1001 Cuts

Funding for 1001 Cuts was provided in part by, the American Medical Women's Association, BOSS Business of Surgery Series, Academic Credentials Evaluation Institute, LevelPar Capital, Elizabeth Terplan and Dr.

Martin Terplan.

Dr.

Myriam Curet, Brave Enough Community for Women Physicians.

Additional funding provided by, and others.

A complete list is available at APTonline.org There's a riddle.

where a boy and his father are in a car crash.

And the car crashes, and the father is killed.

Oh, that's so sad.

Oh geez, it's only a story, Edith.

And the boy is rushed to the hospital.

The doctor looks at him, says I can't operate on this boy.

He's my son. Now, how is that possible?

Hmm?

How is that possible?

The father was a priest, right?

Like a Catholic father?

No, it was a real father and his real son.

Is it a case of mistaken identity?

That's wrong.

Of course it's wrong.

Well, how can you be so sure?

You don't know the answer.

Well, I know when it ain't the answer.

Clock's ticking fellas.

Alright, what about if, uh, if the father married the son's daughter?

This is a family riddle Earl, you've got, you've gotta think clean thoughts.

Hey, give us a little hint.

You want a hint, Clint?

A little hint.

Alright.

The doctor's a woman.

The doctor's a woman.

The surgeon was the boy's mother Oh, you're right!

Oh, great for you Mrs.

Bunker!

That's wrong.

What's the real answer?

That's it.

Mrs.

Bunker is right.

Gee, you know, that never entered my head that a woman could be a surgeon.

Look at the way I've been trained to think.

Like a chauvinist.

Right.

Well, if that's the answer that's the dumbest riddle I ever heard.

Who the hell ever heard of a woman surgeon.

People just don't expect surgeons to be women.

People don't think of surgery as women's work.

And people come up with all kinds of extraneous answers, like maybe the boy has two fathers, or that maybe it's the boy's grandfather, or maybe it's an alien from outer space because that makes more sense to a lot of people than that the boy has a surgeon as a mother The stereotype that we have of surgeons is that of an old, white man.

Each surgical section is headed by a medical core officer, who may act as consultant when authority has been delegated to him by the chief of the Surgical Service.

He assigns each case to the appropriate surgical ward, and is responsible for all operative procedures.

I mean, I think when I was a little girl and I was growing up, it always seemed magical to be able to fix people.

I grew up having the little plastic doctor's kit and everything to go with it.

My first anatomy class I was like, show me the book, show me the atlas and I'll disect the tissues, the muscle, the nerve, whatever it may be.

And it really engrained in me that this is what I wanted to do, is actually, you know, physically touch the patient and try to fix things on the human body with my own hands.

I always wanted to be a surgeon.

People ask me what else I would want to do, and there's nothing else.

From the second that I stepped into the operating room, I knew that it was where was supposed to be.

It was love at first sight.

I didn't choose surgery.

Surgery chose me.

My dad is a trauma surgeon.

So, sometimes there were periods of time where we didn't have childcare, and so we'd have to go with our parents to work.

And I remember just watching what they were doing, and the clamp came off for a little, and the blood, poof, went into the sky, and I was like, this is amazing!

And then, I just could not shake that feeling.

When I got to medical school and saw actual surgical procedures, it really interested me, and just spoke to my soul as to something I really wanted to do for the rest of my life.

When I walk into a room, I'm sure the first thing they see is that I'm a female.

And sometimes they ask if I'm the surgeon.

By and large, when I said to people, I'm considering training in surgery, the reaction was like, oh, that's adorable.

It was a look of shock and dismay.

This can't be done.

How are you planning to have a partner, and children, and, do you know how hard orthopedic surgeons work?

You might not be cut out for that.

And, I remember thinking the whole time, I have never failed anyone's expectations up until this point, so why now?

I think the underlying message I was given as a medical student was to be very cautious of taking any pathway involving becoming a surgeon.

And to hear that over and over again every time you you know, are trying to, you know, focus on a path, I think it's rather discouraging.

A lot of the reasons I've been told I shouldn't go into surgery are because of my personality.

And because I am too nice, and things like that.

But I think that those skill sets are absolutely critical for somebody who's going into surgery, because being able to reassure those families that not only that we know what we're doing, but also that we care about their loved one, I think has a significant impact on a patient's experience, and their family's experience as they go through hard times.

