#APSA50: Benjy Brooks Panel - The Women of APSA

Hey, everyone. This is Alex Cassar, and I'd like to welcome you to this new episode of Stay Current Pediatric Surgery, once again in collaboration with the Behind the Knife podcast. As you may have noticed all over social media, September is Women in Medicine Month, and the theme happens to be trailblazers, advocates and leaders. During the APSA meeting earlier this year, we had the opportunity to interview a panel of women who wear these hats and many more in their daily lives. I hope you enjoy listening to Doctor Catherine Anderson, Doctor Diana Farmer, and Doctor Marion Henry as they share their stories of flat heads from breaking glass ceilings and paving the way for women in pediatric surgery. We are truly lucky to stand on the shoulders of giants. Stay Current is a multimedia publication designed to keep health care professionals up to date on standards of care and new emerging ideas. This chapter is created and edited by Todd Ponsky, Alex Cassar, Alex Gibbons, and Ray Hankin and is recorded and produced at Cincinnati Children's Hospital in Cincinnati, Ohio. Today, our guests are a panel of phenomenal surgeons and leaders. Doctor Catherine Anderson attended Cambridge University where she earned a Bachelor and Master's of Arts before moving to the United States. She then attended Harvard Medical School, followed by an internship in pediatric medicine at Boston Children's Hospital because she was denied a surgical internship. After 1 year, she joined the Georgetown University Hospital General Surgery residency, but left after 2 years due to gender discrimination. After working in community hospitals with a higher volume of operative time, she completed a pediatric surgery fellowship at Children's National Medical Center. She went on to become professor and Chair of Surgery at Children's National, Surgeon in Chief at Children's Hospital in Los Angeles, Chair of the Surgery section of the American Academy of Pediatrics. She's on the editorial. Board of the Journal of Pediatric Surgery. She was the first woman to rise in the ranks of the American College of Surgeons and the American Pediatric Surgical Association. On top of all of this, she was a surgeon scientist with research interests in esophageal replacement. We also have Doctor Diana Farmer, who was one of the first guests on Behind the Knife back in June 2015, episode 11. She is an internationally renowned fetal and neonatal surgeon, chair of the Department of Surgery at UC Davis, and a very active surgeon scientist. She earned her bachelor's at Wellesley College in Massachusetts, followed by her MD at the University of Washington. She then completed her general surgery residency at UC San Francisco, followed by pediatric surgery fellowship at the Children's Hospital of Michigan. Among many honors, she was elected to the Institute of Medicine of the National Academies, one of the highest honors in medicine. Finally, we are joined by Doctor Marion Henry, Associate Professor of Surgery and Pediatrics at the University of Arizona and surgeon in Chief at Banner Diamond Children's Hospital. She completed her bachelor's degree at Princeton University, followed by medical school at Stanford and general surgery training at Stanford University and Yale. Where she obtained her master's in Public Health. She finished her pediatric surgery fellowship at the Children's National Medical Center. Dr. Henry was an active duty surgeon in the Navy for 9 years, earning the rank of commander. She is extremely active in advocacy efforts for the American College of Surgeons and the American Pediatric Surgery Association. And is a leader in the Association of Women Surgeons. So Doctor Anderson, why don't you get us started here? So who is Benji Brooks and what is the society? Benji Brooks was um one of the first female members of APSA, 1st, 1st female pediatric surgeons, period. And she was one of the first people who got actual training from Dr. Robert Gross. Now, Doctor Robert Gross was a wonderful surgeon, a great human being, and a great innovator, as I know you're aware. But he'd never trained a woman. And By reputation, he had, he had prejudice against doing so. Doctor Charles Janeway was the chief of pediatrics at the Boston Children's Hospital and was a contemporary of Dr. Gross. And one day he went up to Doctor Gross and he said, Doctor Gross, I have this resident who wants to be a pediatric surgeon. And would you train this person? And Doctor Gross, of course, assumed that this Benji Brooks was a male, so he said, sure. No, no interview. Everything was very informal in those days. The first day Benji Brooks arrived, and that was when Doctor Gross discovered that she was a woman. But he trained her anyway. She was from Texas, and she was along with a few others. Who were the pioneers. I had the great fortune to be in the 2nd generation of female pediatric surgeons. I don't know. Perhaps it's not really great fortune considering my age now, but um We, uh, they were a very small group, and one of the papers in those early days was a paper about not just lopping out the spleen of a child who had splenic trauma. And it was routine that we all did that. And there was a paper presented on a series, and I can't remember who the author was, or how many patients they had, but they had an enormous success rate and were presenting that of the conservative management of ruptured spleen in children. And Benji Brooks got up. And she said, and I wish I can't, I can't mimic an American accent. And I certainly can't mimic a Texas accent. She got up in her inimitable