The Identities We Choose

15 May 2023

By: Heather Wachtel, MD

Growing up in Vermont, I had one person who looked like me – my sister. The children of a first generation Cantonese immigrant and a second generation Russian Jew, we loved the freedom of the rural countryside which our artist parents had embraced. However, when we returned to New York to visit our extended family, we alternated between eating dim sum with chopsticks in crowded restaurants on Mott Street, and celebrating the Passover Sedar on Long Island. As a result, we could protest that we were too full to eat any more in English, Yiddish, and Cantonese!

Although I treasure my diverse heritage and the warm, loving acceptance of both sides of my family, to be mixed race is also to feel as though you never fully belong. As with many mixed race children raised between cultures, I learned instinctive code-switching from an early age. Code-switching involves adjusting behaviors including speech, appearance, expressions and even thought patterns, to fit in. Code-switching can be conscious or unconscious. I was one self with my Chinese family, another with my Jewish family, and a third with my peers. Yet my claim to each identity felt tenuous, dilute.

College was the first community where I could define myself outside my heritage. In my diverse college class, I did not stand out. I fit in. I was just another student, with no particular effort. This was incredibly liberating. Paradoxically, this freedom led me to further explore both of my family’s cultures. I took Chinese language courses, and in-depth studies of Jewish history. I immersed myself in my life-long practice of martial arts, and I was welcomed at Shabbat at the campus Hillel house. As I learned more, I felt both deeper ownership and a developing understanding that I was not defined solely by my parents’ races.

Then came medical school. Medical school is the ultimate code-switching experience. As medical students, we rotate through clinical specialties. We speak like internists when we are on medicine, we carry reflex hammers on neurology, and we wear scrubs on surgery. We emulate the people around us, trying on their identities and checking them for fit. We peer at ourselves tentatively in the mirror – is this right? Is this me? I embraced my chosen career as an infectious disease doctor, getting up early to join ID rounds, memorizing esoteric bacteria, and making flashcards of viruses, so I could recognize them instantly. I left surgery until the last clinical rotation, knowing that I had no interest, and assuming that by the end of the year I would at least have the skills to survive the grueling surgical schedule. nexpectedly, I found my people.

Surgical residency is so difficult to describe to people who have not gone through it. The complete immersion, the feeling that nothing exists outside the hospital walls for days or weeks at a time. We bond with our co-residents, the people who know to groan about the blown IV, who laugh at the same jokes, who mourn with us over our patients. Ironically, residency was also the first time that I was aware of being treated differently based on my gender, where “woman” was appended as a modifier of “surgical resident”. I fell back on old instincts to blend in. Talk the same as the men. Walk the same. Dressing the same is easy when we all wear a literal uniform! 

Yet these comfortable old code switching habits fail to capture the essence of surgery. To be a surgeon is to always strive to excel, to push for technical excellence, to take the best care of our patients, to teach our trainees, to advance the field. Not to blend in, but to blaze the next trail.  In a way, being different is actually the quintessential essence of surgery. 

As surgeons, we share an identity and purpose which supersedes race and sex and all the other categories by which people are classified. Each of us has had experiences in life where we don’t fit in, or feel that we lack ownership in an identity. Each of us has multiple selves and multiple communities. Yet on Match Day, we each chose to be surgeons, to define ourselves by what we do rather, than how we were born. Every day that we come to work, we renew that same choice. 

Heather Wachtel, MD, FACS is an Assistant Professor of Surgery and Associate Program Director of General Surgery at the University of Pennsylvania. Dr. Wachtel completed her undergraduate work at Harvard University and received her MD from the Yale School of Medicine. She completed residency training in general surgery at the University of Pennsylvania prior to fellowship at the Massachusetts General Hospital. An endocrine surgeon, Dr. Wachtel’s translational research program focuses on the genomics of adrenal tumors and the development of novel targeted therapies for pheochromocytoma and paraganglioma.

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