OWL Essay 2022 — Winner, highly commended, and runners-up


Topic: 'Give me a break and I'll fix it!' 

Congratulations to OWL Essay 2022 winner Saumya Chanana

We also extend congratulations to runner-up Suzen Agharia, and highly commended entries Annora Kumar, Shutong Mo, and Kate Hurst

Winner — Saumya Chanana

'Give me a break and I'll fix it ' —  an ode to the trailblazers
Give me a break and I’ll fix it.
A break in a bone, ignites her soul.
She uses all tools, her strength inferred,
Mental and physical finesse to preserve
Joints, bones of patients, their own worlds
Fractured, dislocated, and out of alignment.
Havoc wreaked, traumas peaked,
Or simply, slowly, worn down,
Degenerated by the pressures of time and life.
She is sure when she says
Give me a break and I’ll fix it.

Give her a break and she’ll fix it.
A break in the system
That seemed fixed and stuck in its way.
They told her be cautious, they told her it isn’t a good fit for you
They say it’s a boy’s club, not a place for people like you.
She knows she is strong, their concerns formed from wrongs.
Her efforts supported, facilitated by those
Who see through these wrongs,
The inequality in having much of us in the shadows,
Out of the picture for so long.
Champions of Change widening the lane,
Creating space for more names
Like hers.

Give them a break and they’ll fix it.
The systems a-changing, hold on
For newer paths, newer ways.
A different method than the old days,
Where a ‘new’ system embraces change,
Diversity not feared but embraced.
For isn’t that the aim of the game?
Our differences reflected, a mirror
Of patients; their faces, souls, and stories,
Albeit no different than those of us, scrubbed in.
A move away from the old structure
Towards one that won’t rupture, a new culture,
To fixing the fractures, traumas of tomorrow,
To a better future starting today.

Give us a break and we’ll fix it.
A system where she feels supported, belonging.
A place where she knows she is not alone,
Her strength grows in a team that shares the load.
The system learning, building, evolving,
To a place where others like her know
There is space for you, for you to be part of the team.
No fear in taking the new roads, following people
Like her. For she once took a lonely road,
Building new tracks, taking new trails.
Perhaps for her, the road was not as smooth
As hopefully it will be for someone new.

Give me a break and I’ll fix it.
My size 6 hands albeit smaller
To those who have walked these roads before.
No longer a stranger to this path,
Those before me went through this last
To make new structures, frameworks, and tasks
To today where I now find myself, at last.
Give me a break and I’ll fix it.
Perhaps one day, I’ll be placing plates and screws
Perhaps for patients who see the similarities
And a little bit of themselves in me.

Together building a community, a world
Where we are all continuing to learn,
Differences are what make us unique.
But this is for the best, blending our tweaks
Together, strengthening what is weak.
Listening, improving, acting on our critique.
For isn’t this the only way for us
To fix our breaks and reach our peak?

Give me a break and I’ll fix it
An aspiring orthopod, dreams of steel,
Draped in lead and ready to lead, but for now content
To be a junior on her dream team.

Comments from the judges:

"I love the truth, the strength and the optimism all rolled into this creative piece. For me a clear winner."

"Beautifully creative and emphatic messaging. This poem takes you through a journey of AOA’s meandering path of realisation to embrace diversity, through the eyes of a junior aspiring orthopaedic surgeon."


Runner-up — Suzen Agharia

Break
verb: break; past tense: broke

1. Sustain an injury
"The patient's arm broke" or, orthopaedically speaking, "the patient had sustained a midshaft humerus fracture, endangering the radial nerve."
Quite literally, a day in the life of an orthopod revolves around the surgical management of musculoskeletal injuries — a broken bone requiring a fix, an osteosarcoma requiring a fix or a torn ACL requiring a fix. Skill and a high degree of manual dexterity can help the orthopod fix countless breaks - but is it enough to fix the instrumentalised patriarchal beliefs that limit orthopaedic surgery to a mere boy's club? 

2. Crush the emotional strength and spirit
"The junior resident's self-confidence broke as they battled through the sleepless nights, emotional exhaustion and harassment."
The rate of burnout among orthopaedic surgeons is higher-than-average at 50-60%1, with a greater prevalence noted among junior residents. Undoubtedly, the rising competition to get into the specialty, nights on-call, long hours, and sleep deprivation only catalyse this until an orthopod finally suffocates under the gravity of expectations they face.

