Friday, January 19, 2018

#ILookLookLikeASurgeon is Catfished: #TimesUp

Since the inception of #ILookLikeASurgeon in 2015, many of us have taken great pride in the positivity of the movement. It is with great sadness that I share the article below, written by an individual* in the #ILookLikeASurgeon community, detailing how a single individual used the movement to harass and manipulate women surgeons for ulterior motives we may never fully understand.
--


Around three or four years ago, an email appeared in my Gmail inbox. It was an account I reserved for subscribing to mailing lists of websites I knew would pummel me with useless emails. A man named Matthew wanted to connect with me. He had a terrible story but not unlike ones I have heard before. A terrible condition, resulting in multiple highly invasive cardiac surgeries, to replace the aorta. The aorta is to be feared and respected when we encounter it. For those who need surgery on it, it is quite literally life and death. These poor souls may face certain death without surgery and risk death with it.
Matthew was one of these people. He was in awe of what we surgeons do, holding life in our hands at times. And he would know. He shared with me operation reports and photos from the operating room where his chest was cracked open and a team of surgeons worked expertly to save his life. I skimmed the report and phrases like ‘cardiac arrest’ and ‘internal massage’ told me that this man’s surgery was anything but routine. I felt for Matthew and what he must have been through. As a surgeon myself, my technical and medical mind was interested at the fascinating surgery this man had undergone.
My gut was not interested though. It was not sympathetic, it was not sad, it wasn’t even fascinated. It was nervous. There was something about this man’s near hero-worship of someone he had never met, of his fascination with me and the job that I did that made my gut churn and my skin crawl. So I politely backed away and never heard from him again. Or at least that’s what I thought.
--
In the years following this, a ground swell began. Around the world, women surgeons are a minority. Regularly, women in medicine and particularly in surgery have been subjected to systemic biases, unconscious biases and outright sexism in their pursuit of a career that they love. Buoyed by investigations and policies into dismantling sexism such as that undertaken by the Royal Australasian College of Surgeons, women surgeons began to publicly advocate for themselves.
In the social media field, the hashtag #ILookLikeASurgeon sprang up. To this day, the hashtag has been used millions of times over. In an effort to combat the catch cry of the ignorant or combatant, that you don’t look like a surgeon, women surgeons took to the internet. They stood up together to show people everywhere that gender was no barrier to success, even when that success landed you in the minority.
Seemingly suddenly, we had gone from lone wolves in male-dominated practices to a pack of like-minded women. Some of these women have become my mentors, friends and confidants. And the effects have reached around the globe, to inspire young women to pursue their dreams and goals.
Harnessing the power of social media meant sticking your head above the sand and having a public profile. In our experience though, we had largely positive experiences. Even on an academic front, the collaboration that came from social media had allowed us to perform research and network professionally in a way that we had never experienced before. Social media gave us power and in return, we gave it ourselves and we gave to our cause freely, graciously and with our whole hearts.
--
It was late 2015. My experience with social media and online presence was growing all the time. Like many of my friends and colleagues, whenever the opportunity arose to plug our cause, we did. And so when a woman named Jill contacted me to feature a photograph on her then, small Instagram account called ‘Inspiring Women in Surgery’, I agreed. There was nothing there that worried me at the time and I gave her nothing that wasn’t already in the public domain. Trust me, this was not a Nigerian prince after my credit card. This was a girl who wanted to be a surgeon and so was doing her bit to showcase all the women who make surgery possible.
The Instagram account grew, and the women featured number from dozens to many more. Conversations were struck up with Jill. And her story was one of hardship and triumph over adversity. Her sister had died during surgery in 2015. They were both residents, both intent on pursuing careers in surgery. She would have been so proud of what Jill had achieved. I was proud; here was a driven, polite young woman doing her bit to showcase what women around the world were doing.
Jill explained to me that her sister had died during a routine procedure. A caesarean section but no mention was ever made of the child. Jill had stood in the operating theatre and watched the medical team work on her sister’s lifeless body, eventually cracking the chest to massage her heart back to life. It didn’t work and her sister died in the cold operating theatre.
