Scalpel's Edge

A surgeon's notes

Lingering in Surgical Training

NB.  This article was originally published in Austin Health Surgical Trainees eZine “LAMINAS” November 2014.  Its now time to share it here.  The Zine is distributed to other trainees and surgeons in my hub.

When I was a third year resident I had a conversation with an orthopaedic surgeon about having children.  He assured me, “Someone will have found the easy way to combine a family and surgical training. Ask around – someone will have found the answer.”  During my surgical training, I have had three children, completed a PhD, stayed married, and I don’t think I found the easy answer.  At times, fitting life into surgical training feels like a thousand unfinished tasks. However, I am now a surgeon, and I finished training with a rich family, home and professional life.

Mr J listening hard

Mr J listening hard

It’s hard to describe having children without sounding like a greeting card, but they are simply the coolest thing I have ever produced.  Taking the time to have children and watch them grow has increased my maturity and given me perspective on work, which otherwise can consume my focus.  It’s hard to walk away from ill patients who need you, but it’s easier when you walk toward someone who also needs you. My children have also introduced me to other parents – people who live and work outside the health industry. All of these things have helped me develop as a human and a surgeon.  Plus, I met and get to live with three really excellent people.

My period of full time research was an amazing experience.  I never wanted to submit a “crap registrar project” so accepted the opportunity to perform full-time research.  During those years, I got to do what “real scientists” do – I prepared H+E and immunology slides and analysed them, I used a scanning electron microscope to take ultra-macro pictures of capillaries and I met a lot of white rats.  I learnt how to understand statistical analysis (properly this time) and I drank a lot of coffee. In practical terms, I did experiments and wrote papers, giving me a much better critical understanding of experimental design and quality of evidence.

However, by taking all these exciting opportunities, I lingered in training for longer than planned. I have taken ten years from AST1 until my fellowship, with an unaccredited year prior to that.  I have worked for multiple bosses who are my age or younger.  The consultant I am on call with today (as a fellow) was in medical school when I started surgical training. I know that if I had my time over, I might not choose to do all the things that I have.  I am disappointed that making the most of opportunities, professional and personal, needs to be a struggle, particularly when the detours I’ve taken have made me a better clinician.

It took me a long time to realise that I was born a surgeon.  I fell in love with general surgery as an intern when I realised we actually fix people, cure some, palliate others.  People thank us for what we do, more often than not.  Certainly the most magical branch of medicine.

MrA focussing on his goals

I started surgical training at Austin in 2004.  During my first year, I was approached to do a PhD.  It was an easy sell to my husband, who was frustrated by my registrar habit of living out of Melbourne.  I started my PhD in 2005, and threw myself into this completely foreign skill set.  I enjoyed the process of project planning, and setting my own goals, hours and responsibilities, under the supervision of two surgeons and a fantastic lab manager.  I was initially funded by the university department, and then received a surgeons scientist scholarship from the college.

Soon after starting my PhD, I turned 30.  We became pregnant soon after and had our first child in 2006, less than twelve months after leaving clinical training.  It was never my intention to do my PhD in order to have children.  But the way my life worked, it simply turned out that way.

Interrupting a university degree for maternity leave, or to study part time, is straightforward – a few forms and a letter of approval. I took maternity leave, and returned to my PhD part time.  I went on to have two more children, and took leave to look after each of them.  Each subsequent period of leave was more fun, because I had some time to lavish on my older children.  During times I was working/studying, the research world – being self-directed and results oriented, tolerated odd working hours and I was able to fit my responsibilities around formal child care.  It was almost like I was a “normal” person (as opposed to a surgical registrar, as we know, vastly abnormal).

However, I wasn’t just a university student during this time, but also a deferred trainee, and dependent on the College of Surgeons for my scholarship income. The College, at least at that time, seemed to view every episode of leave as a personal insult or trick.  There is still an “I did it, you need to do it” mentality that seems to be the default position if decisions become too difficult.  Or perhaps that’s just my memory.  I think the frustration and discrimination I experienced at times was due to the genuine difficulty of trying to reconcile maternity leave and interrupted training with the idea of “fairness” in training.  And I was trying to do things that hadn’t been tried before – take a scholarship part time, interrupt a scholarship midway, and extend total training time for legitimate reasons.  It seems so strange in retrospect that all the choices I made seemed to be unique or new requests, and every one needed some sort of council ruling.

I met some very supportive surgeons through my training (particularly at the Austin, the Victorian State Committee, and the Board in General Surgery).  A few surgeons seemed genuinely excited that I was finding rules that were poorly written or unfair, so they could be changed.  For example, at that stage you could interrupt a college scholarship for up to twelve months for a medical condition, but not for maternity leave.  By the time I finished my scholarship, that had been changed.  However, by trying to do things in a way that hadn’t been done before, I created a lot more work than if I had have progressed through training without detours.

I never tried to take a difficult path.  I was continually surprised that the choices I made caused so much trouble for others.  I’m proud of all my decisions, and I think I would take the same path again. love the life I have now, and the training I have had, and the family I have waiting for me at home. However, I’m not entirely sure that those choices were always the smart ones.

Any medical training is a series of compromises, which becomes more complicated when you have more things to care about.  Even a straightforward course through training causes conflict in relationships with partners, children and friends due to long hours, shift work, and interstate rotations.   I don’t believe there is a simple way to fit your life around training; or being a surgeon, or any other job, for that matter.  But I do believe there is a path of least dissatisfaction.  At each decision, I have tried to genuinely look after my most important priorities first.  And then I have struggled and scrambled and fought to add all of the other cool stuff I want in my life.  In that way, I’ve ended up with a family I love, amazing surgical training, a great job and very few regrets.

3 responses to “Lingering in Surgical Training”

  1. Bev Fosh says:

    Well done Cris! I’m so proud of you and what you’ve achieved

  2. Archana says:

    Wow! I admire your determination and dedication. This should inspire many women to make right choices at the suitable time, to prioritize – even if it means taking a pause in their careers. Good Luck! 🙂

  3. Kimberley says:

    I remember having this conversation with you in the car in 2009. It was a heartbreaking story then and I can’t believe things haven’t changed (hopefully they have a little). I think ultimately all this will make you a better surgeon (not that you weren’t kick-arse already). Whenever I struggle to do something, or there are roadblocks in my way, it generally makes me more determined, and more in tune with the fact that whatever it is I am struggling to do is something I really want. Plus, you’re just awesome and shiz!

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