OWL Essay 2022 Runners-up – Lily Salehi and Susanna Ratnam
'Orthopaedics — the good, the bad, and the ugly'
Lilly Salehi, PGY5, VIC
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.
Why you probably shouldn't become an orthopaedic surgeon
Susanna Ratnam, medical student, NSW
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.