March 21, 2024 • 29 mins
In this episode, Lillian Erdahl, MD, FACS is joined by Amy Hernandez, MD, FACS, from the Department of Surgery, Naval Medical Center San Diego. They discuss Dr Hernandez’s recent study, which uses literature review, personal interviews, and correspondence with Navy Medicine administrative leaders to describe the evolution of women providing surgical care at sea.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr.
Lillian Erdahl,and throughout this series, Dr.
Tom Vargheseand I will speak with recently
published authors about the motivationbehind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants
(00:26):
and not necessarilythat of the American College of Surgeons.
Welcome back to The Operative Word podcast.
My name is Lillian Erdahl.
I am one of your co-hosts, and todayI'm speaking with.
Dr Amy Hernandez,
who is with the Department of Surgeryat the Naval Medical Center in San Diego.
(00:47):
Welcome to The Operative Word.
Thank you, Dr Erdahl.
It's a pleasure and honor to be here.
Well, I am excited to hear moreabout the history of women
surgeons at sea as we discussyour article, Anchors Aweigh.
Tell me a little bit
about kind of the inspirationfor sharing this work
(01:08):
and what started you and your coauthorsand looking into this.
Well, my coauthor, Dr. Tadlock, him and I, he's been a mentor
and a guide for meas I've been going through my career.
And when I graduated from residency,I got 1 week off and immediately
went out to the USS Carl Vinsonand for a workup for several weeks.
(01:33):
And then we came home and immediatelywent on deployment.
My experiences therein kind of the preparatory journey,
and then the subsequent deployment
led to me wanting to fix the world
because I just felt like everything
similarto many other military experiences,
(01:54):
not related to surgery or medicine,everything was like
the first time it's ever happened before,even though it's not.
And so initially he encouraged me to
to write an articleto be committed to military medicine
on how to preparefor a military surgery deployment
and then we took it one step furtherand we we coauthored a book
or co-editeda book on expeditionary surgery at sea,
(02:17):
and it's written by everyonefrom surgical technologist
and laboratory technologists
up to surgeonswho have gone and done multiple sea
maritime deployments,which is really cool,
everyone had a real breadth of experience
and everyonebeing able to offer their stuff.
And so the first of its kind.
And so in working together on that,we talked a lot about women
(02:39):
and it's one of my passions.
I started a women in surgery
lectureship here, and so he knows that'ssomething that I'm really interested in.
And so then we were just talking about
what parts of it were gender basedand not gender based
and just kind of he'svery good at coming up with ideas.
He's excellent at it,
and I'm very good at doing menial laborand looking up things.
(03:04):
And so then which is how we wrote our booktogether.
He would have a grand planand then I would go and scry around and
do grammatical editsto make sure that things looked okay
and that the tablesmade sense.
It was in part, I am part of the articleand I'm part of the history.
But then like, how did it all start?
(03:27):
And how far we've come
and around that time,the article talks about,
you know, from the start to where we areand like at one point
we had a 50% fill rate,even though only 30% of us are surgeons.
So we're more than representingour population.
And that's pretty awesome.
Yeah, a very, very longanswer to your question.
I'm sorry. No, it's awesome.
(03:49):
And I loved, you know, reading
about the history of women,
you know, not just in the U.S.
Navy, but on ships and in naval medicineand how far it goes back.
So tell us kind of,you know, the early history of women
in medicine and surgery at sea.
(04:10):
Yeah. Thank you.
We chose not to focus on all the womenin women in medicine and women in surgery
that has been written about a lot,which is amazing and fantastic.
And everyone listening to this should goand read about all those amazing women.
We did highlight three women,
Mary Edwards Walker in America, and Dr.
(04:33):
James Berry, who ended up being Dr.
Miranda Stewart, found after death in
Great Britain and PrincessVera Gedroits in Russia.
And they were all the first women surgeonsin their respective countries
and they were all affiliatedwith the military.
And so we highlighted them very brieflyjust to say that
(04:54):
they were groundbreakingand the military was
kind of howthey started in each of their countries.
And then when we started talking,
there's not a lot about women in medicineor surgery at all
through a lot of history.
And then in the like 16
and 1700s,it was just not possible for women
(05:14):
to get an education in surgeryand go on a ship.
Like women were not on ships.It just didn't exist.
Both of those thingswere difficult for women, right?
Women weren't welcomed into the professionand they were seen
to be a liabilityor simply not to belong on ships.
That's kind of how I understandit. Exactly.
(05:36):
And so there is just no way to overcomeboth of those barriers.
And so the few women who were describedwere described
as people who were spouses
and then were on deployments,but they were not allowed to be paid.
And then they usually were assisting.
Some were in a nursing role,but in surgical cases.
And so the one that we referencedwas Nellie Giles.
(05:58):
And so there's records of her helping
with all of the casualtieson the HMS Bellerophon.
And she was in her
third trimester when she did that,which is pretty remarkable.
And so that was the initial start of womenhelping with surgical care at sea.
And then in the 1800s,which is such a cool era.
(06:18):
And what we were partially focused onin our article,
Mary Stickney is an exampleof where a captain's wives with
absolutely no education at allwere providing the medical care
for the entire crew on their shipsthat their spouses were captaining.
And so she was on a whaling vessel,the Cicero.
(06:40):
And there are pictures of her,like with a parrot
on her shoulder and descriptions of her.
And so in one of our figures,we have her handwritten diary entries
of the people that were injured,what their injuries are,
and what she did for them.
It sounds like she was quite no nonsensebut well respected by the crew.