way, and she said, you know, I've been doing this for years, and she said, I got up and talked about this in a previous year. And she said, she was very salty, she said, Well, I presented this several years ago, and I got an immediate response from a number of people, but I can't tell you what they said, because they're a gentleman present. That's that's my story about Benji. So, I guess, Doctor Anderson, if you were part of the 2nd generation, I guess I'm part of the 3rd generation of women in pediatric surgery, and I do remember that there were a few of us who would meet uh in one of these, just, just like this, one of the breaks or sometime after the meeting was over. In those days, there were usually two alternatives for the free afternoon. That was a day when we had free afternoons at ABSA, and they were always golf or tennis. So, a few of us women got together and we'd sit in the back of the room and say, well, you know, we really don't play golf or tennis, maybe we can come up with some other activities. This went on for a few years that we would talk about that we wanted something else to do and we wanted an opportunity for women to get together. In the very beginning, the, when we asked for permission to get a room, we were essentially told we didn't want any more of these splinter groups to form in ABSA. They had uh described splinter groups uh in the college, so then we got smart and said, well, we, I guess we won't ask for a room, we'll just start doing it ourselves. And we started very simply, uh, never as a formal organization, but, uh, just getting together for lunch or an alternative. We participated in ideas, we put out ideas for either spa afternoons or just lunch. I think we arranged, I think, uh, Rebecca Meyers helped us arrange kayaking one time. Uh, and we continued on in a fairly informal way. Finally, Uh, ABSA was willing to, uh, give us a room and put us on the, uh, program. We thought that was a big advance. We still had to buy our own lunch, but we were OK with that, um, but that was a big step and at some point in the course of that I'd probably say maybe 2 or 3 years into it we decided that we. Should probably have a name and we did a little bit of research on indeed was it, was Benji the first pediatric surgeon and there were some a little bit of uh controversy, some research, and looking into other things, but the consensus really was that indeed she was the first pediatric surgeon and that's how we self-appointed ourselves, the Benji Brooks Society. And then I think I'll pass the microphone to Marianne Henry, who I would, I would say brought us home. So tell, tell, um, the team about sort of the recent success that you've helped us create. Sure. So, I'll tell about the recent success and then say, but I want to say first that my story starts. I'm not gonna say what generation I am because I don't know, it all gets blurry, but I, when I fell in love with surgery as a 3rd year medical student and went to my 1st American College of Surgeons as a 4th-year medical student. Doctor Katherine Anderson was the president of the American College of Surgeons. So, that was a pretty uh incredible role model and an incredible year to attend as a medical student. And at that time, Doctor Farmer was at UCSF still, and our, our medical schools or hospitals were briefly joined. And so, I remember pediatric surgery meetings, phone meetings, teleconferences with uh the joint departments of pediatric surgery between Stanford and UCSF. And so that is my connection to these women with me here and how I got very inspired in pediatric surgery and involved early on in being able to attend these Benji Brooks luncheons and then The first year I got on the program officially was the year Dr. Talukian was president and I was a lab resident at Yale in Larry Moss's lab, but with Dr. Talukian right down the hallway. So, that was a very exciting time to be coming through the whole process of, you know, training in pediatric surgery. So, I have been attending those luncheons since that time frame. And, uh, last year at the Get together. The question was posed, do we need this anymore? Are there enough women now in pediatric surgery that, that this is obsolete and not necessary? And I would say that there was not, I think, a single person in the room who said, No, we don't need this anymore. There was a very loud voice of women that said, yes, there are still issues, and there is still work to be done, and we do need this. And so we discussed then what, what form should it take? Should we stay the Benji Brooks Society and move outside of ABSA and work on our own as a separate society of women in pediatric surgery. And we decided instead that really women needed to be at the table. And in the room where it happens and that the way we could make the most impact was to petition to be a true ABSA committee so that we could be not only on the program for a luncheon, but on the program for workshops and educational sessions and. Uh, plenary sessions and, uh, so we brought up a, a letter to the board of governors requesting a full committee that was dedicated to women in surgery and they approved it so that the committee is now officially. an ABSA committee, the Benji Brooks Women in Surgery Committee, you mentioned that Doctor Anderson, um, was the president of ACS and she was the first female president of ACS and also the first female president of ABSA. You were just making a joke about your head being flat from breaking all these glass ceilings and tell us, you know, people don't always talk about, um, the adversity that. and you being a