Emotional exhaustion. Depersonalisation. Loss of personal accomplishment3. The three phrases that have shadowed us since the day we embarked on our journey in medicine and will always linger. Afterall, medical professionals, as we know, can fix any medical
condition if they aren't the ones impacted by it.
Drained, they say, denying its very existence.

"I broke. I give up. I surrender. I am handing back my dream of becoming a surgeon3."
Burnout doesn't differentiate between sex, ethnicity, or race — all victims could potentially hit their unfixable states. However, the misconceptions towards orthopaedics — the sheer brute force, inherent misogyny, and gym bro's club — work as granulomas, walling off not only the female population from being attracted to the very intricacies of this specialty but also suppress the ones that do partake in it from thriving. Because God forbid, she contests or challenges the substantial workload. She decided to pursue this. She asked for it. They told her she couldn't do it.  It is these bigoted attitudes that need to be fixed. It is a break from these that she deeply longs for and deserves.

Say, one does muster up the courage to admit to being broken, was it a brave move or a sabotage that will break them further? The concerns about speaking out - being blacklisted, looked down upon, ruined 'good references', and ultimately broken dreams of getting onto the training program. All these factors cloud the forefront of the mind wanting to seek help, wanting to speak up, wanting to be fixed. However, the fear of sabotaging their dreams and reputation hinders them and suffocates them until they physically and physiologically break. It is this toxic culture that needs to be fixed.

noun: break 
1. A pause in work or activity
"Give me a break and I'll fix it!"
This culture can be fixed. It is what is necessary for the progression in not only the field of orthopaedics, but surgery as a whole. Burnout plagues countless surgeons with unfaltering potential and drive. They deserve to be recognised for their hard work. They deserve a break. 

Whether it be a day off, safe working hours, or even a simple check-in with a colleague, a culture of supportiveness and healthy work environment must be built. This change needs to occur at a systemic level to continue supporting budding surgeons as they navigate through their long and undoubtedly difficult journey. While manifesting significant mental and physical tolls for the person going through it, burnout is also associated with increased intraoperative irritability2. Despite being far from optimal, it is hardly something under the control of someone who is completely worn out, exhausted, broken.

This danse macabre needs to be fixed with empathy, not pitiful remarks of "maybe this isn't for you." The entrenched beliefs in the system long for a shift. Mentorship plays an essential role in this as guidance from a senior who has battled these hardships paves a
tunnel of hope - one that will not dim the surgeon's light as they walk through it but mould them into resilient and empathetic heroes.

They need a break to develop their passion towards orthopaedic surgery. To build positive relationships with their colleagues. To have time off work to pursue their hobbies. To enjoy and cherish what they do.
To fix the broken.


References

  1. Arora M, Diwan AD, Harris IA. Prevalence and Factors of Burnout among Australian Orthopaedic Trainees: A Cross-Sectional Study. J Orthop Surg [Internet]. 2014 Dec 1;22(3):374􀍴7. Available from: https://journals.sagepub.com/doi/10.1177/230949901402200322
  2. Wan R, Hui H, Leung KC, Ge S, Hwang AC, Ge G, et al. Burnout in orthopaedic surgeons: A systematic review. J Clin Orthop Trauma [Internet]. 2019;10:S47􀍴52. Available from: https://doi.org/10.1016/j.jcot.2019.01.028
  3. Kadota Y. The ugly side of becoming a surgeon [Internet]. 2019. Available from: https://mindbodymiko.com/the-ugly-side-of-becoming-a-surgeon

Comments from the judges:

"This essay [is] tougher to read; that our young doctors are experiencing this type of culture, exposes a truth which needs to be acknowledged that there is still a long way to go to create a uniformly diverse and inclusive orthopaedic profession. Not the experience of all women though."

"Succinct and to the point."

Highly commended — Annora Kumar

 An old Japanese folktale tells the story of a warrior named Ashikaga Yoshimasa who broke his favourite tea bowl and sent it to China for repair. When he went to fetch it, the crack had been joined together with unsightly staples the size of locusts. Despite its functionality, Yoshimasa was unsatisfied and contracted Japanese craftspeople to devise a more elegant means of repair. The craftspeople replaced the staples with gold pottery glue, creating a beautiful shiny seam running through the bowl. From this, the Japanese art of kintsugi – golden repair – arose (1).

