I really wished I had brought my suit. I was exhausted, grungy, and a little bit shaky from overnight call. The voice in the back of my head was questioning whether the black sheath dress I had hung in my locker yesterday morning was too little, too much, or just not quite right for this presentation. But I had no other option – my newly tailored interview suit was 1,300 miles away, and there was no way I had the time or money to buy one for just a presentation. Thank goodness I had brought flats instead of heels. The adrenaline from the night before could only do so much.
I was three weeks into a general surgery sub-internship at the University of Colorado Anschutz Medical Campus, and the combination of an uncomfortable housing situation and the high demands of a competitive, high volume hospital was wearing on me. At the start of the rotation, my drive from San Diego had ended stuck in Sunday afternoon traffic coming out of the Rockies. This had left me stressed and uncomfortable in an impressive location, which set the tone for the rest of the rotation. The University of Colorado University Hospital is a sprawling new complex smack in the middle of Aurora, a rougher city than its big brother – Denver. I rode my bike in the wee hours of the morning past trailer parks and dingy motels. But the neighborhood passed the “bar test” (most first story windows did not have bars on them), so while I wasn’t leaving my bike outside, it wasn’t uncomfortable to be a visitor with out-of-state- plates.
As a visiting sub-intern in July, both the new interns and I were figuring out the EMR, the attendings, and the hierarchical dynamics of this prestigious surgery service. The restrictions in the EMR kept medical students from doing the small, useful things I was accustomed to doing as a sub-intern (updating discharge summaries, entering patient histories, pending orders for review and signing by the residents). So while I did not feel intimately involved in daily patient management, I could spend most of the day in the OR, assisting or observing the bread-and-butter cases of a general surgery practice. With practitioners specializing in bariatric surgery, hernia repair, and colorectal cancer, there were a range of basic and advanced cases on the service to choose. We had regular lectures and a weekly topic presentation from the medical students. As I worked more with the chief resident on the service, she began to give me advice not only on surgical technique and management, but on being a female surgeon.
Some of this advice was basic surgery stuff. Know your place in the hierarchy (with my personality, a hard task). Know your patient, the anatomy, and the procedure before stepping in the room. But she pointed out some harsh truths that I had already noticed subconsciously. There were no female attendings on the service. The nurses responded to orders from the masculine intern much more quickly than the petite chief resident. And the scrub tech that seemed to be hard of hearing? Jumped at a whisper when the male attending repeated a request for a tool. This subtle difference had been present in every hospital I had worked in, though some more than others. This chief resident told me how she pitched her voice lower and spoke firmly when making requests or giving orders. She geared her interactions with her superiors to emphasize her capabilities and not her personal life (a professional choice, crucial for females in a male-dominated field). She emphasized that while the field is changing, and while the men in power have great intentions and sometimes even great self-awareness, there are centuries of history to overcome, and we are not there yet.
So with this information rattling in my head, I was in front of a half-dozen attendings, a dozen sleepy residents, and a handful of medical students wearing suits for their presentations. Last night on trauma call I had seen an emergency splenectomy (lots of blood in my shoes), gotten stuck with a needle in the ED, and had palpated a steady stream of abdomens, some of which were being prepped and draped at this moment. I was vibrating with nervous energy. I knew the material. I knew I loved this work. Suit or no suit, I knew I looked good. I braced myself and began to talk.