groundbreaker like this, how, how was it to go through those challenges and how much do you appreciate how we've progressed now with the Benji Brooks Society and with all these women in surgery who are mentors to women like us here who are aspiring to be pediatric surgeons? One of the things I'd like to say is that. For me, one of the major reasons that we should, we should have a group of women together is that I kind of got tired of the old boy network. You know, people would be sitting around a table and I would make, and this was in my work as a surgeon. And a I would make a suggestion. And there was no response. And then 5 minutes later, a man would bring up the same question. Oh, Doctor So and so, that's a wonderful idea. And I just sat there thinking, Men network and they've always networked. And I found that as I went through my career, Yes, I was comfortable with men. I had to be. Because I was often the only woman in the room or in the gathering, etc. But I also gravitated towards the wives. And I felt extremely comfortable with them. And so that was an additional reason for for me to be so much of a part of the women in in pediatric surgery. Now as far as prejudice, I don't talk about things that happened. In, um, in my, um, not so much in my medical student career, because I don't think I ever encountered any prejudice either at Cambridge. Um, where we were a class of 120 students per year and there were 8 women more than the Harvard school that I joined halfway through. But when I, um, as I think I, I use this anecdote when during the last meeting, that when I asked Francis Moore, Uh, if he would give me a surgical residency, when and if I came back to Boston, and he said he'd rather give me a job in anesthesia. That really was a big jolt for me. But it didn't, it didn't deter me, and I went to George Washington. And Brian Blade wouldn't give me a job. Because he said, oh, you'll have to start again as an intern, and I'd already was in the middle of a pediatric internship at the time. But Georgetown did. They gave me a a position, and I really can't say. That That there was much prejudice, certainly not from my fellow residents. There were, there were some men who thought they were God's gift to women. As many women find out when they join a man's world, and that's where the Me Too movement came from, I suppose, but I just shrugged it off because I knew that in order to get the same distance of a man as a man, I had to be better. And as women usually say, that's not hard, pardon me. You can edit that out. That's. When I, when I finally finished, I wondered how Men patients would be. Never had any problem. I was often mistaken for a nurse, and that was OK. You sort of get used to that. And I didn't, I didn't let it offend me. Um, but there were many instances where there were, there were men surgeons who Uh, we're a little physical, leave it at that, but they're never any patience. Any men male patients, they were just so grateful, and they were more grateful because women do talk. More to their patients and their families and so on. And so I never had any prejudice since then. And as I went up the ranks in the AAP and then ASA and the college, I really didn't find that there was any difference in the way I was treated. So Hopefully That that helped other women. And I don't know what Diana has to contribute to that since she's younger than I am. Well, there's no question that, uh, Kathy, people like yourselves, uh, made it easier for those of us that followed and that the, I think being the first of something is often. Challenging. It's not that you, uh, seek to be the first. I, I'm the first woman fetal surgeon, but I only aspire to being a fetal surgeon. I never thought about, as I'm sure you really didn't either think, you know, make a plan to be the first woman president of ABSA or the first woman president of the college. You just aspired to contribute to those organizations. Like anybody else and uh became the first of those, but. I do think it helps others, even though, even if it's not a goal, it does. Break the mold. It makes people realize, oh. It's OK. I do think that there was extra pressure to be even more excellent than average, if that is such a thing. And I think There is additional importance to serve those positions with distinction because there now are the nonbelievers who are paying attention as well. I think that's where the extra pressure comes that. Did this person get the job because they were deserving or did they get the job because someone paved the way just for a woman or just for a minority or something like that so I think uh for the early pioneers there is that extra pressure to make sure that you um a deserve the positions and demonstrate that you're worthy in them eventually the time will come when. I hope when Justice Martin Luther King said, you know, I have a dream and I hope that in the future my children will not be judged by the color of their skin, but by the quality of their character, and I think we all hope that, uh, eventually that will be the case, but in the meantime, it's important to go that extra mile. I'd like to make one more, uh, comment before Marion tells us about her experience, but. Women have been beaten down in society for so long. Women have even questioned themselves, and I have had numerous young women come up to me and say, you know, why am I doing this? I talked to the pediatric surgeon from Bahrain yesterday, and she, she was so typical of many women in societies that are beaten down. And she said, I'm just wonder whether, why can I do it? Can I really be? Everything