And it's pretty fantasticthat she took care of like a
(07:03):
gaff hook to the foot woundwith no training,
whereas gaff to the foot would intimidate
probably all of us,no matter how well trained we were.
And I imagine you know, even today,
one of the things you mentionedwas in expeditionary surgery.
How do we prepare?
I wasthinking, trying to imagine these women
(07:24):
and what supplies they did or didn't have
and how they improvised
in austere environments without resources.
You know, there's like when I when I thinkabout the barriers in front of her
trying to provide that care, you know,lack of experience, lack of supplies or,
(07:45):
you know, lack of expectationof getting to a port
where maybe there would be more resources.
Yeah, that's not happening.
There's no helicopter flying it on.
It's just nothing,
which is and even now, and that’s a lot of
what we did talk about in the book
doing surgery at the even now,it's very in
(08:08):
some ways is very similarto doing other surgery, and our book
really didn'tfocus on a lot of surgical technique
because there's lots of other textbooksfor that.
But it was really more focusingon, you know, you are
probably used to being in a operating roomwhere things exist
and you're probably even in residency,you're not even heard of ordering them,
(08:29):
like they just exist.
And then you start to become more involvedin the ordering.
And you know whatyou want in your case card.
And then you go out there
and it's a whole bunch of peoplewho probably haven't done this ever.
Or if they have, they haven't doneit here, and you're in charge
and you haven't done it, and everythingyou're expecting isn't a thing.
(08:54):
And the supplything, it came up with the surgical techs
and it came up with the nurses
and it came up with anesthesiaand it came up with the surgeons
talking about stuff like the supply chain,talking about stuff like
And then what are you going to dowith your patient afterwards?
There are ICUs, but
there is one critical care nursefor every single patient.
And so like if there was a mass casualty,that's very different than if it's
(09:17):
just one surgical patient that I amdropping off with my critical care nurse
who needs to sleep sometimes - ever.
What do you imagine these women like?
You know, Dr.
Stewart, who, of course, was known as Dr.
Berry at the time, or, you know,
what, how did they manage?
(09:37):
You know,I imagine the mortality rates were higher.
And, you know, just thinking about someonein the 1800s recovering from sepsis,
you know, if it happenedfrom an injury, from a dirty,
you know,
implement at sea, I mean, howhow can we draw
inspiration or maybe gratitudethat we often do work with more resources?
(10:00):
I think that that is a great wayto think about it
and to also have a realistic expectation.
A lot more people died back thenand it was it was acceptable.
Whereas here,
I can do something on the shipand there's an M&M process
now for me to submit my stuff,not just as it's not in the moment,
(10:23):
but my case will be presentedby a greater governing
body to make sure that I'm providinga standard of care out at sea.
And so,like if I were to just be like,
they didn't make it, that would notthat would not fly.
And so I think that
drawing inspiration from people
thinking outside the boxand being able to take care of people
(10:46):
under such austereand difficult circumstances is remarkable.
But also acknowledgingthat they lived in a different time
when guillotine amputations were
like standard of care.
Instead of absolutely notsomething you see on your boards ever.
And so.
It is
(11:06):
remarkable to think overyou know, 100 years
how much the practice of medicineand surgery has changed.
You know,some of the women that you talk about
being on ships, again,not always as surgeons,
but on the Mississippi,you know, during the American Civil War,
it you know, it brings to mind, you know,what would it be like?
(11:28):
I mean, it just sort of takes us back to
what would it be like to be on a shipduring the Civil War.
And then I wonder,you know, what maybe has not changed.
So tell me about when women
were allowed to serve at seain the US Navy
and kind of how that came to beand what that looks like?
(11:50):
Of course. Yeah, I think
women weren't allowed on
combatant vessels, medical or otherwise,
because of congressional law.
And so women started joining the militaryand then joining the reserves
and joining active duty,then going on ships like hospital ships,
(12:12):
which is where women were traditionally
serving in maritime roles.
And so
and then womenjoined the military as surgeons.
I think I pulled up my article
to make sure that I got the right year.
Dr. Judy Ellen Schwartz joined in 1971
(12:33):
and then she completed residency in 1976.
And then it wasn'tuntil the law was fully repealed.
So in 1993 women were allowed to serveon combatant vessels.
And then it wasn't until 1997that one of our female surgeons
in the military actually went on a vessel,and that was Dr Beth Jaklic.
(12:56):
And we got a chance to interview herDr Tadlock and I, which was pretty neat
to interview the first woman surgeonto ever go on a ship.
And she's pretty fantasticand really groundbreaking.
She was also, we talked about itin the article a little bit.
She was the first femalegeneral medical officer
to ever served with the United StatesMarine Corps.
(13:16):
So she was first in ain a lot of different ways.
And so what I was struckby actually the most
in her interview was thather experience was pretty much like mine.
I was a bit of a novel figure
when I went there in 2016-17 timeframe.
I was a little novel.People were surprised.
(13:37):
They thought I was the nurse,which is not unique to being on a ship.
On the surgeon Moms group.
That's a prettycommonly represented sentiment.
And so I was novel,but I wasn't disrespected.
I mean, it was pretty muchthe same for her.
People were like, I mean, if you can doyour job, then welcome.
And it's kind of weirdthat you're a woman,
(13:57):
but I guess if you can do it,you can do it.
And she took care of the samebreadth of cases that I took care of.
And so I was in the interview,I was the most struck by
how similarour experiences were in their challenges
because she struggledwith having access to resources.
I had struggled with access to resources.
