I usually meet my patients for the first time in the worst condition possible.
They’re critically ill from either an injury or a general surgical emergency. As trauma and critical care surgeons, it is common for us to treat the underlying problem first, with either emergency consent or that of the family, and then meet our patients afterwards.
When patients recover and I finally introduce myself, they are usually puzzled and confused. They ask, just to confirm, “Who’s the surgeon, again?” I initially attributed this confusion to my gender as there is always less reluctance to call my male medical students, residents, and physician assistants doctors while I am more readily identified as the nurse. When the clarification is made as to who the physician is, the confusion persists. At this point, there’s usually a double take and the question turns into “You’re the surgeon?” with a sense of disbelief.
I’ve grappled with how to respond to this question for quite some time. I usually laugh and say, “I may look 17 but I’ve got a lot of gray hair under this scarf,” referring to my hijab. There’s really not that many gray hairs but it usually comforts my patients and we move on to discussing their care.
I, on the other hand, am not comforted by these frequent encounters. I don’t take offense to the question or the reaction of disbelief in the fact that a hijab-wearing Muslim woman can be a surgeon. I’m saddened that in 2018 the question, You’re a surgeon?, is still being asked. With women accounting for approximately 50% of medical school graduates, and with more women pursuing surgery, it should not be a surprise that women from diverse backgrounds can be surgeons as well. What is not at all surprising is that pursuing surgery continues to be difficult for women, especially when childbearing is considered.
With residency occurring in the most productive years of a woman’s life, the already difficult surgery residency becomes exponentially more challenging if you add in pregnancy. There is a negative stigma about pregnant female surgical trainees. This attitude is so pervasive that many women surgeons postpone childbearing and possibly put themselves and their children at risk for complications related to advanced maternal age. In addition, some women are even encouraged to quit surgery and pursue more “family friendly” specialties when they become pregnant. I almost did not pursue surgery because of these aspects of surgical culture. I was lucky to have met Dr. John Bawduniak, a surgery resident at the time, who advised me during the application process that residency is a finite amount of time and that I should pursue my true passion. Thanks to his sage advice, I changed from applying to a “family friendly” field to applying for my true passion, general surgery. Although I enjoyed the experience of learning to operate and care for surgical patients, I did not enjoy being told to quit surgery simply because I became a mother. I have always desired to have a large family and I did not want to give up that very personal dream because of my love for surgery. I wanted both!
So although unusual, I had five pregnancies and six kids during residency and fellowship. The response to my being pregnant as a fellow was no different than the response I was given as a pregnant intern. There’s a lot to be said when it is easier to overcome language and cultural barriers than it is to deal with the difficulties of being a pregnant surgery resident. I have certainly had other challenges as a hijab-wearing Muslim surgeon. I have been called a terrorist by a patient, been given multiple lectures on what the “true religion” is, and have had patients refuse my care because of my last name and my faith but I have also had great rapport with many more patients because of my hijab.
Overall, I don’t worry about my hijab being an issue for me as a surgeon. Do we need more diversity in surgery? Certainly, and there are many opportunities for us to improve on inclusion. What worries me is the treatment of women in surgery residencies and in practice where motherhood is considered a disqualifying event, hence discouraging more women from pursuing surgery and surgical subspecialties. The reality is, most of our patients don’t really care what we look like, where we come from, or whether we took maternity leave or not. What they need is a competent surgeon to take care of them in their most vulnerable state.
Dr. Qaali Hussein is a trauma/acute care surgeon, and surgical intensivist who practices in Florida.