that I want to be. So women have a little bit of an inferiority complex, and that's where I think we can help other women. Get over that inferiority complex. There's nothing inferior about a woman. Now, I would just like to add to that that particularly my work in global surgery and overseas work has really brought that point that you're making to sharp focus that we are so privileged in this society to have the freedom that we women do, um, and it hasn't been that many generations, uh, where women were afforded those same opportunities for education and the like. And we should never take it for granted because certainly in many societies around the world um it is uh the expectation for women is only to be there to service men and raise the children and etc. and that we should not take for granted the enormous opportunities that we have here and therefore I think we do have an extra responsibility. The wonderful opportunity that the, the society had and the committee now has it is both to, you know, share and celebrate those who came before us because they really did pave a way, you know, I have not been the first in, in anything, which is great. Actually, I guess that's not true. I'm the first female chair of the Health Policy and advocacy Committee because it's only that many years old. But otherwise, I, um, I'm happy to say I have not been the first because there are people who paved the way for, for me to get there. And that doesn't mean there are not still challenges. And I see, uh, leaders ahead of me, women leaders ahead of me face those challenges. And, uh, you know, there are still inequalities in terms of leadership position in particular, in, in surgery in general. And Uh, we hope to look at exactly where we are in the world of pediatric surgery with the status of women and what, what leadership positions they hold. And, um, we're, as a 50th anniversary project, uh, want to tackle that project, but But we still, we still face challenges that are somewhat different, somewhat the same, and sometimes we raise the questions that impact everyone, um, both men and women, and, uh, but we're willing to raise the questions of how do you, um, manage all the aspects of life that you want to manage, whether that's research and career and home life, whatever home life looks like for you. Um, I think it also means we can help mentor and sponsor, not just women, but deserving men and women who otherwise are underrepresented and, um, So the, you know, we have that both uh privilege to thank those who've paved the way for us, but responsibility to continue to help others, um, overcome the challenges that those ahead of us faced and, and overcame for us. Um, and I think that's one of the wonderful things about having a committee of this nature is, is we can, we can do those, that, that dual. Um, goal of, of both recognizing and working for even better times for everyone. I was struck at the meeting. There was great and lively conversation and there was still lots to talk about and that we're not finished and that I was very pleased that the decision had been made to continue and uh I, I remember. Uh, you may, you asked the question about balance, and I remember making the comment then, but I, when I was a, an undergraduate, I went to a women's college and I remember getting the advice at that time that you can indeed do it all and that we should not limit our ambitions in any way, no matter who you are, and that you just maybe can't do it all at the same time and the advice then was you could have a social life and a career. And a family life, but you probably couldn't have all three of those things at the same time and however that's defined, I think that's really true, but I was very pleased at the meeting the other morning that there was still so much lively interaction and there are now so many women that if we went around the room and introduced each other, which is what we used to do, that it would, it would take 3 hours, so that was great. So it was really fun. I think I want to put a caution in because having been one of the only women in a group of men for whatever reason, uh, not just in surgery, but That there can be a tendency among women who are the only ones, maybe it's a token or a developing field. To Basically not help other women, and that I have been subjected to, and it's extremely disappointing to me that that would happen. That a woman, you know, feels special, because she's cherished by her group of men around her, and she doesn't want to let anybody else in. And we've got to caution against that. Yes, I, I would share similar experiences as I went through and I'm, but I'm happy to say there's less of that. I'm, I think I'm seeing, yeah, I think we, I think particularly I'll speak for ABSA that I would say that people have been great with this. I remember, in fact, Doctor Anderson giving me the advice, advising me to start contributing, start actually contributing to ABSA and the ABSA Foundation and the college and. No one had ever suggested that to me before. It was very interesting. It just had never occurred to me that that was something you should do and how glad I was after I started doing that and there were years I felt like I could contribute more or less, but I've made it ever since that day. I have made it a habit to make sure that I contributed to the organizations that mattered to me and just you kind of need somebody once in a while to tell you. What are the things to do and, and what's right and, and what are the unspoken sort of social norms of uh moving forward so I really appreciated that that girl to