Women have been slow to enter surgical fields because surgery has typically not been viewed as a specialty that's friendly towards women.

I'm used to not getting a whole lot of help.

That just kind of is the nature of how it rolls.

I've had more than one occasion where I've posted the case as an emergency and yet, because the room's not ready, I've had to do a scrub tech's job by opening the table, setting up getting the room ready, getting the bed made.

Sometimes even, going back down to the E.R.

and physically wheeling the patient up because something in the system is just not moving fast enough, and I don't want to compromise my patient's outcome.

And this is just something that I've never seen one of my male colleagues have to do.

Ultimately, this is a patient safety issue If a woman is not respected to the same degree as a man, you have to realize this can be a life and death situation where things that are challenging can happen.

And so you all have to be willing to work with each other.

[heartbeat] Every girl in Little League, every woman playing college sports, and every parent, including Michelle and myself, who watches their daughter on a field or in the classroom, is forever grateful to the late Patsy Takemoto Mink.

Denied admission to medical school because she was a woman.

Patsy went on to law school and co-authored Title Nine, banning gender discrimination in our schools.

So long as any part of our society, adheres to a sexist notion that men should do certain things, and women should do certain things, and then begin to inculcate our babies with these notions through curriculum development and so forth, then we'll never be rid of the basic causes of sex discrimination.

After Title Nine, universities were forced to admit women on a much broader, more equal basis, and just an absolute groundswell of women in undergraduate pre-majors, and then also into post-grad programs flooded into medical school.

And every generation since, in the 1990s, I tend to call these people the children of Title Nine.

So they're breaking all these barriers, and they're also finding that no matter how hard they work, they're still subject to these same forces, I think, of an institution that has a top down misogynist or even a patriarchal culture that perpetuates the status quo.

Go ahead and read your Bible, Dennis, and you go to your church, and with any luck, you might win the annual raffle, But if you're looking for God, He was in operating room number two on November 17th, and He doesn't like to be second guessed.

You ask me if I have a God complex?

Let me tell you something, I am God.

The thinking is, is that, okay, if you're going to be a female and you're coming to join our boy's club you basically have to act like a boy to join our club, or try to be a little bit like us.

[excited cheering] Shh.

Shh.

We have Bethany Whisper in our locker room.

Oh, boy.

I guess they do, airbrush out the tattoo, don't they.

You want to see it?

You really want to see it?

Fine.

Let's look at that tattoo up-close and personal, shall we?

And what are these?

Oh my God.

Breasts.

How does anybody practice medicine hauling these things around?

And what have we got back here?

Let's see if I remember my anatomy.

Glutes.

Right?

Let's study them.

Shall we?

Gather around and check out the booty that put Izzie Stevens through med school.

Have you had enough, or should I continue?

Because I have a few more very interesting tattoos.

Sexual harrassment is not about sex, it's about power.

And people are asserting their power to tell women that they don't belong in these spaces.

A study that came out from the National Academies a few years ago said up to fifty percent of women medical students and over fifty percent of women faculty have experienced sexual harrassment.

I, myself, have experienced almost every form of it during my training.

Gender harassment is not about romance gone awry.

It's not about trying to pull women into sexual relationships.

Instead, it's about pushing women out.

Out of careers where they're seen not to fit and not to belong.

The operating room is this very special and sacred space.

And I think most people would be very surprised to learn about some of what goes on.

I remember being at the computer and he was right here, and he pulled down his pants and had this big erection.

He was like, you know you want it, you know you want it.

There was often porn on the computer.

So you would open up your computer, to write a note and click on something, and porn would just splash in your face and you would have no idea and just be completely surprised.

he reached around my side and just sort of took my entire breast in his hand.

There was a guy, who was an older guy, and he would jokingly pulse lavage the girls' gowns and then pat us down and say, good girl, good girl, good girl.

[heartbeat] [beeps] I mean, nothing, nothing is made for a woman in the operating room.

There are, for example, stapling devices, some of which, you actually if you have small hands, actually have to take both of your hands to get enough grip strength to close.

I've had to adjust my own surgical technique because there was an instrument that was meant for a very large male hand, that wasn't gonna work for my hand, and unfortunately we see that all the time and it's a real problem.

