Editor’s Note: This is the first account where adding a title has been a challenge. It could fit under “Career Altering Experiences”, “Staying True to Values”, “Crimes”, or “Resilience.” The courage shown here is exemplary, especially for someone in such an early phase of her career. Many valuable lessons are contained within this text.
“During residency I decided against a career doing orthopaedic trauma as a subspecialty. There were few women within that segment of orthopaedics. The lives of those in academic institutions who did level one trauma appeared to be very difficult because few centers had more than one orthopaedic traumatologist. Instead, I gravitated toward the ‘scheduled trauma’ found within the specialty of sports medicine. I loved sports, the team approach, working with all ages and getting to know my patients.”
I did many interviews to find the right fellowship program for me. Sports Medicine fellowships had recently been added to The Match so the control over where I would enter this next vital part of my training was not mine alone. I matched at an academic institution that was endorsed by people I respected who were from my training program. When I arrived, I learned that the director ran a program whose theme was “his way or the highway.” I was their first female and one of two fellows that year. I learned that several very recent past fellows had left the program early. From the onset, I noticed the presence of presumably “unconscious bias” in the program. My abilities were being underestimated and undervalued in comparison to my male counterpart.
With a sense of uneasiness, I contacted a well-respected academic mentor and his legal professional wife who happened to live in the same state. They asked me how I was feeling inside about my situation. I told them “I feel pretty awful, and that ‘Imposter Syndrome’ began playing into my fears.”
Three months into the fellowship I found out that I had failed Part I of the Board Exam by one point. I made a strategic error by sharing this with my fellowship director. After that, things got even worse. He had remorse about taking me as his fellow and began acting out. This included tossing charts in my direction in the clinic and even throwing sharp objects at me in the OR. Negative words and phrases were used to describe me in my presence. There was nothing subtle about his displeasure. These macroaggressions occurred on a daily basis. When a research paper we had submitted to JBJS was accepted but needed revisions, he disparaged me as first author in front of our program’s journal club. He objected to my suggested edits.
I spoke again to my mentor and his wife. They told me that I needed to “pretend you are an actor in a play; compartmentalize. Learn what to do and say and remain consistent and professional.”
I also spoke to another mentor who was a highly respected academic chairman from elsewhere in the country. He wisely said, “there may be something that happens that may keep you from completing the fellowship. Be ready for it.”
It became hard to show up for work each day. The macroaggressions continued. About seven months into the fellowship, I saw a high school football player along with his trainer in clinic. He was status post anterior cruciate ligament reconstruction and clearly had an infected knee. He had purulence at his portal sites and met the other clinical criteria for a deep post-op knee infection.
It turns out that he had been seen in clinic the week before while I was in the OR. The fellowship director was aware of his presentation and his knee was aspirated. A presumed knee infection was diagnosed, and the player was placed on oral Keflex. He returned the following week because he was no better. The culture, which had never been checked, grew out methicillin sensitive Staph Aureus. When I saw him at week two, he was clearly systemically ill.
I called the OR where the director was operating and asked to speak to him. He refused the call as he had not spoken to me since November. His PA took the line, and I described the situation. He agreed to call me back in 10 minutes.
During the call back, the director did speak and said “We are not going to the OR. We are not breaking the school’s budget on one dumb n—–!” I repeated back to him what I heard; that there would be no surgical procedure on the athlete. I asked what did he recommend doing? His reply was “Change antibiotics and we will see him back.”
Since fellows were not able to operate independently, I had few options. I explained to the patient that the surgeon was not able to take him to the operating room to treat his infection. In the end, I copied parts of his chart and sent him to another ER where the school also had a contract to cover the care of their athletes. His trainer took him there.
The moment that my academic chair mentor mentioned as a possibility had come. I called him to say I was resigning the next day. He guided me in writing my resignation letter. The next morning, I faxed the letter to the chairman of the oversight orthopaedics department, essentially my fellowship director’s boss. I handed the letter personally to my fellowship director. He ranted that “You are more trouble than you are worth” among other things.
My mentor chair called the oversight department chair who conveyed that he was worried about me suing since “She does have a case.” He bargained that if I did not sue, he would personally monitor my director’s cases and would review his complications. He would also force my fellowship director to undergo some training.
My resignation letter was accepted at the university and by the fellowship director. I left the state and returned to my home of record. Later, the fellowship director did try to block me from retaking my board exam. I was advised to get my own attorney to protect me if he tried to sue me.
Through contacts I had developed, I was offered another more prestigious sports medicine fellowship opportunity following some remedial help to make up for what I had missed the first time around. This was a very pleasing development and positioned me well for my future orthopaedic endeavors.
In the end, I was advised not to bring my own suit against my original fellowship director and the program. The positive part of this decision was that I was not “gagged” from discussing the situation as often happens if a case is settled. I, however, have never talked or written about it until now. As it turned out, my male fellowship colleague who I greatly respect, also left the program early. He told me that he wished he “could have been like me” and taken a stand and left when I did.
What did I learn from these experiences?
- Various people including residency directors, fellowship directors and operating surgeons told me my orthopaedic career was over. It wasn’t.
- Time and hard work will improve an unjustly applied negative reputation.
- Do the right thing no matter what the cost.
- Know yourself so you understand the lines you are unable to cross.
- Know what it means to take the Hippocratic Oath.
- Our business is patient advocacy, that is what we do.
- You have time (in situations where people are not dying).
- Get advice.
- Develop a plan and carry it out.
- You are not alone.