girl advice. Well, I'm very glad that one of my advice has been taken by somebody. I think one of the roles of, of a committee like the Benji Brooks Women in Surgery Committee is to help lift all women and so to help combat against that potential, um, you know, problem of, of a woman not, not lifting others around, around her or, or, you know, any other underrepresented person who, who has a position. Um, and we had an interesting discussion on, on tokenism in the, in the committee or in the, uh, lunch meeting, uh, yesterday. Um, but to that end, the committee, you know, aims to put together lists of women speakers and so that someone doesn't have to rely on the one woman they know or the one person they know who can speak on this or The one department that has people, but that we have an, an ability to sort of have resources throughout the country, throughout programs, academic and community, large and small, and really um You know, lift, lift all women, as well as all members of ABSA to, to contribute as much as they can and, and really, you know, call on the wisdom of all rather than just the wisdom of few who get called on frequently. And that's actually a great transition to kind of the question I had and I wanted Doctor Anderson to repeat the story you told about your lapel pin because that's also in talking about the ABSA logo this year has been changed to be not divisive and very inclusive. There's no genders, there's no race, nothing. Everyone's represented with this logo. You can talk about the meaning of that to you. But then also I'd love for our listeners to hear the story about your lapel pin because I thought that was great. OK, well, as, as you know, I was the first woman president of ABSA and I had been a little bit irritated for some years, because I've been in ABSA since 1973. And I became president in 1999. So it's quite a period of reflection for me. And The, the Absa logo was Lucian Leap, I think told the story this morning about how that came about. He just got somebody to Keith Ashcroft to pose. But it bothered me. It was an irritant. And Heidi Hendron is, is a hero of mine and has been, as I said, for a long, long time, very, very supportive of women and particularly of me. And Pat Donahoe. And he just thought it was offensive to have a woman president having to wear a man's profile on her, on her lapel. And so he by himself found somebody, got me to my husband to take a picture of me holding something resembling vaguely remember resembling a baby. And and he had this pin made which is, which Diana is showing you and every female president since then. But as I said, in the, in the in the panel discussion, that was really as sexist as the male logo before. So I brought up, it was quite a few years ago that I brought up in in a business meeting that we really ought to change the the logo. And I think that was probably about 7 or 8 years ago. Um, and, and, and this has come to fruition this year. So, I will just uh corroborate that story that Doctor Anderson would come to the microphone at the business meetings and uh suggest that the logo be changed and at least for the 1st 3 years, you were roundly. Not quite booed. It was a little more polite than that, um, although Doctor Ashcroft, I remember once coming to the mic saying, Something, something close to over my dead body, but it's what was interesting to me today was to see how well received the new logo has been. Um, there has not been any wholesale walking out or complaints about it. I think it was socialized well over time. I think the, uh, 50th anniversary committee made a point of let's tie it to the 50th anniversary, that it's appropriate time for a change, and it has gone very smoothly, but at the first couple of meetings that you presented it, it was not at all well received. There was a feeling that ABSA did not need to change. We should stick with these traditions. It was pretty vocal. Actually, I don't remember that. I really don't. And thank you for telling me about that because I got, I had become so inured to criticism. That I just let it go over my head and so thank you. Yeah, no, they didn't make it easy on you, Kathy, about that, and, uh, but I, I do think that, that, that quality of being come, becoming somewhat numb to the criticism is actually, um, somewhat common and, uh. So it, it's important to have historians look at history from a variety of different perspectives. I can only add that I do remember the negativity to the, uh, to the commentary and that as a younger woman coming up in ABSA, that was somewhat distressing. And, um, so I was very pleased to See that the change in the last few years as they work towards this new logo and that it's not just a gender change. It is really designed to be a, a, a surgeon of any gender, race, um, and the child as well, you know, it is equally inclusive and that, that, um, You know, that, that, that new logo has really been able to include everyone in, in our community. Um, so that it is, um, So that we are inclusive and diverse and uh keeping to those principles. I think that there is a danger of The old people wanting to hang on to power. And I think we should get the heck out of the way and leave it to people like you too. I think that's a perfect note to end on. Thank you all so much for this tremendous honor. It is a remarkable privilege to be in your company and I believe this will uh wholly inspire the next generation to come. Thank you so much. We hope you enjoyed this episode of Stay Current. You can listen, watch, or read our content at any time by downloading the Stay Current app. It's time