We make all kinds of accommodations for the different shapes and sizes of our patients.

Why it's necessary to do that for a surgeon, is, it's laughable, it's so, you know, it just seems like common sense that you need to do that.

Of course you need to do that.

And, when I ask for a different instrument, because that instrument doesn't accomodate me, it's not because I'm being, you know, needy, or asking for something outrageous.

It's becaue that instrument doesn't work for the circumstance that I need to do this operation in.

That's it.

The gloves are all meant for these kind of fat-fingered males and so if you want the correct size for your finger girth, they end up being these short, stubby parts that you don't fit into correctly.

We all kind of just manage and accept it.

We've accepted it, I've accepted it for twenty years that the gloves don't fit but they don't fit.

The height of the beds is super challenging.

For someone of my height, that often means using step stools.

And by the way, these steps stools are often not even, because they're old and nobody replaces them, so they're like ratchety step stools, and now you've got two ratchety step stools stacked on top of each other, and honestly, it's not very safe.

I've gotten pushback for asking for a step.

I get sighs.

I get kind of this, like, (sigh).

There she goes asking for a step.

But the reality is, I can't do the operation without being able to reach the table.

The thing about having equipment that's not the right size, or doesn't fit, is that it makes you feel as though you do not belong in your profession.

The sexism within surgery that I've experienced as an attending, has to do more with men looking the other way.

has to do more with men looking the other way.

Synergistically with that is the sexism that I receive from other women.

And who knew that it was the women who were going to perpetuate and enable the patriarchy that has been in medicine and surgery since time began?

You have to be very conscious of and your approach.

What ends up happening is we ask for things multiple times.

You know, the instrument that we need, we'll ask for it, and then we don't get it, and we ask again, we don't get it.

We ask again, and each time we're like raising our voice because people aren't hearing us.

And then all of a sudden we're told that we're yelling.

I think the only way you can ask for things as a woman and have people like you, is by apologizing for it before and after you ask.

I have to often say, Please, would you mind?

I'm so sorry to bother you. These kind of words before and after my, my order, or what I need done for the patient, that I don't see any of the men using.

Men are assertive, they're instrumental, they're task-oriented and they're competitive.

Women, on the other hand, are nurturant, we're expressive, and sensitive, and warm, and communal, and we're converned about others Which one sounds like a surgeon?

You're expected to be assertive, but you cannot be too bossy.

You're expected to work really hard, but then what is wrong with you?

Where are your children?

How are you not taking care of them?

I've been told I have a resting bitch face.

So that's where they come and tell you to smile.

They're like, why do you look so unhappy.

Oh, do I look unhappy?

No, this is my happy face.

You just wait for my unhappy face.

Right?

And there's certainly no resting bastard face.

Surgery, specifically trauma surgery, requires you to be assertive, to have a louder voice, to be not bossy, but to be the boss in circumstances where that particular thing is going to save somebody's life.

Women surgeons are literally being reprimanded for using the wrong tone of voice, or for looking at someone the wrong way, while in the very next room, a male surgeon is throwing instruments.

If a woman shows up into that same space, and acts the exact same way as that man, the response is decidedly different.

The response is often, Who does she think she is? How dare she talk to us like that. Ultimately, those little digs, and those little things they do add up.

And they add up to time and energy that you needed, that you should've been able to put in other places in your career and couldn't.

Hospitals are some of the most regulated spaces we have in our society.

Literally, a hospital could lose it's accreditation for having one too many coffee cups in a nurses station.

And yet these unethical, immoral, and frankly illegal acts of sexual harassment and discrimination are happening every day.

All women want is equal, expansive, safe learning and working environments.

That's what the law is intended to provide.

These institutions would take Title Nine more seriously if the law was enforced.

If its promise of equality or its mandate for equality is ever held to account, it would improve patient care.

It's the patients who are the victims of the sexism, ultimately.

You know, I'm the intermediary, but it's the patients who suffer from this because there's, there are fewer choices and fewer of us doing good work.

[heartbeat] Day after day, year after year, the experience of being discriminated against of having to work harder, of having to work harder, of hav your work be underappreciated, it eventually got to a point tha it was not worth it for me.

It was no longer worth it to stay in the workplace.

If you had told me when I was a young surgeon that I would leave medicine before I turned 50, I would not have believed you.