The objective of this almost 700-year-old story is not to denounce the practice of fixing things using metal staples. Rather, kintsugi describes a strive for innovation and elegance. Perhaps autologous chondrocyte transplantation is the modern orthopaedic equivalent of kintsugi’s golden glue (2), or perhaps it is the emergence of bioactive glass-based adhesive in situations where traditional polymethyl methacrylate cement will not suffice (3). In the same way that Yoshimasa was unsatisfied with his stapled together bowl, the commonly used outcome measure of fracture union does not predict patient satisfaction after orthopaedic surgery (4). What, then, does it mean to properly fix something? Modern medicine is no longer just about fixing wounds or stabilising bones – medical innovation continues to drive advancements that can increase patient satisfaction and outcomes.
 
In a more literal sense, the origins of kintsugi also emphasise the importance of teamwork, painting a mental image of a group of craftspeople puzzling over the broken bowl. This idea leads to the second point in this essay: collaboration in an increasingly allied health-centred surgical landscape. As stated by Bob in the eponymous television show Bob the Builder, when asked whether he can fix something, he replies with ‘Yes we can!’ and never ‘Yes I can!’ (5). Unfortunately, the show’s title omits the contribution of Bob’s team and is solely named after Bob himself. Similarly, despite the utility of teamwork as a means of crossing professional, disciplinary and sectoral boundaries (6), medical education greatly emphasises individual merit. Individualism may persists throughout one’s career, as illustrated by the ‘tension between professionalism and commercialism’ amongst orthopaedic surgeons described by the Medical Journal of Australia (7). Individualism also exists amongst medical students, with a 2019 study showing that excelling in medical school exams was correlated with poorer teamworking ability (8). In the same way that one cartoon builder cannot fix an entire city by himself, multidisciplinary team approaches have been shown to positively impact patient outcomes (9). Therefore, such approaches should be widely employed to improve operating room efficiency, decrease errors, and save in time and cost (10).

In a less literal sense, the field of medicine itself has areas in which amends need to be made. The Royal Australasian College of Surgeons recognises workplace issues including stress, burnout, and harassment (11). This is illustrated by the 2015 case of a surgical trainee who won a sexual harassment case against her senior only to never work in a public hospital again (12), and such issues also exist in the broader medical field (13). A single lawsuit or inquiry cannot fix the problem of sexual harassment. Similarly, even though a single person may be eager to stabilise a fracture, for the bone to heal a hematoma must form, turning into a fibrocartilaginous callus, bony callus and finally bone remodelling occurs (14). Healing must take into account all stages of assault — prelude, assault, limbo, exposure and aftermath (13), recognising that injury occurs at every stage. The question arises; what can the next generation of surgeons do to support cultural change? At a medical student level, this means fostering an attitude of reflection and zero-tolerance towards harassment, creating a code of professional conduct that remains in place after graduation.

Since the development of kintsugi, several artists have been accused of deliberately breaking historical ceramic pieces just to mend them using kintsugi (1). This, of course, defeats the kintsugi’s original purpose. The process of damage, repair and recovery is inherently traumatic. Within medicine and orthopaedic surgery, technological advancements have enabled more innovative, elegant techniques of repair, and multidisciplinary team approaches help to improve efficiency and patient outcomes after surgery. In cases where no quick fix can be sought, such with complex workplace issues, cultural change should start at medical student level. When single lawsuits or inquiries fall short, attitudes of zero-tolerance towards harassment must be upheld over quiet acquiescence in order to prevent further irreparable harm.

Highly commended — Shutong Mo

Give me a break in bones, and I’ll fix it

“Have you ever broken a bone?”
“So, what happened?”
“Since then, were you feeling vulnerable, physically, emotionally or both?”

The precise memory of the mechanism of injury, symptoms and signs could fade; however, no one would forget the sounds of cracking, popping, grinding and the excruciating pain, that is, the triggers of vulnerability.

We are good at asking questions as a clinician and proud to fix patients’ problems. As an orthopaedic surgeon the gratification of fixation could be immediate, short-term and long-term; a unique gift that draws healthcare professionals into this field. Sometimes, anatomical alignment can be achieved spontaneously or by manipulation under analgesia. Not uncommonly, open reduction and internal fixation will be required to realign the bones, with or without the repair of vulnerable nerves or vessels.