I was perturbed. What a terrible loss for a family but what a terrible thing to have witnessed. Jill was a pseudonym, her heartbreak meant that she didn’t want to publicly disclose her identity. In the online world, wanting to shield your scars from the eyes of others seemed reasonable. The big, wide world could be a harsh place and if you were already nursing pain, extra pain is the last thing you need.
Under that emotion though, were questions. Why did the team let her stay while her sister was having very graphic and invasive resuscitation? Why did she die so suddenly during an elective caesarean section, an operation that in most countries, carries a very low mortality rate. Why did they crack her chest to resuscitate her? Something was off. I didn’t know what it was though. I put it down to a strong, albeit disordered, grief reaction.
I watched the account grow with square after square of remarkable women. Some of these women I had the pleasure of meeting in real life and knew they deserved the place amongst the masked faces of women who called the operating theatre home. Jill was curating a living museum of women who would be role models to many, and upheld the ideals of #ILookLikeASurgeon so we were happy to be involved.
Behind the scenes, Jill loved to interact with the women that she featured. Her messages with me always began the same way, ‘Hi Doctor,’ and she would ask me to do something for her or about surgeries I had done. Had I ever seen a ruptured aneurysm or a transplant? That same feeling that can only be described as icky, was ever present. I could never put my finger on it suffice it to say something was not right.
That icky feeling kept me from over sharing. On my personal Facebook page, a request popped up from ‘Jill Wis’. I politely declined and explained that my personal Facebook profile is for personal contacts; friends and family. Mainly because of my penchant for sharing cat videos or bad humour. She understood completely and there was no hard feelings.
On the anniversary of her sister’s death, Jill shared a photo that was disturbing. A memorial of sorts that showed two photos. The caption below explained how her sister died and that the OR nurses had been kind enough to take two photos for her remembrance. One was a picture of a heart monitor, the numbers reading zero as the patient has passed. The other, a person in theater garb, blood on the glove of their right hand.
Our little group of surgeons chatted about this particular post. We were worried. This was an odd thing to share. We worried about Jill’s mental health and how she was doing. We wondered why the hell anyone would keep photos of their dead sister’s cardiac monitor. We wondered what kind of OR nurse would stop doing their  lifesaving job in order to take a photograph for posterity’s sake? We were reassured that members of her group had spoken to her and that she was getting the help that she needed. We questioned the photos, the story to an extent but we explained away the inconsistencies and the concerns with kindness.
Jill announced some big news in mid-2016. Inspiring Women in Surgery was to be turned into a book. Our kindness persisted, with the social media feed a constant stream of congratulations and pride in Jill. Selflessly, she declared that she didn’t want the profits, she would share them with each of the women. The accolades continued to roll in and we all thought it was a real win for our little cause that could. But more importantly, a win for the girl who rallied from her sister’s death.
The site grew and so did Jill’s interactions with my friends and colleagues. We all chatted regularly about our lives or met at conferences and Jill’s name would come up in conversation. We’d lament her situation and there was this tipping point where someone would quietly allude to the oddities that they had encountered. Then we’d quickly look away or explain away the poor girl’s situation.
The conversations took a downward trajectory in mid 2017. Jill was dying. A terminal cancer was going to take the surviving sister, the pioneer, the advocate. She was facing major surgery depending on the results of a CT scan. They did not bring good news though she embarked on chemotherapy. The little community was heartbroken. I was so sad for her and her family and offered my unconditional (non-financial) support.
Following chemotherapy to shrink the tumours, Jill underwent major surgery. She had nearly ten hours of surgery with a cast of thousands who resected bits and pieces of her; her rectum, her pancreas, her liver, her aorta. She had survived 74 minutes of being ‘switched off’ the heart lung machine, a process we call ‘deep hypothermic circulatory arrest’. A normal period of circulatory arrest is say 20 to 40 minutes, but again, we all let that slide. She posted on her social media how she had survived the surgery and again, an outpouring of grief followed. And relief that she had made it. The community again, rallied behind Jill and her horrendous turn of events.
One day in December, Jill messages me. ‘Hello Doctor,’ she began and proceeded to tell me that it was not good news. She had been made terminal by her doctors and was for comfort measures only. I felt the breath leave my body as I knew that metastatic cholangiocarcinoma was un-survivable essentially. Details of surgery with incisions and pain, feeding tubes and manual rectal disimpactions. The story came with a warning. Do not discuss this with anyone else. So I didn’t. For a little while at least.