(14:19):
People nowstill struggle with access to resources.
And so that
was both encouragingand interesting to me.
And then her description ofjust how it was more challenging
and remarkable for her to have been thefirst person to go with the Marine Corps
was interesting to me as well.
Yeah,I think it's it's so interesting
(14:42):
to me just to to hear the parallels againin my lived experience
and and the experiences that I hearfrom a lot of other women surgeons
in particular, and women physicians,which is,
you know, surprising to me that in 1997,
we finally had the first woman,
(15:03):
you know, on a combatant vessel.
I mean, it just it always struck me
that we hadn't come as far as I expected
at so many of the steps along the way. And
it's whetheryou're the first or the second,
it takes time to change that culture.
(15:23):
And itit can be daunting that the onus is on
the person who has been excludedor who represents the excluded group
to change as opposed to on all of those
who are already there
to to be welcoming.
(15:43):
And it sounds like you foundthat people were welcoming,
but it took a little adjustment period.
I mean, I think it's it's stilldisappointing to me that people its first
assumption is based on their biasand their past experience and sort of
assuming that you're the doctorand it it's
(16:05):
both a small thing and a large thingbecause it is not intentional necessarily,
but when you have to explainfor 20 minutes,
ten times a day who you are, it'sa lot of mental energy.
And it takes away time thatyou could spend actually doing your job.
So, you know, it's Dr.
(16:26):
Jaklic maybemade an impression on the ship she was on.
But not necessarily across the entire
U.S. fleet, unfortunately.
I agree.
Yeah, I, I was surprised that it was
not until the 1990s like I had been bornand women were not on combatant ships.
(16:47):
And that's amazing to me.
And that even it took four more yearsafter women were allowed
in combatant shipsfor a woman surgeon to go on one,
although that'sprobably more representative of
how many women were a partof the surgical community at that time.
But yeah, I think
kind of the death by a thousandpaper cuts is present everywhere.
(17:10):
I at one moment on my last deployment
because I've had the opportunityto deploy again since my Carl Vinson time.
And on that deployment I was called downto the medical department
because some person wanted to know whyI wasn't.
Me and my team weren'tgoing to another vessel to
do their mission.
And so this wasn't a boss.
(17:31):
It was someone the boss had taskedto figure out information.
And so I went down and I was politeand explained what was going on and
kind of how requestsfor medical personnel work
and the different typesof maritime surgical teams there are
and how I was part of a fleetsurgical team and the guy kept pushing,
(17:52):
even though he's not medical, he'snot in the Navy, doesn't
not part of any of these teamsjust kept pushing and pushing.
And so finally I laid my trump cardand was like,
okay, well,if you would like to know more about it,
there's a book about all of this surgeryat sea.
It's called Expeditionary Surgeryat Sea and it’s in publication right now.
(18:13):
You can access the PDFJournal articles online for the chapters.
He's like, that's so interesting.
How do you know about it? I'm like, I wrote it.
And so then he was quiet and
I didn't get asked any more real.
This is called knife handing.
He was like knifehanded me in the hallway and I'm like,
I don't I don't understandwhat's going on right now. Like I am.
(18:34):
I'm the subject matter expert here,not you.
And so after that,he ceased his knife handing and
it wouldn't have reflected
well in the medical professionor me to have
talked him down or been as impolite to meor him as he was being to me.
But it was just like that, that'san example of just I'm like, I don't
(18:58):
I know more here than you, so please,I'm happy, I'm happy to relate to anyone.
I didn't even say I wouldn'tdo what they were asking me to do.
I just wanted them to do itthe appropriate way.
So I guess then there are plenty of peoplewho deferred to me completely,
just as they would if I was a manand so we tried to also address
that in our paper and say thata lot of the stuff is gender agnostic.
(19:20):
It's not the challengesof being at sea.
While some of them might bebecause I was a woman, most of them are
because it's just challenging todo surgery at sea no matter who you are.
Yeah, and it strikes me that
you had the
grace to remain calm and,
(19:43):
you know, entertain the questionsin that scenario for so long as well.
And I think, you know, that's certainlywhat I hear from leaders in general.
Right?
Is, you know,trying to manage your emotions
through any challenging situationor conflict.
But also, I think I hear especially from,
(20:04):
you know, women in surgery,
which is, you know,how much energy they expend trying to
moderate their behaviorso that it doesn't reflect
badly both on their professionand on their gender.
Or, you know, if if we think about,
you know, peoplewho have multiple identities that are
(20:26):
historically not represented in surgery,
you know, it can be so hardsometimes to be the one or the first
and feel this burden that your behaviormight reflect on anyone else
who is perceived as being similar to youbecause of identity characteristics.
And hopefully, you know,that's not too much of a burden,
(20:50):
but it can certainly feel like one
and be a part of that experience,I think, of being the first or being early
in whatever your pioneering.
Agreed. Yeah.
And on my most recent deployment,
our our Executive Officerand then she became our commanding officer
the second in command
(21:10):
and going to the first command whenthe first in command moved on was a woman
and then our operations officer,she was a woman and I was a woman
and our like we had a couple otherprominent people who were women.
And so for Women's History Month,
the XO, her CO, at that time,she just had a couple of words,
(21:30):
but then the OpsO, she was taking the event kind of of
course, she
introduced the whole event and she's like,This shouldn't be remarkable.
Everyone is remarkableand like it should be no more firsts.
And so I was like, I'mtaking a different approach.
I'mcelebrating the firsts for women.
But then in the end, both of us
ended up doing the same thingwithout planning it together.
