Tag Archives: surgery

Irene Cybulsky: A Stymied Surgeon Tries a New Tack

Dr. Irene Cybulsky in a surgica mask and gloves with an ambulance in the background

Debbie says:

In some ways, “The Only Woman in the Room,” Christina Frangou’s article on Dr. Irene Cybulsky in Toronto Life, is a completely predictable story. Dr. Cybulsky started medical school in 1984, and chose surgery — and then cardiovascular and thoracic surgery — as her specialty. Her progress was plagued with sexism: as Frangou says, medicine may have more and more women, but surgery is still a male field.  After her first one-year job as a cardiac surgeon, the permanent position went to a man:

Her boss gave her a reference letter emphasizing that she took good care of patients and got along well with nurses, but he sidestepped what mattered most to hiring committees: Cybulsky’s technical abilities as a surgeon. The letter burned at her. “[My patients] do well because I did a damn good operation,” she told the author Judith Finlayson for a book about women in the workforce, “but that gets lost.”

In 1995, she got the job she was looking for, and continued (are we surprised?) to be plagued by sexist assumptions and sexist jokes. For a time, the only other woman in the department was from Ghana, so Cybulsky also got to see the intersectional harassment of a Black woman surgeon. In 2009, she was promoted to head of the cardiac surgery division–the first Canadian woman ever to lead a cardiac surgery unit. She saw this as an opportunity to bring some equity — both gender equity and attention to other issues, like a general reform of how patients were referred to surgeons.

A 2021 study published in the Journal of the American Medical Association showed that male physicians in Ontario disproportionately refer to male surgeons. Another study suggested that women surgeons are less likely to receive referrals after an unexpectedly bad outcome, while the same is not true for men. When a female surgeon has a complication with a patient, the referring doctor is less likely to refer patients to any female surgeon. Women typically receive more referrals for non-operative patients and perform fewer highly remunerated surgeries. As a result, on average, women surgeons in Ontario earn less than men for the same hours worked.

Cybulsky set out to transform the system. Patients awaiting surgery would go on a centralized list, and whichever surgeon was on call would perform the operation.

… the change was logical, fair and consistent with how things worked in other surgical departments. Still, the surgeons who were most opposed couldn’t get past it. So they focused their rage on the person who’d made the change. Word of their displeasure inevitably reached Cybulsky, and she knew she’d come close to mutiny in her division. But she also knew leadership meant dealing with adversity. It wasn’t her job to be liked; it was her job to lead and to provide the best quality of care to patients. Important change didn’t happen without fallout

Again, are we surprised? No one likes having their prestige and power reduced, and professionally successful white men have a tendency to take it … personally. All the details are in the article, and they’re all pretty predictable, including that the female physician from another specialty chose to minimize or ignore any conversations about gender inequity and focused on Cybulsky’s “communication style.” In 2016, after refusing to retire gracefully, Cybulsky was fired from her position, though she was kept on as a hospital surgeon (and had a head of surgery job at a partner hospital).

For me, here’s where the story gets interesting. You might expect her to just swallow it and keep doing surgery. You might expect her to go keep bees, or open a yoga studio, or write a scathing memoir. But she became a surgeon because she likes solving problems, so she focused on this one.

She had an option available to Canadians which is not offered to U.S. citizens: the Human Rights Tribunal in Ontario, where her husband urged her to file a claim. She did that  — and she did more. She went to law school in her mid-50s.

Human Rights Tribunal hearings look very different from a court cases: they take place in conference rooms in hotels or convention centres, and go on for a few days here and there. There’s no stenographer and therefore no transcript. The hearings are the last line of defence against discrimination and harassment, and the policy is to resolve cases in a “fair, just and timely way.” Yet under Doug Ford[the right-wing premier of Ontario]’s government, the number of full-time adjudicators dropped from 22 to 11, and hearings sometimes last years. The glacial timeline would be laughable if the stakes weren’t so high.