--
Eventually, news of Jill’s demise had spread. “Have you heard about Jill? Oh poor thing!” or her poor family were kept in people’s thoughts and prayers on social media. As the news was public, we chatted.
How awful that Jill has cholangiocarcinoma.
Cholangiocarcinoma? I thought it was rectal cancer…
Someone else had heard it was a neuroendocrine tumour.
And what about her sister? She died during a caesarean section.
No, it was a mastectomy.
The gut and the skin had gone from minor players to major players in my emotions. They were joined by my racing heart and my heightened senses. That feeling I couldn’t put my finger on had become one very clear thought. We had all been duped.
I decided to dig and messaged Jill via a social media direct messaging platform. How was she, what a tough time it is for her, you know, platitudes until I dived into my first question. Who was your publisher? She gave up the details. The temptation was too great to not engage more and find out more. The fantastical details flew. She was wealthy beyond my wildest dreams. She declined the retainer from her publisher because she didn’t need the money. I asked why she was anonymous and she told me she doesn’t need the friends. But one day, she announced she planned to reveal her true identity to me.
“Just you and me and a bottle of wine”
That was it. That was when I knew. It was a man. There was no Jill.
And then we did what Jill had asked us not to do. We talked. We all compared notes. Astonishingly, not a single person was surprised. The reaction was the same in all but one person. I. Knew. It. Nobody had quite believed what had been said. There were too many changed stories, medical inaccuracies and messages that left the recipient feeling uncomfortable.
Like a house of cards, they began to tumble one by one. There was no book. Affiliations with companies fell once they realized this was a ruse and Jill refused to identify herself. Messages came flooding in from women who had talked to other women who added pieces to the puzzle. The final piece however came from one woman.
She had spoken to a man called Matt who was a friend of Jill’s. He himself had terrible medical problems. Aortic surgery. She provided his name and a link to his LinkedIn profile. And the final card fell.
It was Matthew.
The same Matthew who had emailed me years before asking about his surgery, sharing his operation reports and always politely saying, ‘Hello Doctor’ just as Jill had done.
As companies contacted “Jill” to confirm her identity and individuals in our group asked that our photos and quotations be removed, we repeatedly refreshed our screens as we watched InspiringWomenInSurgery.com slowly dismantled before our eyes. Suddenly Facebook bore no mark of ‘Inspiring Women in Surgery’ or ‘Jill’. The 294 posts of women in their scrubs and face masks vanished from Instagram. And finally, Matt too disappeared from social media.
There was no Jill. There was only Matt. And then, there was neither.
--
In 2017, sexual harassment starred in the spotlight thanks to women who outed Hollywood producer Harvey Weinstein. The Weinstein effect followed with more and more powerful men falling under the weight of accusations of decades of abuse. Abuse of women, abuse of men and most importantly abuse of power. These women stayed in the darkness with their accusations and scars, afraid to speak up. When they bravely took these sordid tales to the light, their house of cards fell.
Time’s Up, they proclaimed. No longer would fear keep them in the darkness. Fear of reprisal, fear of being disbelieved or fear of being alone. Everyone was to be held accountable for keeping those women in the dark by abuse of power.
That is what Jill had done to us. She had made us doubt ourselves, keeping our concerns in the dark. When we got over our fear of being labelled cruel for judging the girl with cancer who just wanted to help the world, the flood gates opened and the depths of her deception were revealed.
Amongst the women who I know, nobody had given money. But they had given time, emotion and details of their lives that might be considered personal. And now, the embarrassment of knowing that something was wrong but not saying anything. Of being duped. I mean, we are smart and strong women yet there was over two years of deceit. And although we had not shared too much, we wondered who had.
This was our Time’s Up. Time was up on being too frightened to call out something that just didn’t feel right. And when we did, the results were spectacular. In less than a day, two “people” disappeared into the ether.
We know they will resurface. But we also know that we have learned valuable lessons. Anonymity is a protection for the person who is anonymous but not those who accept it. Social media is powerful but whether that power is used for good or bad remains firmly in the square of the user. And most importantly, when something feels wrong, it may well be.
Time is most definitely up to put a need to be polite ahead of a need to ensure your own safety.
Time is up on being duped by men (or women) for their own needs when ours go unmet.
And time is up for fear. We will not be silenced or scared to call out bad behavior when it happens to us or to anyone else around us.