(21:51):
Even then,I think that both of those are right.
I think it's right to be likewe shouldn't have firsts anymore
because we should be working towardsnormalcy
and also celebratingthe people that went before us,
which is part of what this article,what the women, I had,
I think such a smooth experiencebecause all these other people worked
really hard for meto have a smooth experience.
And I'm really grateful for thembecause then I wouldn't
(22:14):
have ever gotten to crawlaround the nuclear reactor of a carrier.
Like that's a really neat,unique experience and not a lot of people
can say they've done.
And I was able to do that and
I was able to to care for people, the menand women that I was deployed with,
which is an honor to do it any time, butespecially at sea in a unique environment
(22:37):
because of all the people who wentbefore me and made my journey not as hard.
And so part of the articlewas to talk about their struggles.
Part of it was to celebrate what they didso that we could,
I could, I and other women like mecould be where we are.
And part of it was also to show that
when we finally were ableto get into this space,
(22:58):
which took way too long,but when we finally were able to,
then it really didn't takelong for us to to not only
like match
people, but like sometimes even exceedlike the year the fiscal year 2020
when we were more than 50%of the representation,
(23:19):
even though that's that'spretty remarkable because there's not...
Those women worked so hardand are so successful.
Yeah,I think it's amazing to celebrate that.
And again,you know, celebrating women is not about,
you know, leaving men behind or notcelebrating men.
It's it's simply to say, isn'tit wonderful that we can now
(23:43):
have people of any genderin the same space
doing the same work that that you know,your gender is not a barrier?
Yes.
I mean, the same opportunity. Yeah.
Tell me about Admiral Franchetti.
It was so she wasn'teven a part of our original transcript.
No offense, ma'am, wherever you are.
And then as the the editors were asking us
(24:06):
to kind of hone down what our thought,like what our main point was,
I really
appreciated themmaking us focus a little bit more because
not only in that time did the Navy Timescome out because she was formerly
she was formerly sworn in, butthen she had that article that we cited.
And I did not realize that it was,
(24:28):
she was supposed to be in a leadershiprole, but in a noncombatant vessel.
And Congress repealed that amendment
at that time.
And so she then she thatthat shifted the whole course of her life
and her whole career,because then she got to go and be assigned
a billet on a combatant vessel.
And it just it was so poignant because I'm like,
(24:50):
this is the point we're tryingto make like that when you finally,
when the military finally doesallow women to do these really neat roles,
then we were like groundbreaking,like we're moving forward at
a good rate
and being a good examplefor what equality can look like.
(25:13):
the military is not perfectand that would not be the message
I'm trying to send with this podcast.
But I do think that in some wayswe're afforded opportunities
that aren't always availablein other places and
when we're allowed
to serve in those ways,then I think it's really neat
that we as a community were able to useit really well.
(25:36):
And I think that,
you know, my little shipboard deploymentsare nothing like the in the sea,
you know, but she took those opportunitiesthat were given to her
and then ran with them.
And she's our first female CNO,which is pretty incredible.
That is incredible.
And, you know, I,
I also was able to
(25:57):
hear Vice Admiral Raquel Bono speak
at an association of womensurgeons conference.
But I think, you know,seeing how those women
and how you are giving back and,you know, Dr.
Tadlock, to be able to say you know,how can we help
(26:18):
the next generation of surgeonsat sea to be prepared for what it's like
and not just surgeons, but all of the teammembers taking care of patients at sea?
You know,how can we help our profession
and help others in our professionto be prepared and offer
the best care, you know, is
(26:39):
not exceptional simply
because you've cited all these otheramazing people who have done it,
but also is exceptionalto take that extra time,
to give back and to try to helpeveryone else be prepared.
So, you know,thank you for being an example of,
you know, how amazingit is to have women surgeons
(27:02):
thinking about their teamand everyone who follows in their wake.
Thank you.
I was when I was a resident, people
both enjoyed and probably dreadedfollowing me on rotations
because my turnover was like 45 minuteslong, multiple loose leaf sheets of paper.
I'm like, and this and like,my gosh, it's just I'll get it.
(27:26):
And but that's just who I am.
And so this book is prettymuch like my giant turnover because I just
very much want
it doesn't have to be necessarilythat it's new for every single person.
And so I'm, I really hopethat it helps people, so does Dr.
Tadlock and he has done againhe's a very big picture person.
(27:49):
So he has done a lot with the maritimeand the military surgery community
and really kind of pulling in
to make it cohesive because you canwrite a book and then nothing happens.
And so he's kind of the person toto keep it going.
And we really hope that it helpsin our careers and career to come.
(28:11):
Even since writing the book and getting itpublished, things have changed.
And so what we hope for volume twoto reflect those changes for the teams
and that hopefully people willbecause they're
the different authorsof the different types of people on ships
that there’s ownership and buy inso that they're not just like, it's
(28:32):
a bunch of surgeons talking,but that it's it's for everybody,
which I think is
everyone can be a team player like that.
But I do think that that is a strengththat women tend to have more of
and so that's the strengththat I've always had.
And so it's niceto have used it for something.
Well, I really enjoyed
(28:54):
hearing a little bitabout the history of women surgeons
in the Navy,and I know that there's so much more.
And so I hope that everyone will readyour article and look for your book.
And thank you for your serviceto our country.
Thank you for your support, ma'am.
And thank you so much for this interview.
And I hope people enjoy the article.
(29:19):
Thank you for listening to
the Journal of the American Collegeof Surgeons Operative Word Podcast.
