Women are well-represented in medicine now--about half of all new medical school graduates this spring were women. But these demographics are changing more slowly in some areas of medicine, with surgery still dominated by men. Our Knowing Pains story this week is by Dr. Edie Zusman, a trail-blazing neurosurgeon. Her story echos those of generations before her who opened doors for women in business, law and politics. We all know there's more work to be done, but thank to women like Edie, we've come a long way! Enjoy. Molly
She came into my hectic neurosurgery clinic elegantly dressed, her suit perfectly accessorized, her voice soft but deliberate. Even at 73, Irene West was confident that the surgery I proposed to treat the painful and debilitating degeneration of her spine would be worth the rare, but potentially catastrophic risks.
She trusted me. She’d said at one point that she did a lot of research to find the right surgeon and chose me, a young female among a sea of better known males, to be her neurosurgeon. Any woman of my generation who would enter this male-dominated field so rife with ego, she reasoned, had to be superb.
I am grateful that she did, because while I was caring for her she taught me that clearing obstacles and forging new ground without bitterness and outrage was not only possible, but empowering. As it turned out, this petite African American woman whose measured determination had influenced her children to stand tall and proud at a time of great social upheaval became a role model for me, just as I hope to be a role model for young women neurosurgeons who will no doubt face hurdles of their own.
When I was a girl growing up in the 1970s, anything seemed possible. The U.S. Supreme Court and Congress had outlawed discrimination based on gender in education, housing, and even human reproduction. I was blithely sure that the women’s movement had paved the way. I could be - no, I would be - a neurosurgeon.
The brain fascinated me from the time I was eight. In third grade I made a model of the organ, labeled the cerebrum and cerebellum and taped on it an electroencephalogram to illustrate its wondrous activity. Learning how it worked, why it didn’t always work properly, and how to make it work better became my passion, and would become my profession.
Despite my early intellectual curiosity, my mother made sure that that I knew that my smarts weren’t all that special - everybody has gifts - and what matters is what you do with yours to make the world a better place. Straight A’s didn’t matter if I wasn’t going to do something useful with my talents.
What I didn’t realize as an ambitious and academically precocious teenager was that becoming a brain surgeon demanded much more than ambition and superior grades in science. I never guessed that my career choice would be an exercise in compromise. Nor did I know just how infuriating it could be trying to rise to the top of a profession designed, dominated and driven by men.
On paper, I was certainly up for the challenge. While in high school, I was accepted into the accelerated, six-year honors medical program at Northwestern University, which allowed me to start medical school at the age of 19. The plan would ensure that I’d finish my education and still have time to complete my equally ambitious personal agenda – to get married and have children - before age 35! By 1987, I had my medical degree and was eager to bring my talent and drive to a fine university medical center where I would train for my specialty.
Today, 20 years after my entrée into the field of neurosurgery, my story is one of great success and satisfaction. I am filled with memories of patients for whom my expertise and training have been invaluable.
I recall, for example, the single father of three who came to me with a pituitary tumor that was causing him to go blind. Today, he can see, has returned to work, and provides for his children. I’ll never forget the man with frequent epileptic seizures who had been turned away by other doctors. I got a letter from him recently. He said he hadn’t had a seizure since I removed a portion of the temporal lobe where his seizures originated. That was six years ago. And I remember the woman, in her 70s, with a weak heart and a dangerous blood clot between her brain and her skull. The surgery was considered “heroic” and high-risk. Two years later, she is functioning independently and enjoying life with her family.
But my professional success has come at a price. Thinking that 1970s feminism had paved my way, I hadn’t bargained for the pervasive barriers that could still prevent women from reaching their potential.
Looking back, I know the bumps I encountered along the road toward neurosurgery were in view even before I’d finished medical school. During one rotation, a department chairman at a West Coast medical school volunteered to write letters of recommendation to neurosurgery programs for me, but refused to accept me into his own program. “You are one of the best students we’ve had, but I won’t be able to accept you,” he said. “The other guys just aren’t ready to train a woman yet.”
Interviews for residency training were equally challenging. The neurosurgery chairman at one top-flight university, for example, asked me how long I could operate without needing to urinate. I’d just assisted on a 14-hour brain tumor surgery without a break, while the male surgeon in charge had taken two.