The original adjudicator in Cybulsky’s case announced his departure after a few days of hearings, which meant they had to start over. The delay was bad news for [the hospital’s] lawyers. With each passing day, Cybulsky sat in class at law school and soaked up knowledge. Sometimes, she’d have to miss class for the hearing, so she’d read ahead in her courses. [She and her husband] had a running joke about what would finish first: the HRTO claim or law school.

Law school won. She graduated in June of 2020.

In March of 2021, the tribunal found that Cybulsky’s rights were breached three times …

“It is an act of discrimination to fail to take seriously the applicant’s allegations about the relationship between gender and perceptions about her leadership,” the adjudicator, Laurie Letheren, the vice-chair of the Human Rights Tribunal of Ontario, wrote. “Her dignity and self-worth were undermined, and those consequences are directly connected to the fact that the applicant is a woman.”

The decision also faulted the hospital for not embracing Cybulsky’s gender. “One might have expected that having the only female head of cardiac surgery in Canada would be something that a teaching hospital … would want to celebrate,” Letheren continued. “Unfortunately, this was not the applicant’s experience. The role that her gender played in her experience in the context of this male-dominated profession was ignored.”

So she’s “vindicated,” she got the small settlement she asked for, and she’s building a life as a Canadian attorney. I am really drawn to the law-school response to her situation, and deeply respectful of the choices she made. And I can’t help feeling that there are two groups of people who lost a great deal in this story: women physicians coming up through the system, who will see how hard you have to fight even after your career is damaged; and the patients who won’t receive the skill and care she brings to solving problems.


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At the Will of the Body, Part 2: (Becoming a Body)

Lisa Freitag says:

Dr. Lisa Freitag is a former pediatrician in Minneapolis, Minnesota. She wrote some guest posts for us in 2013, and we are delighted to have more of her insightful presence here. This is the second of three or four parts; the first is here. Watch for the others over the next month or so, between posts from Laurie and Debbie.

It was a fortunate coincidence that I found a copy of Arthur Frank’s 1991 book, At the Will of the Body, just a week or so before I fell and broke my arm at the shoulder and elbow. During the incoherent time that followed, I wasn’t able to read much, but I found Frank’s book surprisingly easy to read for an academic text. I had to reread it (several times, actually); its observations on what it means to be ill were close enough to my experience that much of it instantly resonated.

Frank has become, since writing At the Will of the Body, an acknowledged expert on the modern doctor-patient relationship and how it is failing both doctor and patient. This book has his very first observations on the subject, not yet fully developed, but all too clear to a reader of his later books and papers. I read the first chapter, ‘Becoming Ill,’ the night before going in for surgery. In it Frank describes the interaction between himself and his physician after he had a heart attack, He is surprised and dismayed at the clinical coolness with which his doctor relayed the diagnosis. The doctor speaks as though the body was nothing other than a thing, and its ills a mechanical breakdown which can be managed with no concern to the inhabitant of that body. Frank says, “Thus in disease talk my body, my ongoing experience of being alive, became the body, an object to be measured and thus objectified.”

This is perhaps not the wisest thing to read the night before surgery, particularly if one is already aware of, and resentful about, the distance which modern medicine has placed between itself and the people it purports to want to help. The next day I would have a first-hand experience of the objectifying process. Following the ways in which I lost my self to the practice of medicine at least gave me something to do while I was waiting. It was certainly better than giving way to the gnawing uncertainty and fear that comes before surgery.

The giving up of my self began, actually, in the parking lot. The hospital was under construction, and there were very strict signs conveying rules regarding who was allowed to drive where. When my husband dropped me off at the front door, an actual armed guard appeared, his duty clearly to make sure we were allowed to use the entrance. Only after assuring him that I was a patient were we allowed to stop there. Just to be allowed in the entrance, I had to change from person to patient.

Just inside that door, a brash woman demanded paperwork and answers to a bunch of questions that in other circumstances would have been grounds for invasion of privacy. She did not question her total right to answers, or her ability to keep them private, despite there being only a small padded partition between her and the coworker sharing the same desktop. At that stop, I gave up both privacy and identity. I was given a wristband proclaiming my new identity; Lisa,  open reduction of humerus and olecranon fractures, 01/05/56, no allergies.