If you enjoyed today's episode,spread the word on social media
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Subscribe to The Operative Wordwherever podcasts are available
or listen on the American Collegeof Surgeons website at FACS.org/Podcast.
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr.
Lillian Erdahl,and throughout this series, Dr.
Tom Vargheseand I will speak with recently
published authors about the motivationbehind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants
(00:26):
and not necessarilythat of the American College of Surgeons.
Welcome back to The Operative Word podcast.
My name is Lillian Erdahl.
I am one of your co-hosts, and todayI'm speaking with.
Dr Amy Hernandez,
who is with the Department of Surgeryat the Naval Medical Center in San Diego.
(00:47):
Welcome to The Operative Word.
Thank you, Dr Erdahl.
It's a pleasure and honor to be here.
Well, I am excited to hear moreabout the history of women
surgeons at sea as we discussyour article, Anchors Aweigh.
Tell me a little bit
about kind of the inspirationfor sharing this work
(01:08):
and what started you and your coauthorsand looking into this.
Well, my coauthor, Dr. Tadlock, him and I, he's been a mentor
and a guide for meas I've been going through my career.
And when I graduated from residency,I got 1 week off and immediately
went out to the USS Carl Vinsonand for a workup for several weeks.
(01:33):
And then we came home and immediatelywent on deployment.
My experiences therein kind of the preparatory journey,
and then the subsequent deployment
led to me wanting to fix the world
because I just felt like everything
similarto many other military experiences,
(01:54):
not related to surgery or medicine,everything was like
the first time it's ever happened before,even though it's not.
And so initially he encouraged me to
to write an articleto be committed to military medicine
on how to preparefor a military surgery deployment
and then we took it one step furtherand we we coauthored a book
or co-editeda book on expeditionary surgery at sea,
(02:17):
and it's written by everyonefrom surgical technologist
and laboratory technologists
up to surgeonswho have gone and done multiple sea
maritime deployments,which is really cool,
everyone had a real breadth of experience
and everyonebeing able to offer their stuff.
And so the first of its kind.
And so in working together on that,we talked a lot about women
(02:39):
and it's one of my passions.
I started a women in surgery
lectureship here, and so he knows that'ssomething that I'm really interested in.
And so then we were just talking about
what parts of it were gender basedand not gender based
and just kind of he'svery good at coming up with ideas.
He's excellent at it,
and I'm very good at doing menial laborand looking up things.
(03:04):
And so then which is how we wrote our booktogether.
He would have a grand planand then I would go and scry around and
do grammatical editsto make sure that things looked okay
and that the tablesmade sense.
It was in part, I am part of the articleand I'm part of the history.
But then like, how did it all start?
(03:27):
And how far we've come
and around that time,the article talks about,
you know, from the start to where we areand like at one point
we had a 50% fill rate,even though only 30% of us are surgeons.
So we're more than representingour population.
And that's pretty awesome.
Yeah, a very, very longanswer to your question.
I'm sorry. No, it's awesome.
(03:49):
And I loved, you know, reading
about the history of women,
you know, not just in the U.S.
Navy, but on ships and in naval medicineand how far it goes back.
So tell us kind of,you know, the early history of women
in medicine and surgery at sea.
(04:10):
Yeah. Thank you.
We chose not to focus on all the womenin women in medicine and women in surgery
that has been written about a lot,which is amazing and fantastic.
And everyone listening to this should goand read about all those amazing women.
We did highlight three women,
Mary Edwards Walker in America, and Dr.
(04:33):
James Berry, who ended up being Dr.
Miranda Stewart, found after death in
Great Britain and PrincessVera Gedroits in Russia.
And they were all the first women surgeonsin their respective countries
and they were all affiliatedwith the military.
And so we highlighted them very brieflyjust to say that
(04:54):
they were groundbreakingand the military was
kind of howthey started in each of their countries.
And then when we started talking,
there's not a lot about women in medicineor surgery at all
through a lot of history.
And then in the like 16
and 1700s,it was just not possible for women
(05:14):
to get an education in surgeryand go on a ship.
Like women were not on ships.It just didn't exist.
Both of those thingswere difficult for women, right?
Women weren't welcomed into the professionand they were seen
to be a liabilityor simply not to belong on ships.
That's kind of how I understandit. Exactly.
(05:36):
And so there is just no way to overcomeboth of those barriers.
And so the few women who were describedwere described
as people who were spouses
and then were on deployments,but they were not allowed to be paid.
And then they usually were assisting.
Some were in a nursing role,but in surgical cases.
And so the one that we referencedwas Nellie Giles.
(05:58):
And so there's records of her helping
with all of the casualtieson the HMS Bellerophon.
And she was in her
third trimester when she did that,which is pretty remarkable.
And so that was the initial start of womenhelping with surgical care at sea.
And then in the 1800s,which is such a cool era.
(06:18):
And what we were partially focused onin our article,
Mary Stickney is an exampleof where a captain's wives with
absolutely no education at allwere providing the medical care
for the entire crew on their shipsthat their spouses were captaining.
And so she was on a whaling vessel,the Cicero.
(06:40):
And there are pictures of her,like with a parrot
on her shoulder and descriptions of her.
And so in one of our figures,we have her handwritten diary entries
of the people that were injured,what their injuries are,
and what she did for them.
It sounds like she was quite no nonsensebut well respected by the crew.
And it's pretty fantasticthat she took care of like a
(07:03):
gaff hook to the foot woundwith no training,
whereas gaff to the foot would intimidate
probably all of us,no matter how well trained we were.
