OWL Essay 2023 Winner and runners-up
Topic: 'Orthopaedics — the good, the bad, and the ugly'
Congratulations to OWL Essay 2023 winner Suzen Agharia.
We also extend congratulations to runners-up Lily Salehi and Susanna Ratnam.
Winner — Suzen Agharia
The Menu
Appetiser
A Gastronomic Overture of Triumph
The eager wait comes to an end as the appetiser is served – a symphony of success stories that resonate like harmonious melodies. Within the realm of orthopaedics, each beautifully crafted hors d'oeuvre paints a picture of resilience, determination, and the grit of women who have successfully carved their names in a historically male-dominated field.
As she immerses herself in the appetiser, unspoken camaraderie between the trailblazing women in the field greets her with a sense of connection. Mentorship – the passing down of this torch of ambition and perseverance paves the way for many aspiring orthopods like her to unfold the canvases of their careers. She savours each morsel of achievement recognised and efforts validated; all of which renew her sense of purpose in the field.
With each bite, the appetiser also tantalises the success and breakthroughs in this innovative field, helping countless to not only regain their mobility, but also allowing grandparents to dance with their grandchildren once more, allowing athletes to break world records once more, and allowing transformation to take its rightful place.
Main Course
The Overcooked Dish
After an endearing start, the main course is served – a dish complex in its composition and presentation, carefully curated with the intricate layers of being a female orthopaedic surgeon.
Akin to a chef orchestrating a culinary masterpiece, she navigates her skills with precision in the operating theatre, blending the art of healing with the science of surgery. Yet, part of the experience: a growingly charred aftertaste - questions about her capability linger as she is dished a hefty serving of administrative tasks, overpowering the fleeting taste of success.
With the sizzle of the surgical suite, the tension of the operating table, and the relentless working hours experienced inadvertently by 63% of orthopods, 58% of them being female¹, the pressure cooker comes closer to exploding. Amidst the chaos, the lack of support becomes painstakingly obvious.
Exhaustion simmers on the back burner as she gleans how they navigate the overwhelming ordeal of inadequate maternity leave policies and scarce childcare facilities. As the banquet unfolds, it becomes evident that female orthopaedic surgeons are more susceptible to the burnout that brews in the kitchen. The stress, the frustration, and the feeling of being underappreciated all contribute to this overcooked dish of burnout.
Ensuring the right length of cooking time is as crucial to a meal as balance is to professional satisfaction and personal well-being. Nevertheless, senior chefs work tirelessly to create an environment where the banquet is enjoyed, not endured, allowing every surgeon to savour the true essence of their craft.
Dessert
A Bitter Reality
As the feast continues, there is an unsettling sensation once dessert arrives; a sense of unfairness in the way its colours are presented. Mirroring its appearance, its taste adds an unpleasant note to the menu. It resembled a culinary disaster with burnt edges, and a persistent undercurrent of gender bias tainted the entire dish.
The dismissive attitudes, condescending remarks, and sour notes of microaggressions to overt hostility create a toxic environment that dissuades countless who would have otherwise flourished in this transformative field of surgery.
Like an invisible seasoning that flavours every interaction, female orthopaedic surgeons often find themselves being served smaller portions, regardless of their dedication and competence. Wage disparities underscore this unappetising reality, with data from the Australian Taxation Office reporting a salary difference of over $280,000 between male and female orthopaedic surgeons². With orthopaedics having the second highest pay gap amongst all surgical specialties³, the unpalatable truth is that the wages they receive are not commensurate with their skills and efforts.
As she savours the last bites of this introspective dessert, she recognises that the dessert is not an ending but a beginning – a call to action. The flavour of scepticism reminds her of the importance of her presence in the field. Afterall, a monotonous dish can be created by anyone, but the ability to curate well-balanced excellence lies only in the hands of someone like her – hands that have persevered through indescribable hardship, forging a strength capable of shattering the walls of misogyny. Unsavoury 'ugliness' is being transformed as female orthopods advocate for their freedom to taste success without the bitter aftertaste of inequality, bias, and harassment.