But have we thought about the impact of fixing on patients? Of course, we did. Fracture clinic for outpatient review, ongoing allied health inputs, rehabilitation program and the involvement of prosthesis institutes are all up to date to tailor patients’ needs.

“And how are you feeling now?”

The patient’s answer varies. For some, their functionality returned to the baseline prior to injury. For some, their life was not the same anymore, associated with chronic pain, reduced mobility, sensation, or social interactions. They may or may not require further interventions.

An increase in psychological resilience was reported to be positively related to physical functions after going through a fracture (1). After an uncomplicated fracture, people tend to feel stronger with the experience of injury, despite feeling vulnerable initially. This process revealed how strong we would be after appreciating how vulnerable we were in the first place.

Give me a break in training, and I’ll fix it.

In orthopaedic training, the historical stereotypes of rigid gender roles, masculinity, and the stigma of comments like ‘you don’t look like a surgeon’ from the patients or the public in general (2), acts as a break preventing female junior doctors from pursuing orthopaedics as their lifelong career. We feel vulnerable in this process. Fixation is on the way by advancing orthopaedic devices to require less physical strength, more flexible and maternity-friendly training program, social media campaigns and awareness education, such as #heforshe and #Ilooklikeasurgeon (2). The female orthopaedic group is getting stronger by recognising our vulnerability and appreciating the endless effort and support along the way, an evolving imaging of modern orthopaedic surgeon from ‘you don’t look like a surgeon’ to ‘this is my surgeon’.

A break results from a strong force that can be statically or dynamically. A break occurs at the weakest point. For fractures, it affects not only the bone but also the surroundings, such as muscles, ligaments, nerves, vessels, soft tissues, and skin. For a woman pursuing orthopaedics, it affects not only your own work and life, but also the supportive culture from our male colleagues at work and family at home, as well as a flexible orthopaedic training network.

Carolyn Ruth Bertozzi said in her interview after awarding the 2022 Nobel Laureate in Chemistry:
“I understand the gravity of being a female and now the Nobel Laureate in the sciences. There aren’t that many of us yet although there is certainly a trending in the right direction and an uptick. I think to the extent that a younger scientist and an early career scientist can look at my path and draw some inspirations from it. I would feel deep gratitude (3).”

Likewise, the blessings of being a female and an aspiring orthopaedic surgeon is that although there aren’t many of us yet, there’s certainly a rise with the ongoing support and care from orthopaedics association, mentors, and the training program. We should embrace it with deep gratitude.

Let’s fix the break, as soon as possible.


Highly commended — Kate Hurst

Give a girl a break and she’ll fix it, Fisher-Price doctor’s kit in hand, sticking her doll’s head back where it belongs. The dream of being a doctor is yet a bud as she learns of her passion to put things back together again.

Give a woman a break and you know she’ll fix it; work ethic and dedication coming to the forefront as she overcomes the barriers to gain a seat at the table of medicine.

Give a junior doctor a break and no doubt she’ll fix it; putting in the hours behind-the-scenes to give herself every advantage to compete with her male counterparts. Fierce and passionate, fighting for every opportunity to scrub in and watch her female role models fix their own breaks.

Give an orthopaedic surgeon a break and it's her calling to fix it, hammer in hand knowing she’s exactly where she’s meant to be.

By their nature, women are manufactured to mend in one form or another and it is this quality that sees female practitioners engage in more patient centred communication than their male counterparts [1]. In fact, it has actually been found that compared to male surgeons, the patients of female surgeons are less likely to die, get readmitted to hospital or suffer from post operative complications [2]. What’s more, is that of patients who have a preference for gender, most are more likely to select a female orthopaedic provider[3]. So why not give the girl the break? I guarantee you she’ll fix it.

The gender gap that exists within orthopaedic surgery is, whilst improving, still an issue that faces blossoming female orthopods today. In 2020, females represented only 4.3 per cent of active Australian orthopaedic surgeons and 14.9 per cent of orthopaedic registrars, which in itself, demonstrates the extent to which this disparity exists [4].