And I imagine you know, even today,
one of the things you mentionedwas in expeditionary surgery.
How do we prepare?
I wasthinking, trying to imagine these women
(07:24):
and what supplies they did or didn't have
and how they improvised
in austere environments without resources.
You know, there's like when I when I thinkabout the barriers in front of her
trying to provide that care, you know,lack of experience, lack of supplies or,
(07:45):
you know, lack of expectationof getting to a port
where maybe there would be more resources.
Yeah, that's not happening.
There's no helicopter flying it on.
It's just nothing,
which is and even now, and that’s a lot of
what we did talk about in the book
doing surgery at the even now,it's very in
(08:08):
some ways is very similarto doing other surgery, and our book
really didn'tfocus on a lot of surgical technique
because there's lots of other textbooksfor that.
But it was really more focusingon, you know, you are
probably used to being in a operating roomwhere things exist
and you're probably even in residency,you're not even heard of ordering them,
(08:29):
like they just exist.
And then you start to become more involvedin the ordering.
And you know whatyou want in your case card.
And then you go out there
and it's a whole bunch of peoplewho probably haven't done this ever.
Or if they have, they haven't doneit here, and you're in charge
and you haven't done it, and everythingyou're expecting isn't a thing.
(08:54):
And the supplything, it came up with the surgical techs
and it came up with the nurses
and it came up with anesthesiaand it came up with the surgeons
talking about stuff like the supply chain,talking about stuff like
And then what are you going to dowith your patient afterwards?
There are ICUs, but
there is one critical care nursefor every single patient.
And so like if there was a mass casualty,that's very different than if it's
(09:17):
just one surgical patient that I amdropping off with my critical care nurse
who needs to sleep sometimes - ever.
What do you imagine these women like?
You know, Dr.
Stewart, who, of course, was known as Dr.
Berry at the time, or, you know,
what, how did they manage?
(09:37):
You know,I imagine the mortality rates were higher.
And, you know, just thinking about someonein the 1800s recovering from sepsis,
you know, if it happenedfrom an injury, from a dirty,
you know,
implement at sea, I mean, howhow can we draw
inspiration or maybe gratitudethat we often do work with more resources?
(10:00):
I think that that is a great wayto think about it
and to also have a realistic expectation.
A lot more people died back thenand it was it was acceptable.
Whereas here,
I can do something on the shipand there's an M&M process
now for me to submit my stuff,not just as it's not in the moment,
(10:23):
but my case will be presentedby a greater governing
body to make sure that I'm providinga standard of care out at sea.
And so,like if I were to just be like,
they didn't make it, that would notthat would not fly.
And so I think that
drawing inspiration from people
thinking outside the boxand being able to take care of people
(10:46):
under such austereand difficult circumstances is remarkable.
But also acknowledgingthat they lived in a different time
when guillotine amputations were
like standard of care.
Instead of absolutely notsomething you see on your boards ever.
And so.
It is
(11:06):
remarkable to think overyou know, 100 years
how much the practice of medicineand surgery has changed.
You know,some of the women that you talk about
being on ships, again,not always as surgeons,
but on the Mississippi,you know, during the American Civil War,
it you know, it brings to mind, you know,what would it be like?
(11:28):
I mean, it just sort of takes us back to
what would it be like to be on a shipduring the Civil War.
And then I wonder,you know, what maybe has not changed.
So tell me about when women
were allowed to serve at seain the US Navy
and kind of how that came to beand what that looks like?
(11:50):
Of course. Yeah, I think
women weren't allowed on
combatant vessels, medical or otherwise,
because of congressional law.
And so women started joining the militaryand then joining the reserves
and joining active duty,then going on ships like hospital ships,
(12:12):
which is where women were traditionally
serving in maritime roles.
And so
and then womenjoined the military as surgeons.
I think I pulled up my article
to make sure that I got the right year.
Dr. Judy Ellen Schwartz joined in 1971
(12:33):
and then she completed residency in 1976.
And then it wasn'tuntil the law was fully repealed.
So in 1993 women were allowed to serveon combatant vessels.
And then it wasn't until 1997that one of our female surgeons
in the military actually went on a vessel,and that was Dr Beth Jaklic.
(12:56):
And we got a chance to interview herDr Tadlock and I, which was pretty neat
to interview the first woman surgeonto ever go on a ship.
And she's pretty fantasticand really groundbreaking.
She was also, we talked about itin the article a little bit.
She was the first femalegeneral medical officer
to ever served with the United StatesMarine Corps.
(13:16):
So she was first in ain a lot of different ways.
And so what I was struckby actually the most
in her interview was thather experience was pretty much like mine.
I was a bit of a novel figure
when I went there in 2016-17 timeframe.
I was a little novel.People were surprised.
(13:37):
They thought I was the nurse,which is not unique to being on a ship.
On the surgeon Moms group.
That's a prettycommonly represented sentiment.
And so I was novel,but I wasn't disrespected.
I mean, it was pretty muchthe same for her.
People were like, I mean, if you can doyour job, then welcome.
And it's kind of weirdthat you're a woman,
(13:57):
but I guess if you can do it,you can do it.
And she took care of the samebreadth of cases that I took care of.
And so I was in the interview,I was the most struck by
how similarour experiences were in their challenges
because she struggledwith having access to resources.
I had struggled with access to resources.
(14:19):
People nowstill struggle with access to resources.
And so that
was both encouragingand interesting to me.
And then her description ofjust how it was more challenging
and remarkable for her to have been thefirst person to go with the Marine Corps
was interesting to me as well.
