'Surgery Is Never Elegant When Women Are in the OR'

Monica Morrow, MD, Adds Storyteller to Her CV

Nick Mulcahy

June 02, 2019

CHICAGO — Monica Morrow, MD, has a gravitas that comes with 30-plus years of surgery at one of the world's most famous and scrutinized cancer centers, Memorial Sloan Kettering in New York City.

Monica Morrow, MD

Her name is ubiquitous in the world of oncology for a lot of reasons and roles: trailblazer, clinical trial leader, professional society stalwart, guideline creator, prolific author, and iconic surgeon.

Morrow brought that bearing — and her long trail of accomplishments and identities — with her to the stage of the Arie Crown Theater here at the 2019 American Society of Clinical Oncology annual meeting. She was one of five participants in the ASCO Voices session, an hour-long storytelling session in the midst of the 5-day data blizzard, now in its second year.

The New York surgeon was one of five people chosen to tell a story on stage, minus the usual ASCO props of slides, podium, and scientific script. Actually, she was chosen last year, but couldn't make it at the last minute. So, the crowd had to wait a year. It was worth the wait.

Here's Morrow's story:

"I think I have always known that I wanted to be a surgeon. When I was 7, I brought the heart and lungs of a cow in for show and tell — from our butcher — which grossed the teacher out but the other kids thought it was pretty cool.

"About a year later, I found the body of a dead cat, floating in a stream near our house and spent an hour poking it with a stick because I wanted to see what was inside. My interest in innards persisted, so medical school was a natural choice. When I got there, I rapidly discovered that making rounds 5 hours a day did not compete with being in the operating room.

"Now, at that time, women in the operating room, whether they were doctors or nurses, were expected to wear little green dresses with pantyhose underneath in order to prevent 'pubic fallout.' [laughs from audience]

"Now, the other absurdity of this concept can only be really appreciated if you know that most surgeons at that time didn't wear underwear because they didn't want to get blood on them. Nonetheless there is nothing more uncomfortable than pantyhose under an OR gown under a hot OR light, so I rapidly found a pair of scrub pants only to be asked by a member of the faculty whether or not I thought I was a boy.

"That should have given me a clue about what I was getting into.

"When I started surgical residency, surgery was an overwhelmingly male dominated field and there was one woman in the program ahead of me and she was fired as I was finishing my internship, which was not immediately reassuring. Nonetheless, during my residency I learned the joy of doing an operation for the first time, how to survive on very little food, less sleep, and to stand up and take it when being grilled for one's errors in the operating room and on the floor. There was nothing sexist about that — that's just what surgical training at that time was like.

"So fast forward to 1981. I'm starting my surgical oncology fellowship at Memorial Sloan Kettering Cancer Center where I'm excited to be in this mecca of cancer care and learning cancer surgery from giants in the field. So imagine how I felt about 2 weeks into my fellowship when I am standing in the operating room with a very senior surgeon and the world's most annoying medical student, who was kissing up to this surgeon by telling him how elegant his operating technique was.

"The surgeon stares across the operating table at me and says, 'Surgery is never elegant when women are in the operating room.'

"You can't make this stuff up.

"By the end of my first month of fellowship, I had been told by one surgeon that I wasn't wanted there and propositioned by another member of the faculty, who was naturally married. Fortunately, everybody was not like that. And over the course of the next 2 years, I learned a lot about cancer surgery and the fellowship went well.

"So I could perhaps be forgiven for somewhat naively believing that in the end what really counted was your accomplishments and not what you looked like.

"And then I started to look for a job. And I happened to see the letter that was written by my chair, which began with the sentence, 'Can you believe it, a woman who can actually operate.' I knew with that recommendation, I was destined to get a top academic job. [big laughs]

"We still lack equal pay for equal work" Monica Morrow, MD

"Cutting short this sad story of poor little Monica and the evil surgeons, you might think that I went into breast cancer because I wanted to spend my days dealing with women. Alternatively, you might think I did because I wasn't able to do any other kind of surgery. But neither of those things are actually true.

"At the time I started my faculty career was a time of great intellectual excitement in breast cancer in general and surgery in particular thanks to the pioneering work of Bernie Fischer and Umberto Veronesi.

"Breast cancer was on its way to becoming the poster child for evidence- based, multidisciplinary care that it remains today. I found that was much more exciting to me than the thought of standing in the operating room for many hours taking out the pancreas and putting [it] all back together again.

"So through a mixture of logic and serendipity, I embarked on a career that I still find exciting and invigorating. All of us who deal with cancer patients are privileged to encounter our fellow human beings at some of the darkest and some of the happiest moments of their life. I have really been impressed by the fortitude and the grace with which my patients deal with some pretty awful situations. And it's taught me about what's actually important in life. And hopefully made me a better person.

"So, why am I here telling you this today? After all, it's 2019. And the kind of overt bias is unlikely to happen today and, if it did, that individual would immediately be sent to their computer to do a program on diversity and inclusion, which would no doubt solve their problem immediately. [more big laughs]

"But as we all know, the battle for gender equality is far from won as has been pointed out to us very clearly in the past couple of years. We still lack equal pay for equal work; women are promoted more slowly than men for the same level of achievement; and although the number of women in the pipeline has been increasing steadily over the years, we lack representation in equal numbers in leadership positions. And sexual harassment remains common.

"This is occurring at a time when 50% of our medical students are female. If we do not fully support these women, embrace their talents, and help them to achieve their maximum potential we will be losing 50% of our workforce in the battle against cancer — and that's something that our patients cannot afford."

2019 American Society of Clinical Oncology (ASCO) Annual Meeting: ASCO Voices meeting session. Presented June 1, 2019.

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