Sit at the table

Feminism is: the belief that men and women should have access to equal rights and opportunities; the political ideologies that support this; organised activity on behalf of women's rights and interests.

Bold is: having a strong, vivid or clear appearance; showing a willingness to take risks; confident and courageous.

This International Women's Day, the callout is to be bold for change. To speak up for equal rights. To stand up for women in the workplace and for men who choose to be stay-at-home dads and for couples who choose to remain childless and for all those in between. To open our ears and our hearts to people who's stories differ so much from our own. To build from these lessons a better world for all of us.

I want to share with you some stories of struggles. Of warnings and things we could do better.

A few years back, I worked with a kindly older male surgeon who, as with many of his era, was at a point in his career where he wanted to share pearls of wisdom. In amongst stories of working in developing nations in his youth and the trials of diagnostic challenges in his early working years there came the stories of regret. The regret at not seeing his own children growing up. Missing their first steps, their first words, their first day of school and the concerts and recitals and good grades on tests. The fact that his children were half-grown by the time he had finished his training and found time to get to know them. And now, as a grandfather, he has the opportunity to make good on that lost time. He's been present for these milestones, one generation later than he would have liked.

It might be a generation later but the struggles are no less for my modern-day surgical trainee colleagues. So many of them, happily married in their previous careers where time to share was plentiful, or during medical school before the realities of a surgical career took hold, now face the challenge of holding together a love based purely on the tenuous string of the past. They have, in the words of Buddhist monkThich Nhat Hanh, no time to water their garden.  They leave for work before sun-up and come home after sun-down. They rarely see their children, except as glimpses from the bedroom door, trying not to wake them at such peculiar hours. Their spouses, almost always women, often give up their own careers to make this lifestyle work. Isolated, alone, feeling unsupported, they work unrelentingly to make lunches, clean the house, buy groceries, pay bills, help with homework and run around for after-school activities. They understand that patients are important; that surgery sometimes has to happen at all hours of the night; but they didn't sign up for this. And so, not infrequently, the moods of my colleagues are sullied by their regret and disappointment at how trapped they feel by their careers. They love their work. They love helping people. But more and more that seems to be at the expense of their family and their personal happiness.

I've heard on the grapevine of women training in surgery who work until the moment their waters break and find themselves back at work only a handful of days later. The surgical roster doesn't make room for relief doctors and the service couldn't possibly survive without the helping hands of that trainee. I've heard of another who, undergoing a caesarian section, was physically unable to stand to operate for several weeks so instead found herself with the unenviable task of clinic duty for several weeks, until her own health would allow her scrub once again. Both of these situations would be frowned upon by treating obstetricians, and while these women could be congratulated for following their dreams should it have been their desire to go back to work so soon, having supportive loved ones at home to care for the newborn, it was not by choice they ended up back at work. It was the threat of losing their place on the training program. The threat of losing all that which they had worked so long to achieve.

I am, at present, child-free and with no plans to begin a family. And yet hardly a day goes past where the statement, "I am pursuing a surgical career," is not followed by a question, "and when will you have children?" or something similar. When I suggest that this is not a present concern, people ask me what I will do if I change my mind. It's exhausting to be required to defend this decision, and to have some sort of back up plan should my ovaries expire at some point in the future when I may also decide I want children. I've always thought that is a problem to tackle in the future, should it become one. The questions that follow can be like a verbal bombardment: who will take care of your kids when you're working? How will you drop them off at school? What will your husband think of you being at work all of the time? Women are asked constantly to plan for future partners and children that do not exist yet. They are asked to alter their career pathways on the off chance they may change their mind about family. Plenty of men my age would have no present desire for children, and should this attitude one day change, they would be well within their rights to procreate with a consenting individual. I understand, of course, the biological differences that press on these decisions. But I also understand that I may never change my mind about children, or never find a partner who would wish to have them, or become ill and die before the opportunity arose. Or any number of other possibilities. If we pressure women (and men) to alter their life trajectory on the basis of such nebulous possibilities, we shut of present opportunities for success and fulfilment.

Medicine and surgery are not unique in the barriers they place before trainees. Plenty of careers require long, arduous, personality-sapping hours. Plenty of careers give little flexibility to men who wish to take time out to assist with child-rearing, or who desire flexible working schedules to be a part of their child's world. Many careers make it difficult for women to re-engage after the months or years they may take out to support their children. It's long been time for this to change.

Sit at the table. This was one of the statements that resonated most from Sheryl Sandberg's "Lean In." You can't succeed if you don't put yourself in a position to do so. If you don't seek the advice and support of those who can help you climb the ladder (or master the jungle gym) of your career. For many men who wish to be stay-at-home dads, this statement can be equally difficult. Many try to join mothers' groups, only to be cold-shouldered by the women running them. Some are eyed suspiciously when they sit at the park watching over their kids. If we wish to promote equality, we must welcome women and men on both sides of this equation. We mustn't punish those who take time out of their careers to invest in their offspring. We mustn't look down upon those who choose not to, or cannot have, children. In the words of Ms Sandberg, a truly equal world would be one where women ran half of our countries and men ran half of our households. If we truly wish for equality in the healthcare sector, we must allow men and women to take time out for personal reasons when required. Women must be welcomed when they do sit at the table, and men must not be shunned for making time for their families.

Don't wait for somebody to hand you a tiara. In school, we are rewarded on the basis of our behaviour and our grades. We are celebrated for our high scores. Teachers may make a point of rewarding students who do well, or those who improve their performance significantly over the year. The workplace doesn't hand out gold stars. You will not get a raise just for doing well. It is rare to be singled out and congratulated for your work. If you want people to notice your efforts, or you want to be challenged further, you have to ask. Explain to your seniors that you seek new challenges. Speak up for those you think are not being recognised. Challenge your own colleagues to join you. Create spaces for learning and career progression. If you don't do this, will anybody?

This year, be bold. Ask to try new things or take time out for other pursuits, whether that be research, family or innovation. Demand to sit at the table, whether that is at work, at home, or at the local park. Make it clear that, sometimes, you really have to leave the office or the operating room to make it to an event that is important to your loved ones. Sometimes that event might be as simple as dinner where everyone sits at the table and the television isn't on. Sometimes it might be as notable as the school production. Remember that, while a satisfying career is important, you are unlikely to lie on your deathbed wishing you had gotten those three projects in a day earlier, or done a hundred more innovative cases or attended a few more meetings. In the stress of kicking career goals, it can be easy to forget the simple pleasures that make our souls sing. Time with our loved ones can be the emotional fuel to persist with career challenges. The answer to equality isn't necessarily to deprive parents of time with their newborn children in order to persist with career goals. And while it's sometimes possible to have one spouse at home doing the child-rearing, this is often not financially viable. We need to be bold enough to ask for flexibility to make work work for us.

What would you do if you weren't afraid?


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