Yeah,I think it's it's so interesting
(14:42):
to me just to to hear the parallels againin my lived experience
and and the experiences that I hearfrom a lot of other women surgeons
in particular, and women physicians,which is,
you know, surprising to me that in 1997,
we finally had the first woman,
(15:03):
you know, on a combatant vessel.
I mean, it just it always struck me
that we hadn't come as far as I expected
at so many of the steps along the way. And
it's whetheryou're the first or the second,
it takes time to change that culture.
(15:23):
And itit can be daunting that the onus is on
the person who has been excludedor who represents the excluded group
to change as opposed to on all of those
who are already there
to to be welcoming.
(15:43):
And it sounds like you foundthat people were welcoming,
but it took a little adjustment period.
I mean, I think it's it's stilldisappointing to me that people its first
assumption is based on their biasand their past experience and sort of
assuming that you're the doctorand it it's
(16:05):
both a small thing and a large thingbecause it is not intentional necessarily,
but when you have to explainfor 20 minutes,
ten times a day who you are, it'sa lot of mental energy.
And it takes away time thatyou could spend actually doing your job.
So, you know, it's Dr.
(16:26):
Jaklic maybemade an impression on the ship she was on.
But not necessarily across the entire
U.S. fleet, unfortunately.
I agree.
Yeah, I, I was surprised that it was
not until the 1990s like I had been bornand women were not on combatant ships.
(16:47):
And that's amazing to me.
And that even it took four more yearsafter women were allowed
in combatant shipsfor a woman surgeon to go on one,
although that'sprobably more representative of
how many women were a partof the surgical community at that time.
But yeah, I think
kind of the death by a thousandpaper cuts is present everywhere.
(17:10):
I at one moment on my last deployment
because I've had the opportunityto deploy again since my Carl Vinson time.
And on that deployment I was called downto the medical department
because some person wanted to know whyI wasn't.
Me and my team weren'tgoing to another vessel to
do their mission.
And so this wasn't a boss.
(17:31):
It was someone the boss had taskedto figure out information.
And so I went down and I was politeand explained what was going on and
kind of how requestsfor medical personnel work
and the different typesof maritime surgical teams there are
and how I was part of a fleetsurgical team and the guy kept pushing,
(17:52):
even though he's not medical, he'snot in the Navy, doesn't
not part of any of these teamsjust kept pushing and pushing.
And so finally I laid my trump cardand was like,
okay, well,if you would like to know more about it,
there's a book about all of this surgeryat sea.
It's called Expeditionary Surgeryat Sea and it’s in publication right now.
(18:13):
You can access the PDFJournal articles online for the chapters.
He's like, that's so interesting.
How do you know about it? I'm like, I wrote it.
And so then he was quiet and
I didn't get asked any more real.
This is called knife handing.
He was like knifehanded me in the hallway and I'm like,
I don't I don't understandwhat's going on right now. Like I am.
(18:34):
I'm the subject matter expert here,not you.
And so after that,he ceased his knife handing and
it wouldn't have reflected
well in the medical professionor me to have
talked him down or been as impolite to meor him as he was being to me.
But it was just like that, that'san example of just I'm like, I don't
(18:58):
I know more here than you, so please,I'm happy, I'm happy to relate to anyone.
I didn't even say I wouldn'tdo what they were asking me to do.
I just wanted them to do itthe appropriate way.
So I guess then there are plenty of peoplewho deferred to me completely,
just as they would if I was a manand so we tried to also address
that in our paper and say thata lot of the stuff is gender agnostic.
(19:20):
It's not the challengesof being at sea.
While some of them might bebecause I was a woman, most of them are
because it's just challenging todo surgery at sea no matter who you are.
Yeah, and it strikes me that
you had the
grace to remain calm and,
(19:43):
you know, entertain the questionsin that scenario for so long as well.
And I think, you know, that's certainlywhat I hear from leaders in general.
Right?
Is, you know,trying to manage your emotions
through any challenging situationor conflict.
But also, I think I hear especially from,
(20:04):
you know, women in surgery,
which is, you know,how much energy they expend trying to
moderate their behaviorso that it doesn't reflect
badly both on their professionand on their gender.
Or, you know, if if we think about,
you know, peoplewho have multiple identities that are
(20:26):
historically not represented in surgery,
you know, it can be so hardsometimes to be the one or the first
and feel this burden that your behaviormight reflect on anyone else
who is perceived as being similar to youbecause of identity characteristics.
And hopefully, you know,that's not too much of a burden,
(20:50):
but it can certainly feel like one
and be a part of that experience,I think, of being the first or being early
in whatever your pioneering.
Agreed. Yeah.
And on my most recent deployment,
our our Executive Officerand then she became our commanding officer
the second in command
(21:10):
and going to the first command whenthe first in command moved on was a woman
and then our operations officer,she was a woman and I was a woman
and our like we had a couple otherprominent people who were women.
And so for Women's History Month,
the XO, her CO, at that time,she just had a couple of words,
(21:30):
but then the OpsO, she was taking the event kind of of
course, she
introduced the whole event and she's like,This shouldn't be remarkable.
Everyone is remarkableand like it should be no more firsts.
And so I was like, I'mtaking a different approach.
I'mcelebrating the firsts for women.
But then in the end, both of us
ended up doing the same thingwithout planning it together.
(21:51):
Even then,I think that both of those are right.
I think it's right to be likewe shouldn't have firsts anymore
because we should be working towardsnormalcy
and also celebratingthe people that went before us,
which is part of what this article,what the women, I had,
I think such a smooth experiencebecause all these other people worked
really hard for meto have a smooth experience.
