parking lot. Early traffic whizzed by in the pitch darkness. The neighbor escorted my girl, lost, through the complex till they found a unit with a wide-open front door. I was still showering. The confusion and pain brought by our reunion rattled me. Concentrating for a five-hour APR was a challenge, and rationalizing the parenting guilt remains impossible today. Recalling that morning gives me nausea.

In 2011, during divorce proceedings and a cross-country move, I lived in hotels in Phoenix and commuted to Virginia for weeks at a time to secure a job. I worked surgical hospitalist shifts – sometimes five days straight – then flew back to a smelly extended-stay hotel for my week with my daughter. Family life was a fiasco. My girl grew accustomed to suitcase living and vending-machine meals. One morning I dropped her at school with Lunchables and no shoes. That night we splurged on a nice hotel with a pool. At 3 a.m., a fire alarm woke us and we marched outside. Police and fire trucks came, adding sirens and radio chatter to the clamor. My little girl twitched and yawned in my arms, and I stared into the pool hoping juvenile amnesia would erase this heartbreaking adventure in career and family.

After arriving in Virginia, my daughter and I were fully reeling from the break-up, the move, and separation from the nanny who’d been my daughter’s rock. I couldn’t fathom putting her in daycare, yet my nearest friends and family lived 2000 miles away. I quickly realized caring for a kindergartner half of every week would be impossible in most surgical practices. Even my modified hospitalist practice, with a clinic and an operating day, would get hit with the occasional snow day, knocking three patients off an overbooked schedule because I had to entertain a five-yr-old.

I opted to continue as a surgical hospitalist - a career move few had heard of, much less wanted on their mid-career résumé. I was grateful the option of being the nights-and-weekends surgeon even existed; the year prior it did not. Thankfully I can keep my career alive working the hours nobody wants.

A friend of mine wasn’t as lucky – she’d struggled as a new mom/new attending in a traditional academic practice which offered no scheduling flexibility. Then divorce left her caring for a toddler unassisted, ending her general surgery career just two years after completing training. What a loss for our community! What a cost to find a replacement. How sad, to have trained so many years for a dream that was realized for two fleeting years.

We can do better for ourselves and our patients. Our workplace is an anachronism, and the faces of #ILookLikeASurgeon reflect an energetic future of surgery. I love the spirit in this Twitter campaign. Let’s bring it to bear. Let’s celebrate diversity, break stereotypes, and advocate for real workplace change that make sense for our families, our lives, and our patients.

Chris Porter MD - general surgeon and founder of OnSurg.com