The Instant Gratification of Being a Surgeon

Despite accounting for a third of all physicians, women are underrepresented in surgery, especially at the very highest level. There are only 16 women who are the heads of surgical departments in the U.S. and Canada, and only 8 percent of full professors in surgery are women.

Sareh Parangi is a practicing thyroid cancer surgeon at Massachusetts General Hospital, and an associate professor of surgery at Harvard Medical School. Thyroid cancer is relatively uncommon—the American Cancer Society predicts that there will only be 62,450 new cases in 2016—and it’s very treatable. It disproportionately affects women. For The Atlantic’s series of interviews with American workers, I spoke with Parangi about the stress of the operating room, why surgery is one of the most respected professions, and what it takes for female surgeons to advance in their careers. The interview that follows has been lightly edited for length and clarity.

Adrienne Green: What inspired you to go into medicine?

Sareh Parangi: My mom mentioned a couple times that she had been admitted to medical school when she was younger, but she didn't go because it was too difficult with my dad's career. She thought that it wouldn’t work with raising a family, so she became a teacher instead. I think, subliminally, that had inspired me. But more consciously, I went to an all-women’s college and intended to either be a language specialist or a child psychologist, but all my science teachers were so inspirational.

Green: How did you get the job that you have now, and how long have you been a surgeon?

Parangi: I finished my surgical residency at University of California at San Francisco in 1998, and I spent about nine years at one of the Harvard hospitals, Beth Israel Deaconess. Then, I have been at Mass General about another nine years. So it’s been about 18 years. I have been at a lot of different hospitals. The culture is very similar at all these places: UCSF and Harvard are probably the upper-echelon of surgery, so the training is remarkably similar across the board. The residents I see currently training do really amazing research that I think will affect generations to come. Similarly, when I was a resident, I felt like we did some amazing research about surgery.

Green: What is your specialty?

Parangi: When I started with the residential team, my research was mostly tumor progression—how tumors become metastatic, and how can we prevent that using drugs. For example, I did this research for the first time ever using genetically engineered mice—which at that time was brand new—that had pancreatic tumors. We could put them on drug regimens to see which combinations of drugs would work the best. That was also new, because people had always used chemotherapy or one agent, but never a combination of [treatments].

Now, I work specifically on thyroid cancer and trying to figure out which patients with thyroid cancer will do poorly. When you operate on a patient, you think everyone's going to do really well because 90 percent actually do, but 10 percent do really poorly. Using various cultures and animal studies, we can figure out if the genetic background affects who's going to do worse. What we found is, for example, there's one gene mutation called "BRAF" that is present in 70 percent of patients with thyroid cancer. But when we can identify it in the tumor and the blood, patients tend to do a little bit worse. Also, we've identified other genetic changes [that have effects too], that if a genetic mutation is combined with a mutation in "BRAF," then the combination tends a very poor prognosis for the patient. Now, there are actually drugs that will attack just that mutant gene and silence it. That's one area of research that we've almost taken to completion. In five years, we went from studying only mice all the way to actually giving drugs [based on this research] to patients in our clinics.

Parangi: That was one of the draws of surgery for me. As a physician, I think you feel a little defeatist. People have high blood pressure, and obesity, and diabetes. You're just constantly writing prescriptions and you don't really know if people are taking them or not. You don't know what's happening, and then they come back to you in six months or a year, and not much has changed.

As surgeons, there's instant gratification. Often times, you can fix whatever is wrong. If someone has appendicitis, they're doing terrible and they could die from such a simple thing. After a 45-minute operation, they go home the next day and they do great. The same thing happens with thyroid cancer. A lot of times, when people come to see me they're distraught. They have cancer; they're really worried. They think they're going to die. It's pretty common in teenage girls, and when the mom and dad are distraught I hold their hand and describe the whole thing for them. I say, "Ninety percent of people do really well, we're going to treat [the cancer] with one surgery, it's a pretty low morbidity surgery, and most of the time patients do great." They go home the next morning. They're feeling good.

Overall, it's a very positive profession. Certainly, there are some areas of surgery—pancreatic cancer, colorectal cancers, lung cancers—where as a surgeon, you feel a little like you keep operating on people. They’ll do great with your operation, you take out the lung cancer, their breathing gets better, and they get chemotherapy. But then two or three years later, it recurs in their liver or brain.

I have patients that I've been following for 10 or 15 years that have been seeing me from the very beginning of their cancer every year. I have had a handful of patients die of thyroid cancer, but when they do poorly I see them all the way through to the end. I see their families, and go to the funerals. They know I love gardening, so they send me gift cards or plants to put in my garden for their husband or wife who passed away.

Green: The operating room seems like a very high-stress environment. What is it like actually being in surgery?

