Surgeon: Thanks for the award but the OR is calling
Surgery resident Leora Balsam won the Association of Women Surgeons’ Outstanding Woman Resident Award. “She’s 90 pounds and solid as a rock,” said one doctor.
Perched on Leora Balsam's forehead, between the surgical cap and disposable mask just above a pair of intense blue eyes, a miner's flashlight glimmers. And she's digging. She's got her bloodstained, white-gloved fingers embedded deep in the cavity of her patient's chest, her head bent low in concentration, and she's poking around. Hoping to strike gold.
This is the second of four surgeries scheduled for the day. The night before, she flew to Long Beach to retrieve the heart of an organ donor. Tomorrow, the stream of surgeries starts over again. But for now she is totally immersed inside the chest of an 80-something white male searching for a "suspicious nodule in the right, upper lobe of the lung."
Her patient always comes first.
It's this type of intensity that won Balsam, MD, a resident in cardiothoracic surgery, this year's Outstanding Woman Resident Award selected from a nationwide pool of nominees by the Association of Women Surgeons. The prize honors her "exceptional leadership abilities" and "excellent technical and patient management skills" as well as recognizing her as a role model for other surgeons and those who aspire to join the profession.
"She weighs about 90 pounds and she's solid as a rock," said Thomas Krummel, MD, chair of the Department of Surgery, who nominated Balsam for the award. "That means a lot in surgery."
Balsam is grateful for the recognition. But she doesn't really have much time to talk about it. She's got X-rays to examine, surgeries to plan and cutting to do. Besides, she'd much rather talk about surgery itself than the role of women in surgery. The camaraderie, the excitement, the ability to change someone's life for the better in a short amount of time.
"Being recognized is nice," she said, but quickly added, "I never wanted to be treated differently."
In the operating room, the show starts when the surgeons show up. Balsam and her attending surgeon, Jessica Donnington, MD, boldly walk through the door, sanitized hands held shoulder high. The gloves go on. The curtain goes up. The head nurse announces the name of the patient, following directions on a sign on the wall: "Prior to incision, verify correct patient."
And the knife comes out.
The two female surgeons will spend the next two and a half hours tête-à-tête over the patient's iodine-painted body, blotting away blood, inserting clamps, pushing aside scar tissue, searching for the nodule, cutting it out and sewing him up.
"We found it," Donnington announced to the surgical team in the small room after about 30 minutes of cutting and digging. There's a momentary pause of relief, then everyone gets back to work.
Just a few decades ago, it would have been exceedingly rare that the two stars of this show would be women. Not only is surgery a traditionally male field among medical specialties, but cardiothoracic surgery is one of the most macho of the subspecialties within surgery.
Yet with half the entering class of medical students nationwide now women, more have begun to infiltrate surgery as well. Krummel, the chief of surgery at Stanford University Medical Center, said he continues to make a concerted effort to improve on the numbers of women in surgery on campus. If the department wants the best candidates, it has to make sure that it's welcoming to women.
For Krummel, as the father of three daughters, it's also a topic that's close to his heart.
"My generation's feminists are fathers with daughters," he explained.
Currently 17 out of the 58 surgical faculty members at Stanford are women. That number has continued to grow since Krummel took over as chief of surgery in 2002, and it places Stanford in the top five of medical schools nationwide, first among the top ranked schools, ahead of Harvard, Yale and Johns Hopkins.
"My strategy is real simple," said Krummel. "Recruit. I'm always recruiting. The more women you get, the more you draw."
Krummel said he's recruiting future women surgeons who are the best of the best, gender aside. After all, Stanford gets 500 applications for six spots. And he points to Balsam as an example.
Balsam joined Stanford in 1998 as a surgical resident. Prior to that, she completed her undergraduate degree magna cum laude from Harvard then went on to get her medical degree at Harvard as well. The daughter of an endocrinologist who grew up outside of Boston, she sharpened her dexterity skills as a cellist from the age of 9, eventually playing in the Harvard orchestra. She always wanted to be a doctor.
"I must have decided so long ago, I don't remember deciding," she said.
When she chose Stanford to do her residency work, it had little to do with the number of women on its faculty. She chose Stanford because of its rich tradition in cardiac surgery with founders such as Norman Shumway, MD, who performed the first heart transplant surgery in the United States in 1968. Cardiac surgery was a place to try new things, to push the envelope.
The issue of women in surgery never came up.
"I don't think I was thinking enough about it," she said, thoughtfully. At 34 years old, like most women in her residency class, she's unmarried and has no kids. She'd like to have a family, but she's awfully busy.
"My mom keeps asking when," she said with a grin. "A lot of women in surgery have families later. It's not easy to balance."
Balsam works an average of 88 hours a week now, down from 120 hours for the first few years of her residency before the national accreditation agency for training programs limited the time to an 80-hour work ceiling. Cardiac surgery has an 88-hour exemption. The workload is almost twice as high as other medical specialties. Residency also stretches longer, a total of seven years compared with five.
"For most students this runs right through prime child-bearing years," said Krummel, who has been instrumental in helping rewrite the American Board of Surgery policy that now allows six weeks of maternity leave during residency.
Krummel's support of women in surgery has definitely made a difference for today's young surgeons, said Myriam Curet, MD, associate professor of surgery and former president of the Association of Women Surgeons.
"When I went to medical school, there were very few women who went into surgery," noted Curet who completed her residency at the University of Chicago in the 1980s. "None of them were married and none of them had children. It was a huge battle we had to fight."
Balsam said the situation has definitely improved for her generation. She hasn't experienced any discrimination. She has women role models, such as Curet, in whose footsteps she can follow.
But, still, she doesn't have a lot of time to ponder the issue. After all, the curtain's about to go up again. She's got another surgery to perform.
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