And I'm really grateful for thembecause then I wouldn't
(22:14):
have ever gotten to crawlaround the nuclear reactor of a carrier.
Like that's a really neat,unique experience and not a lot of people
can say they've done.
And I was able to do that and
I was able to to care for people, the menand women that I was deployed with,
which is an honor to do it any time, butespecially at sea in a unique environment
(22:37):
because of all the people who wentbefore me and made my journey not as hard.
And so part of the articlewas to talk about their struggles.
Part of it was to celebrate what they didso that we could,
I could, I and other women like mecould be where we are.
And part of it was also to show that
when we finally were ableto get into this space,
(22:58):
which took way too long,but when we finally were able to,
then it really didn't takelong for us to to not only
like match
people, but like sometimes even exceedlike the year the fiscal year 2020
when we were more than 50%of the representation,
(23:19):
even though that's that'spretty remarkable because there's not...
Those women worked so hardand are so successful.
Yeah,I think it's amazing to celebrate that.
And again,you know, celebrating women is not about,
you know, leaving men behind or notcelebrating men.
It's it's simply to say, isn'tit wonderful that we can now
(23:43):
have people of any genderin the same space
doing the same work that that you know,your gender is not a barrier?
Yes.
I mean, the same opportunity. Yeah.
Tell me about Admiral Franchetti.
It was so she wasn'teven a part of our original transcript.
No offense, ma'am, wherever you are.
And then as the the editors were asking us
(24:06):
to kind of hone down what our thought,like what our main point was,
I really
appreciated themmaking us focus a little bit more because
not only in that time did the Navy Timescome out because she was formerly
she was formerly sworn in, butthen she had that article that we cited.
And I did not realize that it was,
(24:28):
she was supposed to be in a leadershiprole, but in a noncombatant vessel.
And Congress repealed that amendment
at that time.
And so she then she thatthat shifted the whole course of her life
and her whole career,because then she got to go and be assigned
a billet on a combatant vessel.
And it just it was so poignant because I'm like,
(24:50):
this is the point we're tryingto make like that when you finally,
when the military finally doesallow women to do these really neat roles,
then we were like groundbreaking,like we're moving forward at
a good rate
and being a good examplefor what equality can look like.
(25:13):
the military is not perfectand that would not be the message
I'm trying to send with this podcast.
But I do think that in some wayswe're afforded opportunities
that aren't always availablein other places and
when we're allowed
to serve in those ways,then I think it's really neat
that we as a community were able to useit really well.
(25:36):
And I think that,
you know, my little shipboard deploymentsare nothing like the in the sea,
you know, but she took those opportunitiesthat were given to her
and then ran with them.
And she's our first female CNO,which is pretty incredible.
That is incredible.
And, you know, I,
I also was able to
(25:57):
hear Vice Admiral Raquel Bono speak
at an association of womensurgeons conference.
But I think, you know,seeing how those women
and how you are giving back and,you know, Dr.
Tadlock, to be able to say you know,how can we help
(26:18):
the next generation of surgeonsat sea to be prepared for what it's like
and not just surgeons, but all of the teammembers taking care of patients at sea?
You know,how can we help our profession
and help others in our professionto be prepared and offer
the best care, you know, is
(26:39):
not exceptional simply
because you've cited all these otheramazing people who have done it,
but also is exceptionalto take that extra time,
to give back and to try to helpeveryone else be prepared.
So, you know,thank you for being an example of,
you know, how amazingit is to have women surgeons
(27:02):
thinking about their teamand everyone who follows in their wake.
Thank you.
I was when I was a resident, people
both enjoyed and probably dreadedfollowing me on rotations
because my turnover was like 45 minuteslong, multiple loose leaf sheets of paper.
I'm like, and this and like,my gosh, it's just I'll get it.
(27:26):
And but that's just who I am.
And so this book is prettymuch like my giant turnover because I just
very much want
it doesn't have to be necessarilythat it's new for every single person.
And so I'm, I really hopethat it helps people, so does Dr.
Tadlock and he has done againhe's a very big picture person.
(27:49):
So he has done a lot with the maritimeand the military surgery community
and really kind of pulling in
to make it cohesive because you canwrite a book and then nothing happens.
And so he's kind of the person toto keep it going.
And we really hope that it helpsin our careers and career to come.
(28:11):
Even since writing the book and getting itpublished, things have changed.
And so what we hope for volume twoto reflect those changes for the teams
and that hopefully people willbecause they're
the different authorsof the different types of people on ships
that there’s ownership and buy inso that they're not just like, it's
(28:32):
a bunch of surgeons talking,but that it's it's for everybody,
which I think is
everyone can be a team player like that.
But I do think that that is a strengththat women tend to have more of
and so that's the strengththat I've always had.
And so it's niceto have used it for something.
Well, I really enjoyed
(28:54):
hearing a little bitabout the history of women surgeons
in the Navy,and I know that there's so much more.
And so I hope that everyone will readyour article and look for your book.
And thank you for your serviceto our country.
Thank you for your support, ma'am.
And thank you so much for this interview.
And I hope people enjoy the article.
(29:19):
Thank you for listening to
the Journal of the American Collegeof Surgeons Operative Word Podcast.
If you enjoyed today's episode,spread the word on social media
by using the hashtag #JACSOperativeWord.
Subscribe to The Operative Wordwherever podcasts are available
or listen on the American Collegeof Surgeons website at FACS.org/Podcast.
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