--
Please note that all investigations have been handed over to the proper authorities.


For more information on catfishing and online impersonation, please click here.
If you believe you have been a victim of a crime, please contact your local law enforcement or use this form if the act occurred in the United States.


Finally, if you believe that you were contacted by this person (Jill) in this story and wish to be put in contact with other women who were involved, please email:

*Given the sensitive nature, the women involved have chosen to keep authorship anonymous.

Wednesday, January 10, 2018

January 2018 #obsm chat: Dealing with the Aftermath of Successful Weight Loss



You’ve lost a lot of weight either through bariatric surgery or another weight-loss method.  Now what? Before embarking on a weight loss or bariatric surgery program, most individuals are informed of the lifesaving benefits of the treatment and anticipate the possibility of a brighter, healthier, longer future.  Visions of greater choice of clothes, friendlier numbers on the scale, decreased pain, and increased self-confidence perfuse the pre-weight-loss psyche.  Outstanding weight-loss success can bring so many positive things into one’s life, yet much less attention is typically paid to the emotional costs of that success.


The Guardian recently published an excellent article on the issue of dealing with excess skin following highly successful weight loss.  Reading the post offers an honest window into the torment of no longer feeling comfortable, or even literally fitting into, your own skin.  Despite dramatic weight loss success, many individuals experience a newfound insecurity when their familiar curves are replaced by loose appendages.  This can be both physically uncomfortable and emotionally scarring.


Highly effective weight loss can lead to very different responses from some around the successful individual, some of whom are enthusiastically supportive.  Spouses or significant others, however, may become jealous or resentful and fear that their relationships will be jeopardized.  Changes in sexual interest and responsiveness may sound enticing, but what if it puts you out of sync with your partner? Newly differing levels of physical activity may be another source of disconnect.  Eating buddies may mourn the loss of the shared joys of eating out together as they had in the past.  Though some may treat successful weight loss patients with more respect, this raises suspicions that they were being judged by their appearance, rather than their personhood in the first place.  That can feel good yet be confusing and even upsetting at the same time.  Getting attention for your physique may seem desirable, but not always, especially when there is a history of sexual abuse.


With bariatric surgery, there are increased risks of substance abuse, particularly with alcohol, especially following gastric bypass.   Some have struggles with acid reflux, particularly with the band or sleeve.  Others find that taking medications can be challenging in addition to trying to remember to take all the necessary vitamins and supplements in the proper amount and at the right time.  Going through a period of thinning hair can be unnerving and can impact self-confidence.  Finding that you can no longer tolerate specific foods can be quite an adjustment as well.  Lastly, while many experience a boost in mood, there is still the specter of increased suicidal risk over time, a very serious concern.


In our next Twitter chat (Sunday, January 14 at 9 pm EST) we will discuss dealing with some of the less positive aspects of successful weight loss. Specifically, we will be addressing the following:


Questions:

1. How does overcoming #obesity impact one’s personal relationships?
2. In what ways has excess skin after weight loss proven to be a concern, and what role does body contouring surgery play?
3. To what extent do substance issues, sticking with vitamin regimens, food intolerance, and issues such as thinning hair affect the successful weight loss patient?
4. How does successful weight loss affect self-esteem and mental health? How can those changes be addressed?
5. What are some other negative or unexpected consequences of successful weight loss?  What are ways to deal with those?
6. What can healthcare providers do to help one prepare for and deal with some of the downsides or challenges of successful weight loss?