By Justine Broecker, MD
An Interview with Dr. Toncred Styblo, a surgical oncologist within the Department of Surgery at Emory University for over 30 years, with her daughter, Dr. Justine Broecker, a PGY-4 general surgery resident at Mayo Clinic Florida.
Please introduce yourself.
My name is Toncred Styblo. I have a practice primarily for the treatment of breast disease and breast cancer. I completed my undergraduate and masters in Biology and Biochemistry at Stanford, my medical school and general surgery residency at St. Louis University , and my surgical oncology fellowship at Medical College of Virginia. I’ve been on the faculty at Emory since I finished my fellowship for over 30 years.
Where did you grow up?
I grew up in the Bay Area. I was the oldest of four children. My father was a private general surgeon, my mother was a high school English teacher. I’m the only child that went into medicine in my family. I grew up doing classical ballet through college including summer and Nutcracker performances (I was the sugar plum fairy). I also played the piano and the flute.
What do you remember about your father’s practice?
He was a solo private practitioner in general surgery. He worked long hours, and he was gone in the morning before I woke up and I usually didn’t see him until after dinner when he would come home and read/study for cases the next day. I got to know my father each year when we took a family vacation for a month; we took family car trips across the country seeing the national parks.
He was my first mentor. I saw someone who was always challenged and learning about surgery and medicine. He would read and learn on a regular basis even though he was in private practice. He was always intrigued by new medical discoveries and information. That was an inspiration for me about how dynamic the field of medicine can be.
What did you enjoy about ballet and are those skills translatable to surgery?
I think ballet and surgery are similar in that they require physical stamina, the ability to learn choreography or procedures and perform them with a focus on efficiency and elegance of movement. And, always challenging yourself to improve are hallmarks of both a good dancer and an accomplished surgeon.
When did you decide to become a doctor and surgeon?
I always admired my father a great deal and he was the inspiration for me choosing medicine as a career. I was discouraged on more than one occasion by primarily men, male colleagues, and teachers from becoming a physician and then eventually becoming a surgeon because they said that it would be difficult to have a family and to have a personal life if I chose that as a profession. I tried other things—for a while I was a medieval history major—but, I did not have the passion for it that I did for science. I thought about doing other non-surgical subspecialties, but I felt that surgery was my passion, it was what I loved doing and I decided regardless of what personal sacrifices I would need to make to become a surgeon, I could never short-change myself by choosing a profession that I didn’t love in order to have an easier personal life.
When did you first think about doing surgery? What were your influences?
My 3rd year surgery rotation I enjoyed enormously. I still remember a patient I presented—we had to give an oral presentation to the chairman of surgery—I still remember the case and the name of the patient. I remember participating in a medical student surgery course which was the first time I had the opportunity to operate and it was very apparent to me at that point that it was something I absolutely loved. I would be forever sorry if I didn’t decide to become a surgeon because I really loved being able to see the anatomy, perform surgery, and be the person responsible for completing the operation.
What did your father think of your decision to go into surgery?
He never expected me or wished me into surgery. He was very realistic about the challenges in terms of personal challenges, the physical challenges, the family challenges. But at the same time, when I chose to do surgery he was enthusiastic about teaching me what he could and providing his insight and experience. I haven’t had many mentors in my professional career, but he was certainly the first.
He taught me simple things such as how to tie knots, how to handle tissue and instruments. He taught me how to approach a case, about the fact that there are points in the operation where you can no longer abort, the point of no return, and what sort of aspects you want to evaluate during an operation before you get to that point, how to take care of patients postoperatively, how to speak to patients, what patients expect, all of those things.
I never ever operated with him and that was one of my disappointments. At the time when I was in medical school and residency in Midwest—where he actually did medical school and residency as well—there weren’t any opportunities to operate with him. The medical legal system wasn’t flexible enough.
What was it like applying to surgery as a female medical student? How many women in your class applied to surgery?
Only about 20% of my class was female. There may have been one or two of us who went into surgery. I actually don’t remember any other women at the time, but I have come to learn that at least one went into surgery.
I don’t remember interviewing. At the time I was finishing medical school, I initially had anticipated becoming a cardiac surgeon, so I had done a number of externships in cardiac surgery, but after that I had the self-realization that I didn’t want to do cardiac surgery, I wanted to do general surgery. I called the chairman of the department, Dr. Wilman, and told him I wanted to do general surgery and asked if I needed to interview for residency and he said that if I wanted a position it was mine. I interviewed at other programs which were pyramidal programs which I wasn’t interested in going to. SLU was not a pyramidal program which was why I chose to stay there. I didn’t want to feel like I was competing for a position with my classmates. I also remember that there were many programs that never finished a woman, and I made a point of not going there. SLU was a Jesuit program that had graduated many women because they had trained many of the nuns who became missionary surgeons in 3rd world countries. My first chief resident was a woman. They had a track record of graduating women. I was not the first by any means.
What was surgery residency like as a woman? Did you face sexism as a resident and if so how did you navigate that?
I was the only female resident in my class. We had roughly one female resident per class that I recall. I don’t remember having any female surgery faculty. I did have a chief resident when I was an intern who did a fellowship and came back to be on the faculty but not before I finished residency.
In retrospect, I think there was a lot of sexual harassment and discrimination. For example, our chief resident dinner was always at an all-male club that didn’t even have a female restroom. I never commented or objected to it.
I was aggressive during my residency to make sure that I had the operative experience I needed. It’s hard to judge what your co-residents are actually doing because you don’t actually know. We had a busy clinical residency so there were a great deal of opportunities to get surgical experience. I think because of the volume of practice being a female was not an issue, but I think if the program had less volume and more residents, I think it would have been an issue.
I also had an exceptional experience because I became a chief resident as a 3rd year because my chief resident had surgery. I was proactive about taking on autonomy, I didn’t ask, I just did it.
There was far less faculty supervision at that time. If you were capable of doing the procedure, it was much easier and more acceptable to do it without asking the faculty for help, and it was much more acceptable for them to let you do the majority of the procedure.
Why did you decide to do surgical oncology?
I wanted to do academics and I realized I needed to do specialty training. I liked general surgery, and I thought surgical oncology gave me the opportunity to do a breadth (GI, HPB, endocrine, head and neck) and I wanted the breadth and diversity of surgical oncology.
Who were your most important mentors in residency and fellowship?
During residency, my father was a mentor to me. The chief of surgery at the city hospital –Raymond Keltner—was a great mentor to me. He had trained as a MASH surgeon and also had done a vascular surgery fellowship and he was one of the most gifted surgeons I have ever known. He had enough personal skill he didn’t do the operation, he guided you and allowed you to learn how to do operations on your own as he was confident enough in his ability to address your shortcomings as a new surgeon to keep the patient safe. When I got to fellowship, Walter Lawrence who was the chair of surgical oncology, was one of my mentors because he was a wonderful teacher. As well as an administrator, he held many national titles within the national cancer community. I was the first female fellow they ever had in the program. I never felt that I was the first female fellow he made the point of being inclusive in every way.
Justine Broecker, MD, is a PGY-4 general surgery resident at Mayo Clinic Florida. She is from Atlanta, GA, and graduated from Emory School of Medicine. She can be found on Twitter @jasb805.
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