Parangi: I do think that the operating room is a little bit of a high-stress environment, because when you put a patient to sleep and you've got two hours to do surgery, you've really got to stay focused. As a surgeon, you might have done this operation 100 times or maybe just two times. Then you've got a very complex team—an anesthesiologist, a surgery resident, a medical student, a nurse—that you’re working with and you're sort of captain of the team.

Also, the technology used in surgery these days has gotten immensely complicated. We use laparoscopic equipment, robotic equipment, endoscopic equipment, and you have to learn so many different machines parts.

Green: What is an average day like for you as a surgeon?

Parangi: Two days a week, I operate full-time for the whole day. I'll usually get up at 6:15 a.m., send my kid off to school, and then I'll be in the hospital by 7:30 a.m. to meet the first patient of the day. I usually do three or four cases in one day. Each surgery is about two hours, with about an hour-and-a-half of clean up in between. I do the surgery, go down and talk to the patient's family, and then come back up and meet the next patient to start that operation. Usually, those days end around 5 or 6 p.m.

One day a week, I see the same patients that I've either operated on or patients that I will be operating on in the future in my office. You explain to them that they need surgery, the risks, the benefits, and those kinds of things. Then one day a week, I generally spend time with my post-doctoral fellows and the residents who work in my lab doing research.

Green: That sounds like a really busy schedule. What is the work-life balance like?

Parangi: It can be very difficult and a lot of times, especially as a woman surgeon, you get pulled in a lot of directions because you still have a lot of responsibilities at home. You still have to make sure the kids have all their school equipment, are signed up for the right courses and sports, have their health certificates ready. At the same time, I think we all make it work.

For me, having a spouse that's also a surgeon has been really critical, because I think he totally understands what I do. We split things up pretty evenly. I do more cooking, because I enjoy it. He does all the finances and billing—I don't like that, so I don't do any of that. We both try to maintain some semblance of our own personal time. I might do gardening, a book club, and some exercise. I have a 21-year-old and a 16-year-old now, so they're a lot more independent. But when they were younger, it was definitely crazy.

Green: You mentioned that your mom gave up going to medical school because of exactly that struggle for work life balance. Were you inspired by her choice to be cognizant of work-life balance when you pursued medicine?

Parangi: I totally was. My mom always said, “Your education is the most important thing. Don't even consider marrying until your education is complete, and you know where you'll be.” I definitely pursued that. I had one or two serious boyfriends, but it wasn't anything that I considered towards marriage.

But, interestingly, the day I finished medical school, she came to my graduation and she goes, “Okay, now’s the time that you should consider getting married, so who are you looking at?” She said, “You know, you have to marry another surgeon, because I don't think an engineer or professor or anyone is going to really understand what it is that you do and they’re going to sit at home and brood that their wife is away and dinner's not ready.” The messages get subliminally in there, and I'd already met my husband-to-be and he was going to be a surgeon, so I think it ended up pretty much working out exactly as she was saying.

Parangi: I think there are more now. When I was a medical student and I decided to go into surgery, I think there'd only been something like 14 previous woman graduates ever from that program. It was not super common. The statistics say that about 16 percent of attending surgeons in the U.S. are women. But in surgical residencies, it's closer to 30 percent now. The pipeline is building up.

Where we fall down now is, the higher you go up, the less chance that there will be women. If 16 percent of assistant professors are women, only something like 8 percent of [full] professors are women. Last year, we finally had a breakthrough. Prior to last year, there had only been six woman chairmen of surgery in the history of the U.S. All of a sudden last year, they doubled the number and now we have 14 across the U.S.

Green: Is that jarring for you?

Parangi: Not really. I think it's sort of to be expected. You’ve got to play the game right, publish a lot, and have a supportive chairman who's willing to put you up for promotion. Then, when someone calls his office and says I'm looking for a chairman in Georgia, or University of California Irvine, or L.A., that he thinks of you rather than only thinking of boys. Not only do all your ducks have to be lined up in a row as the woman who wants to get somewhere, but I think also the men in your life who are your mentors, your chairman, the people you work with, your colleagues, they have to be ready to promote you as well.

Green: People often regard doctors, and surgeons in particular, with a special kind of respect. Do you feel like that positively impacts your identity?

Parangi: Yeah, I do. I think a lot of it is because they view you as a doer: You’re going to fix their problem, take out the cancer, and fix that body part that hurts. Whatever it is that the surgeon does, it’s practical.

I think that people respect that in a different way. I think they also realize that it takes a lot of training for you to be able to do that. I think even within the hospital, there's always a little bit of extra respect for surgeons, because we work very hard and also take it to heart if bad things happen to our patients. I know everyone talks about surgeons as callus robots or technicians, but I don't see that at all. I think that plays into the respect that the patients have, because we tend not to bury our head in the sand. If one of my patients does poorly, I spend extra time with that person and their family and call them all the time and look out for them extra.

This interview is a part of a series about the lives and experiences of members of the American workforce, which includes conversations with a sexual-assault nurse, a paramedic, and an optometrist.