Finally, she puts down her knife, not with disappointment or doubt, but with pride at having performed yet another successful operation while reflecting on the culture shift she has brought about and the future generations of trailblazers she has inspired.
References:
1. Kollias, C., Conyard, C., Formosa, M. F., Page, R., & Incoll, I. (2023). Distress and career regret among Australian orthopaedic surgical trainees. The Medical Journal of Australia, 218(6), 265–266.
https://doi.org/10.5694/MJA2.51823
2. Biased referral patterns show male physicians refer more patients to male surgeons than female surgeons. (2021). Retrieved September 12, 2023, from
https://www.unimelb.edu.au/newsroom/news/2021/november/biased-referral-patterns-show-male-physicians-refer-more-patients-to-male-surgeons-than-female-surgeons
3. Halim, U. A., Qureshi, A., Dayaji, S., Ahmad, S., Qureshi, M. K., Hadi, S., & Younis, F. (2023). Orthopaedics and the gender pay gap: A systematic review. The Surgeon.
https://doi.org/10.1016/J.SURGE.2023.02.003
Runner-up — Lily Salehi
The good, the bad, and the ugly! A fitting description of my journey to reach where I stand today, with each word in the phrase bearing its own distinct weight.
Orthopaedics has always been the good part of it. It has consistently represented the bright side, the pinnacle, the ultimate aspiration —the very motivation to endure all the hardships. The only light at the end of a dark tunnel that has been my journey to get here and do what I love freely! Orthopaedics is now more than just a fulfilling career for me; it is undeniably the most gratifying, rewarding, and enchanting profession I can think of. But above all, it is now a majestic symbol that represents how one’s inner strength and determination can grant them the confidence to pursue their desires without limitations.
Let me walk you through the bad and ugly now. I was born and raised in Iran, a country known for many things but undoubtedly infamous for its authoritarian tendencies, lack of political pluralism, and restrictions on fundamental freedoms. This is even more prominently evident when it comes to women’s rights. Women are not allowed to wear what they want; they must wear compulsory Hijab even if they do not believe in it. They cannot ride bikes, sing, or go to stadiums to watch their favourite games.
Raised in a household that has steadfastly supported gender equality, I have been a dedicated activist in this realm from an early age myself. About 12 years ago, when I was merely a young medical student, there was a mass protest against the government in Tehran as a result of fraud in the presidential election. The goals of the protests were government transparency, civil liberties, and women's rights. The Iranian government responded to the protests with a heavy-handed crackdown, arresting opposition leaders, activists, and journalists. Several protesters were killed, and many others were injured or imprisoned. I was fortunate enough to be arrested and imprisoned for only a few days—twenty-two to be exact. I did not have the right to talk to my family or friends, and no one knew where I was for the first two weeks. Following the trial, I was granted my release from prison but with certain obligations and conditions, one of which was the understanding that repeated behaviour could result in expulsion from the university.
As a female intern, I was not allowed to be alone in a room with my male colleagues at work. One night when I closed the door to let my registrar rest for a few minutes in the middle of a busy emergency department, the security guard came in and started shouting at me, demanding me to leave the hospital and wait to be called by the higher authorities. The following day, I received a call from the chief security officer, requesting my presence at a meeting. Ultimately, I was informed that I would not be able to complete my medical school. Even if I were to persist and complete my internship, my eligibility for specialty training would be revoked.
My aspirations, dreams, and hopes all shattered in a single day. I was forced to leave the country to pursue my all-time dream, becoming a strong, inspiring Orthopaedic surgeon. Leaving behind my home, possessions, family, and friends, adapting to a new culture, and acquiring a new language were significant challenges. Yet, they all paled in comparison to the one thing I had yearned for my entire life— the freedom to pursue my deepest desire.