Not all of the sexist behavior I faced in those days was as subtle. There was the staff member at a prestigious eastern school who, impressed by my research experience, said he would like me to work with him in his laboratory, then slid his hand along my thigh under the table.
Fortunately, I was too determined to be distracted from my pursuits. Besides, I was young and naïve at the time, and I was sure the discriminatory treatment would stop just as soon as I had the credential, as soon as I was among their ranks.
For many years, I thought that to be treated like an equal in neurosurgery I’d have to look like a neurosurgeon. So I pulled my long brown hair back, donned clunky glasses and wore a starched shirt with cufflinks under my lab coat. I hoped that by neutralizing my gender, my technical abilities and patient care skills would become the focus, squelching any bias.
In hindsight, it made little difference. Even after 20 years performing craniotomies, removing brain tumors and probing for the source of epileptic seizures, the slights continued. But they only strengthened my resolve to succeed, and to encourage the next generation of women entering my field. That means freely offering my personal phone numbers and email address to medical students and residents who need encouragement or advice at any point along the way. It means housing young researchers on rotation at my home. It means advocating on their behalf when they face discrimination or other obstacles.
There have been breakthroughs. I was the first female neurosurgeon at several universities. I started the brain tumor program and epilepsy research centers at the University of California, Davis. I was president of Women in Neurosurgery, the leading professional organization for women neurosurgeons, and was the first woman neurosurgeon in the 75-year history of the American Association of Neurological Surgeons to serve as a board member.
Today, I hold a full voting post at the AANS, and topping our agenda is the dire need to increase the numbers of applications from women and minorities for neurosurgery residencies to keep our profession thriving. Now that I have walked through the door, my role is to hold it open for others. Some of the same men who’d obliviously undermined my foray into the field now sit at the table with me, looking for ways to attract more women into neurosurgery. Today, for the first time in its history, the association has a sexual harassment clause enabling women to be heard when they experience some of the same things I encountered earlier in my career.
Yet, proud as I am about reaching these milestones and earning my credentials, I don’t display the plaques and certificates outside my office door, as some of my male colleagues do. Instead, they adorn my more private, interior office walls, serving as my own necessary reminder of what I’ve accomplished.
Just as I keep my awards and plaques concealed, so too have I hidden my power, using it quietly in the background to move my very ambitious agenda forward. Ironically (and by necessity), exerting influence over 21st century neurosurgery has demanded behavior reminiscent of a 1950s housewife.
I’ve learned, for example, that my ideas and bold suggestions for our hospital system will have a greater chance of success if a male colleague presents the plan. I am learning the value of such problem-solving strategies, which ultimately earn recognition and respect through more subtle navigation.
I’ve learned, too, how to deal with those patients who - unlike Irene West - may have looked at me, politely expressed thanks for explaining the procedure and then insisted on talking with the “surgeon.” These days, before we have the first office visit, every patient receives a fancy folder that includes a brief synopsis of my accomplishments. By the time they arrive, they are more likely to appreciate my expertise, and we can get down to business.
I have succeeded in growing my practice as a surgeon, using my talent and expertise to save and extend lives. I am grateful to Mrs. West for her instinctive faith in me, and for sharing her family’s story, to help me grasp the idea that bias is a sign of an evolving society, not a signal to surrender. She helped a generation to see beyond race by raising strong children and participating in the process. Just as she learned the value of remaining engaged, so have I. I am helping my generation (and inspiring the next) to see beyond gender by staying involved, joining boards, connecting with doubters, and by telling my story. And while I’m proud that I’ve been able to reach my career goals, I hope that women in the future can fulfill their dreams without having to endure bias. I look forward to the day when my experiences stop being the norm, and instead become an historical footnote.
Have you experienced sexism at work? Tell us your story.
Edie Zusman (44) is Director of adult neurosurgery at the Sutter Neuroscience Institute in Sacramento. She is recognized as one of the leading female neurosurgeons in the United States. She is active in several leading neurosurgery organizations and was the first woman neurosurgeon on the board at the American Association of Neurological Surgeons. Edie lives in California with her husband, son, daughter, and dog, Lucy. She is quick to point out that motherhood is a lot tougher than brain surgery.