Being queer without proximal or distal control

“What do you mean your partner? Does that mean a man?” These were among the questions one of my mentors asked me when we were discussing my list of pros and cons regarding the vascular surgery residency training programs to which I would apply. “Yes, my partner is a man.” The expected “oh…” was a reply I heard going to research meetings and throughout the residency interview trail. Unclear was whether this “oh” was one of disappointment, a nervous response, or concern if I would “fit” in vascular surgery. This “oh” haunts me because, in one short utterance, all of my accomplishments can be easily stripped away.

But I am tired of hiding my queer identity. The further I progressed through my medical education, the harder it became to compartmentalize my professional and personal environments. My stuttering and avoidance of discussing anything outside of medicine with surgeons became more difficult. So, I have decided to embrace myself fully and let my two worlds collide. I was mesmerized by vascular surgery in medical school. It combined the unique, broad surgical opportunities from complex open surgery to innovative endovascular techniques, along with the continuity of care from an outpatient perspective, where one is actively engaging in patients’ healthcare.

I wanted the opportunity to build connections with my patients and aid in intimate, life-changing procedures. At the same time, I knew I was entering a field that historically did not accept me as an equal human being, let alone as a surgical colleague. Somehow, I convinced myself it was alright as long as I separated my personal life from work. As society continues to become more accepting and inclusive, medicine continues to lag. Further, surgery is at the final frontier of acceptance and inclusivity.

While I agree being queer is only one aspect of my identity, it is a significant one that has affected my personal and professional life. I intentionally brought up my partner during my residency interviews with a significant amount of “ohs” that typically led to no follow-up questions or the occasional conversation one would expect in a heterosexual situation.

Wellbeing

Up to 30% of surgical physicians have been surveyed to have homophobic attitudes.¹ Within medical students, almost half expressed some explicit bias against lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) people, and 82% expressed at least some implicit bias.² Further, three out of 10 non-LGBTQI+ Americans would feel “very” or “somewhat” uncomfortable if they found out their doctor was gay.³ This translates to discrimination in the workplace that can affect the wellbeing of a physician.

In surgery, we have been taught professionalism is key to fostering a good work environment and upholding the values physicians agreed upon when saying the Hippocratic oath. Unprofessional behavior encompassed discussing political views or personal life events at work. However, this view on professionalism is inherently built to protect the comfort of heterosexual, cisgender white men.

Within operating rooms (ORs), there is always time where surgeons will quickly talk about their wife and kids. There are moments where you’re proud of life events outside of work that it is human nature to share them with the people you see the most. For the gay resident who still deals with homophobia within their family, this conversation can be a landmine.

Having political discussions dismissed regarding my fiancé and the ongoing debates on whether we have the right to have children in every state becomes isolating. The political debates on the need to re-evaluate whether or not marriage equality and its subsequent human rights for the LGBTQI+ community are valid remain silenced out of fear of causing debate or unprofessional behavior. However, these are problems that affect my wellbeing.

Battles

Surgical residency is hard enough. Adding additional stress from fear and isolation that affects a queer person piles on another layer of resiliency that one hopes to obtain. It was not until midway through my time in medical school in 2015 that the United States of America legalized same sex marriage, which is not too far away from the present. Prior to this, I was not afforded the same right to marry my partner as my heterosexual counterparts. You learn to choose your battles with regards to correcting people who think you’re married to a woman. I’m tired of correcting the outside-hospital-transfer patient who is actively listening to why queer people shouldn’t get married or adopt children on the television. I’m an exhausted resident who knows nothing good can come out of arguing with a patient who is here for their health needs.

I bottle up the “ohs” and the multiple times I’ve wanted to correct someone, but it only eats away at me. Going into vascular surgery, I knew my masculinity would be questioned because I can have flamboyant tendencies. Yet, I embrace my masculinity as more than just the heteronormative use of the word. At the same time, I hope diversity continues to push the boundaries of vascular surgery and becomes a model of redefining professionalism. My request of vascular surgery is for the specialty to be more proactive about embracing diversity. When leadership stays silent about ongoing issues, it leads to us feel isolated.

We need proactive allies. It’s not enough to “accept” or “tolerate,” but rather embrace and protect through allyship. During my medical education, I have seen hate crimes where gay people have been murdered, assaulted and discriminated against just because of whom they love. Nothing stops those people from being me. My white coat and degrees do not protect me from being verbally abused while walking down the street with my partner.

Inclusion

I’m not asking for the divisions and departments of vascular surgery to go to every pride march (though I know we would all have a good time). I am asking for simple inquiries about my life and the injustices that affect me. In order to create a more inclusive and supportive environment, I believe the field of vascular surgery needs to include the following:

• Allyship with the LGBTQI+ community that goes from passive activism to proactive activism. The Society of Vascular Surgery (SVS) needs to standardize what is true allyship, have concrete ways of reporting discrimination against the LGBTQI+ community and have zero tolerance for negative behavior
• Reevaluating and normalizing personal life discussions at work and within meetings. While diversity brings in different people from within the society, inclusion starts with integration and acceptance of minorities. Normalizing personal life discussions fosters more productive and candid discussions to truly appreciate and respect our differences
• Plans from leadership on addressing the divisions and departments of vascular surgery whenever there is an event in the news that can be triggering to minorities. I don’t want to be isolated when these tragic events happen. I don’t want there to be silence at work because it is uncomfortable. I need help. I need support because most likely I’m not okay

It’s alright if having these conversations makes you uncomfortable. Trust me, I’ve been out of my comfort zone since the minute I entered medical school. I intentionally chose my residency program because, not only did it support my career interests, but it also understood the importance of my queer identity.

I cannot thank the vascular team at Northwestern University enough for talking and truly engaging about my personal life, normalizing it for the first time. Yes, I enjoy talking about sports, but I also love talking about fashion and pop cultural references. Yes, my OR will one day play Lady Gaga during an aorto-bifemoral bypass. Most importantly, these are all interests also seen in a vascular surgeon. In the end, the respect I hold for my mentors and patients is the same that I hope to receive—regardless of my identity.

References

1. Burke B.P., White J.C. Wellbeing of gay, lesbian, and bisexual doctors. BMJ. 2001;322(7283):422–425.
2. Burke S.E., Dovidio J.F., Przedworski J.M., Hardeman R.R., Perry S.P., Phelan S.M., et al. Do contact and empathy mitigate bias against gay and lesbian people among heterosexual first-year medical students? A report from the Medical Student CHANGE Study. Acad Med. 2015;90(5):645–51.
3. The Harris Poll. GLAAD Harris Poll Accelerating Acceptance 2018: A Survey of American Acceptance and Attitudes Towards LGBTQ Americans. 2018.

Eric Pillado, MD, is an integrated vascular surgery resident at McGaw Medical Center of Northwestern University in Chicago.