I was a physician on staff at that hospital for almost ten years, yet the hallway down to the surgical waiting room was totally unfamiliar. Fifteen years ago, I used to walk these halls as though I owned the place, a fiction to which everyone else also ascribed. I was quite aware that as a lowly pediatrician, I did not own anything, but was still comfortable in belonging there. I saw no one I knew, and was relieved that no one who knew me had to see me in my new guise.

The surgical waiting room is like one of Dante’s levels of Hell. I am not entirely sure what I gave up there, but it was a loss worth grieving. Perhaps it was something like freedom. After turning over the evidence of my new identity to another woman at another desk, I was told to sit. And wait. My husband was with me, but neither of us knew how to act. Other family groups shared the room, but each group isolated ourselves in our own private knot of pain and worry. It seemed to be expected, and was surprisingly hard. We were all waiting to be admitted to the inner sanctum where, amid wonder and terror, we would be saved. Or cured. Or something. It was like waiting for Godot. The only appropriate response would have been to run away, but that was impossible. So we sat. Patiently. Patient. Waiting.

In a later chapter, that I had not read at the time, Frank talks about the body as territory, which medicine claims as its own by the combination of clinical distance and clinical expertise. Frank was given a new identity, as I was, as the cancer patient in a certain room. His doctors spoke to him about his disease in the passive voice, as though no actual person was involved. His body became the recipient of a treatment called chemotherapy. He says,

When a person becomes a patient, physicians take over her body, and their understanding of the body separates it from the rest of her life. . . Medicine cannot enter into the experience; it seeks only cure or management. It does offer relief to a body that is suffering, but in doing so it colonizes the body. This is the trade-off we make in seeking medical help.

He admits that, if the treatment works, as it did in his case, the colonization might be worth it.

By waiting in that room, I was allowing the colonization of my body. I had been identified. My elbow and shoulder had been mapped out for attention. Waiting was a form of consent, permission to be converted fully into a body.

In the next room, a small exam room, I lost my clothes. In a pretend effort to help me preserve something of myself, I was offered replacement clothes, an enormous blue thing with ties at the back and, amazingly, a pocket containing a small heater. That they had really no concern about my essential nakedness was demonstrated by leaving the door to the room open. My body sat in a huge recliner chair, in full view of everyone in the hall outside. No one passing by seemed to notice. I found that I really didn’t care much either.

The next room was a sort of surgical staging area. We bodies were lined up on gurneys, separated from each other by thin curtains. Here, I finally met a doctor. So did everyone else. At this point we were supposed to be sedated into incoherence. I was not, because I did not want narcotics. My punishment for this was a nerve block, a trivial procedure, at least for the anesthesiologist. Holding still for this, and not screaming, was like being complicit in my own torture. I do not recommend this route.

I was beginning to resent becoming a body, but then I had a pain-inspired revelation. Early in my training, I had seen operations similar to what was about to happen to me. I had two fractures, one in my elbow and one in my shoulder. A person I had met only once, an orthopedic surgeon, was about to cut ten-inch incisions over both joints in order to directly manipulate my bones into their proper position with his gloved hands. He was then going to keep the bits of bone where he put them by inserting metal strips held in place by screws. I had a vivid image of this, but could not apply it to myself. This is, after all, not something you do to a person. It can be done only to a body. And so, I submitted willingly to colonization. I became a body for them. And for me. It was much better that way. In the operating room, as the anesthesia hit my veins, I felt a surge of relief close to joy.

One week later, at my post-op appointment, I was still a body. The surgeon told me that most people want the metal removed from their elbow after it heals. I told him that it would take a massive amount of discomfort before I wanted anything like that operation to happen to me again. He seemed offended that I hadn’t appreciated the experience more. Maybe he was just disappointed that he would not get to cut me open again. Most surgeons are known to be massively disinterested in anything that doesn’t involve scalpels. He glanced at my two scars, assigned a nurse to remove the staples he’d put in a week ago, and left without a word.