In fact, if you give a girl this system, it too is a break she can fix. With more female representation on interview panels and more female role models on the orthopaedic pathway, positive steps are being made to minimise this gap. To give a girl a break is to give her an opportunity to make a difference in the lives of her patients, an opportunity to make a difference in a system that is ready for change and an opportunity to make a difference for those that come after her.

So give the girl the break and witness her fix it. Witness the years of dedication to her dream and fighting for a seat at the table come to fruition. Witness the creativity she brings to the field with abstract thinking and new ideas. Witness the refreshing style of patient-centred care and communication that is unique to the nature of a woman. Witness the precedent she sets for her female counterparts, who themselves, may still be mending their dolls, dreaming one day to be like her.

Giving her the break will not only fix the obvious fractures in an industry designed for men, but will give her a blank page to script a new start for women in surgery. A start where there is equal opportunity, where maternity leave and breast feeding are not only supported but
encouraged, where young women do not have to jeopardise having a family to have a career and where, most importantly, there is equal representation.

Investing in women is an investment in the future. It's investing in the introduction of family culture to the field of orthopaedics. Investing in equality and hope for little girls and young women everywhere, and, more than anything, investing in the greater good of the patient.

So give the girl the break and watch what she can do.

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  3. Mehrvar C, Deignan E, Hurtig M, Cohen G, Zalzal P, Safir O, Alhalawani A, Papini M, Towler MR. In vivo analysis of a proprietary glass-based adhesive for sternal fixation and stabilization using rabbit and sheep models. J Mater Sci Mater Med. 2021 Apr 29;32(5):53. eng. Epub 2021/04/30. doi:10.1007/s10856-021-06527-5. Cited in: Pubmed; PMID 33914176.

  4. Harris IA, Dao AT, Young JM, Solomon MJ, Jalaludin BB. Predictors of patient and surgeon satisfaction after orthopaedic trauma. Injury. 2009 Apr;40(4):377-84. eng. Epub 2008/12/02. doi:10.1016/j.injury.2008.08.039. Cited in: Pubmed; PMID 19041968.

  5. Bob the Builder. 11/10/2022. [04/10/2022]. Available from: https://en.wikipedia.org/wiki/Bob_the_Builder

  6. Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open. 2019;9(9):e028280. doi:10.1136/bmjopen-2018-028280.

  7. Ryan HY, Sun GY, Monuja M, Gillespie M, Burns A, Solomon M, Adie S. Adherence by orthopaedic surgeons to AHPRA and Australian Orthopaedic Association advertising guidelines [https://doi.org/10.5694/mja2.51490]. Medical Journal of Australia. 2022 2022/09/05;217(5):240-245. doi:https://doi.org/10.5694/mja2.51490

  8. Parker R, Hodierne L, Anderson ES, Davies RSM, Elloy M. Academic ability and teamworking in medical students [https://doi.org/10.1111/tct.12800]. The Clinical Teacher. 2019 2019/06/01;16(3):209-213. doi:https://doi.org/10.1111/tct.12800.

  9. Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: A review. Surg Neurol Int. 2014;5(Suppl 7):S295-303. eng. Epub 2014/10/08. doi:10.4103/2152-7806.139612. Cited in: Pubmed; PMID 25289149.

  10. Overdyk FJ, Harvey SC, Fishman RL, Shippey F. Successful strategies for improving operating room efficiency at academic institutions. Anesth Analg. 1998 Apr;86(4):896-906. eng. Epub 1998/04/16. doi:10.1097/00000539-199804000-00039. Cited in: Pubmed; PMID 9539621.

  11. Batten J. Improving surgical workplace culture. Royal Australasian Collge of Surgeons; 2019 11/10/2022. [06/02/2019]. Available from: https://www.surgeons.org/en/News/News/improving-surgical-workplace-culture

  12. Walker P. Australian senior surgeon attacked for remarks on sexual harassment. The Guardian Australia. 2015 10/03/2015.

  13. Stone L, Phillips C, Douglas KA. Sexual assault and harassment of doctors, by doctors: a qualitative study [https://doi.org/10.1111/medu.13912]. Medical Education. 2019 2019/08/01;53(8):833-843. doi:https://doi.org/10.1111/medu.13912.

  14. Sheen JR, Garla VV. Fracture Healing Overview. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022. eng.
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