And finally, the good, is that I have discovered a place that truly feels like my home. I am incredibly fortunate to be employed in a workplace that brings me immense joy, surrounded by colleagues and consultants who are so supportive and kind that I consider them as part of my extended family. There won't be any challenge too daunting to deter me now, and I am determined to show every young girl who knows me that they can achieve anything they put their hearts and minds into.
Runner-up — Susanna Ratnam
Why you probably shouldn't become an orthopaedic surgeon
Telling someone you want to pursue Orthopaedics is like telling them you want to quit your stable job to pursue your lifelong dream of becoming an actor. Not just any actor, one of those Hollywood A-listers who lands blockbuster role after blockbuster role and walks away from the Oscars like a mum trying to juggle groceries.
When you first tell people, they make a face. It seems to say, ‘She can’t be serious. Does she know that its competitive and brutal?? Should I tell her?’. It takes most people about 2 seconds to decide against this.
“Oh...that’s interesting.” They’ll smile politely.
A few brave souls will stick it out and begin the lecture that, unbeknownst to them, wannabe orthopods have heard many times before. You dismiss the thoughts that if you were male, the same person would have shaken your hand and wished you good luck. Sending a male into orthopaedic training is like sending a duck into a duck pond. Sending a female into orthopaedic training can seem like sending the duck into a shark tank.
After you hear enough of these lectures, it becomes a fun game to rank the speeches on the effectiveness of the arguments. A surface level argument may talk about how impossible it is to get into ‘THE PROGRAM’. These are problems faced equally by men and women trying to work in any medical speciality and, as evidenced by the fact that there are still consultants in our hospitals, this doesn’t make a career path unobtainable. If you are someone who isn’t fixated on ‘THE PROGRAM’, these arguments do nothing to you. Everything you love about orthopaedics can be experienced without ever becoming a consultant. Power tools. Teamwork. The satisfaction of watching arthroplasty patients walk out of hospital.
The moderate arguments will talk about the sexism. Orthopaedics has established itself as a specialty where men can go to feel like men. While there is nothing wrong with the primal urge to saw things open or hammer things into place, you will eventually come across people who think these are things that only men can enjoy. Individuals who conflate their masculinity with their orthopaedics may feel threatened by the fact that a woman half their size can do their job just as successfully. You may have to bear the brunt of that; whether it be from indirect verbal jibes or social exclusion or the constant need to prove yourself. This is a valid point. However, all of us are born into a man’s world. There is no guarantee that choosing a more ‘female friendly’ profession will protect you from this. Sensible women will eventually develop strategies to work around this bulwark, regardless of where they work.
When a girl wants to become a surgeon, she goes to Dymocks and buy two books. One is ‘Scrubbed’ by Nikki Stamp and the other is ‘Emotional Female’ by Yumiko Kadota. It’s a rite of passage. Reading the books is like a test of courage. ‘If you’re not okay to go through what these women went through’, you tell yourself, ‘you’re not fit to be a surgical trainee’. It’s only fitting that the best arguments can be formulated by people who have read these books.
The ugly side of any surgical training is in the compounding. The long hours, the casual sexism, the breakdown of your support networks, the sleeplessness, the hunger, the constant competition, divorce, being betrayed by friends or even mentors of 15 years. One or two of these things is manageable. But a female surgical trainee, or even a consultant, must endure most of these until the day they hang up their scalpel. And once you do, you may be slapped with the fact that life has moved on without you while surgical training has shredded your mental health to ribbons. No matter how much you love orthopaedics, this argument is the only one that makes you seriously contemplate walking away.
There is no answer to this argument, except to acknowledge that it’s okay to walk away. Both Kadota and Stamp end their books by ending their surgical careers and moving on to better things. While it’s not a story book ending, anyone going into surgical training should understand that no dream is worth sacrificing your physical and mental health.
In the end you walk away from these discussions still wanting to do orthopaedics. The journey is hard, but not impossible. And, for all the negatives, fixing bones is still intoxicating.