I loved practicing medicine.

But, it's the accumulation of these small incidents that happen day in and day out that it feels like death by a thousand cuts.

When a woman decides to leave the field, because she felt like she was pushed out, or just couldn't put up with the discrimination that she was experiencing, that's a loss for the entire community that she might have been serving.

It has to start with me.

I have to be more aware and be less tough skinned, honestly.

Like, maybe I can take it, but I'm not going to let anybody else take this.

I'm not going to let someone, a resident or med student deal with this anymore.

And so I'm going to change the environment for them.

Belonging in a place means that you can be yourself, and you can be valued and seen and appreciated for who you are.

I am successful right now in the position that I am, because my leadership supports me And it's critically important for women that are leaders to find those kind of environmens where you feel that you can belong, you don't have to fit in.

I now am in my own practice, where I have my own operating room, and these subtle and overt acts of sexism, you know, certainly aren't tolerated.

And what that allows is the excellence in patient care.

We have many studies already that have come out, that have documented that patient care is better when it's performed or provided by women, whether it's women internal medicine or women surgeons.

Good morning.

One of the things that we know from lots and lots of studies is that women physicians spend more time with patients, women physicians are more likely to ask about social circumstances, women physicians are more likely to adhere to guidelines, for example.

So when we talk about patients who are cared for by women having better outcomes, this isn't a random statistical anomoly.

It's totally reasonable to think that that would be the outcome based on, you know, 40 years of data we have on the way that women doctors care for patients differently.

I think if I had stayed in any kind of employed practice model, or even big group model, I would have burned out and stopped practicing.

And so I decided 6 years ago to start my own practice.

And I didn't care how hard it was gonna be.

I probably work harder now than I ever did before, but it's on my own terms, and I am so happy and confident.

I have great patient outcomes.

I have a beautiful practice.

I've designed the life that works for me.

I started my social media a couple years into my private practice, hoping to use it as a way to market for patients to come into my office, and, I had a twenty second video go viral at 18 million views.

And Buzzfeed picked it up.

And it was 100 percent me just explaining what happened at my first job, and how I was discriminated agaist because I decided to have children.

And so, that to me just shows that people want to talk about this topic.

People, especially women, are dying to talk about this topic and to try to figure out how we can make things better for women.

How I got involved with social media is, there was a hashtag called I Look Like A Surgeon. And when the movement happened, there were tons of stories about people that have felt this way, worldwide, that created this network of people that understood the problem, and that wanted to be part of the solution.

I look like a surgeon.

I look like a surgeon.

I look like a surgeon.

I look like a surgeon.

A surgeon can look different and still be an amazing surgeon, because you should be judged by your technical qualities and your clinical qualities, not by your appearance.

In 2017, four women surgeons staring down at a patient was on the cover of The New Yorker magazine.

And women who were surgeons around the world started replicating this image in their own operating rooms, The cover showed four women in doctor's scrubs over an operating table, and was meant to illustrate on broad issues of health, body and image.

Well, now women are taking pictures and posting them online.

Surgery is a male dominated medical field.

The cover felt to a lot of surgeons who were women like it was a turning point, where it meant that we were seen and that we were going to continue to be seen, and that we were going to be valued members of the surgical profession.

Everybody has the same story.

All the women surgeons sort of fight the same battles, and we all know that it's not right.

We have to start with conversation, and uncomfortable conversation.

And so I think it starts with awareness, which is why I started some of my social media accounts, just to show people that you can do it.

That there is a possible way through this.

And then after awareness it's advocacy, and then making a real change, but I don't even think we've hit the awareness part of it.

To me, the bottom line is, if women surgeons are providing better care, then we all will do better.

We will all be healthier, and have better outcomes as patients, if we have more women surgeons in the workforce.

It's about the boy's club no longer being a boy's club, and just being a club of intellectuals who care about the wellbeing of human beings.

Funding for 1001 Cuts was provided in part by, the American Medical Women's Association, BOSS Business of Surgery Series, Academic Credentials Evaluation Institute, LevelPar Capital, Elizabeth Terplan and Dr.

Martin Terplan.

Dr.

Myriam Curet, Brave Enough Community for Women Physicians.

Additional funding provided by, and others.

A complete list is available at APTonline.org