By Dr. Elinore Kaufman
“Don’t worry, I still wear make-up every day.”
A surgical resident was assigned to talk to our group of medical students about being a woman in surgery—the first of many such talks and events I have attended, and this was her opening line.
I think I know what she was trying to get at. I think she was trying to say—you can be a surgeon, and still be yourself. You can be a surgeon, and still be a woman. To me, it sounded like something else. It sounded a bit more like—makeup is what makes someone a woman– like not having any on would be a sacrifice or a failure. Like you can be a woman and a surgeon, just so long as you are able to uphold the expectations of conventional femininity.
When I started medical school in 2007, I had been out as queer for a decade. Not all LGBTQ+ people share this experience or the desire or privilege to be able to say the same, but I never considered not being out on any application or at any stage. I do my best to make sure that I am providing visible and vocal representation wherever I am. My personal experiences of discrimination from doctors were minor, but I was well aware of how medicine had pathologized and excluded many in my community. Entering medical school, whatl I encountered was less open hostility toward LGBTQ people, and more pernicious ignorance and invisibility. Many of my classmates, it seemed to me, and many more of the faculty, had no idea that gay people existed. They did not expect colleagues, patients, or families to be anything other than straight. Even fewer were aware that transgender people existed, or might be amongst their patients or colleagues, much less about their particular medical needs. I was shocked to find that of my class of approximately 250, only one other student was out when we started. There were vanishingly few out faculty, and so our campus LGBTQ group focused on forming connections and offering basic education.
When I became a surgical resident, I did not get involved with the LGBTQ group in surgery, because there wasn’t one, and AOSA–the Association of Out Surgeons and Allies–did not exist yet. I did treasure the experiences I had with queer surgeons—my chief resident, for example, and the surgeon who I barely knew, but who was playing an all-Ani DiFranco soundtrack in the OR. In residency, I was fortunate to be at a program that had several queer residents, and we organized a series of informal get-togethers without any particular faculty or program support. I did attend any number of women in surgery events and gatherings, but I never felt quite at home. Not only because I wasn’t wearing makeup, but because so many of the concerns focused on what I often call SPP—Straight People Problems.
SPP are often problems that have to do directly with heterosexuality, and heteronormative assumptions. Many are challenges related to husbands: husbands whose explicit or implicit expectations of their wives or of their lives are incompatible with being married to a surgeon. Husbands who may share tasks but do not share the mental load of home life or childcare. SPP also often focus on childcare. I do have children, and I share many of the challenges of being a “surgeon mom” with my straight colleagues. But because I am queer, I have always envisioned a wide range in how families come to be. I did not expect that because I was a woman, I would be the only or primary caregiver. My partner, endlessly patient and supremely loving, does much of the primary parenting. And I do everything I can: neither of us is surprised by needing to take responsibility at home.
SPP also have to do with wearing makeup, with finding comfortable high heels, and with planning a wedding. I really, truly, understand that wearing makeup and high heels is perfectly fine. The problem comes when these are expected or required by our peers, colleagues, society, or in our own minds, and when these are assumed to be what we have in common, as women, and when focusing on these topics is seen as an automatic lever to build community among women. Queer people of course can and do wear makeup, but for me, it is my queer identity and analysis that changes and challenges these expectations, and often enough, alienates me in these spaces.
AWS exists at least in part because being a woman in surgery is still not the norm. The default expectation for many is that the surgeon will be a man. The consequences are pernicious, from patients who don’t believe that we can be their doctor to gloves and instruments that don’t fit and attendings that distribute autonomy unevenly. But the converse is also true. Being a woman who is a surgeon transgresses our societal expectations of what a woman is and what she can and should do. There’s that famous trap: you can’t do the job if you don’t take charge, but if you’re assertive, you’re pushy. No one likes you, you can’t get cooperation, and then, once again, you can’t do the job. We cope with these parallel challenges with creativity, humor, grace, and frustration.
But too often I find that women in surgery, and women-in-surgery-focused events and organizations also react to this marginalization by aggressively reasserting conventional femininity, and with it, heteronormativity. Women in surgery have so many shared experiences, and so many differences of identity, opportunity, and perspective, as well. When we find community and solidarity as women in what remains a male-dominated field, I hope it can be less about reasserting our ability to conform to expectations and more about creating new ones, for ourselves, our trainees, our patients, and surgery as a whole.
Elinore Kaufman, MD, MSHP is an Assistant Professor of Surgery in the Division of Trauma, Surgical Critical Care, and Emergency Surgery at the University of Pennsylvania, where she does her best to bring a full and authentic self to all of her work. She is currently serving as Secretary of the Association of Out Surgeons and Allies. She lives in a house painted rainbow in Philadelphia’s Gayborhood with her partner and their 41/2 and 81/2 year old kids.