EP 38: How Becoming A Patient Changed Her Outlook on Life

Episode Description:
Women have made incredible strides in the surgical field but are still a minority in the operating room. This episode features board-certified cardiothoracic surgeon Dr. Susan Trocciola who shares her experiences with gender bias and discrimination as a woman in surgery. She always focused and worked hard for her career, but everything changed when she was given a life-threatening diagnosis. Coming to the reality that life is not guaranteed, she worked to achieve a better work-life balance by setting boundaries and prioritizing her wellness. Her experiences as a patient also helped her see medicine from the other side, changing how she provides care to her patients.

Transcript:
[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:03] Welcome back to the Hope4Med podcast. I am your host, Dr. JB, and today’s featured guest is Dr. Trocciola, she is a board-certified cardiothoracic surgeon. Welcome to the show.

[00:00:15] Dr. Trocciola: Thank you. I’m thrilled to be here.

[00:00:17] Dr. JB: So Dr. Trocciola, please start from the beginning, tell us your origin story.

[00:00:22] Dr. Trocciola: Well, I always knew I liked medicine, I mean, I was a child that if someone was bleeding and most kids ran away, I ran towards it. So I always loved medicine, it was always made me curious, but I grew up with this family where my dad was the first to go to college and a pretty traditional family where we’re taught women should be nurses or teachers, and really kind of discouraged from thinking about being a doctor, and so I became a teacher. So I actually was a teacher before I became a physician. And then I, believe it or not, taught a research course to try to encourage more girls to go into science, and all at once all my students talked about being doctors and I was like, well, if they can become doctors then I become a doctor. So I actually went back to med school at age 27.

[00:01:06] Dr. JB: Oh, wow. That’s awesome.

[00:01:09] Dr. Trocciola: Yes. And I, I have no, I mean, I’m glad I did. I enjoyed my twenties, I had fun New York City, and then I went to med school. And I went to med school thinking I did not like surgeons, kind of thinking surgeons were not good, nice people, thinking maybe I wanted to be a pediatrician. Actually I was interested in oncology, so I thought maybe a pediatric oncologist, and then in med school, during my rotations third year, you always do the one you don’t want to go into first, so I did surgery first and I loved it. I just like fell in love with it. I mean I just, I really liked the people, I like the fact that there were go getters, I liked the fact that they were doers. If someone was sick, we put a line in. If someone was sick, we brought them to the OR, and I was surprised how much I liked it. And while medicine was interesting intellectually, I just liked being a doer. So I ended up after a lot of thought and kind of self reflection, I decided to be a surgeon. And again, I thought I was going to probably be a pediatric oncology, and that was part of the reason I chose going to Cornell for residency, because I knew they had an association with Sloan Kettering, so I thought that would be good.

[00:02:14] And then again, my first rotation as an intern, I was on cardiothoracic surgery and I loved it. And I was also challenged because my very first day I introduced myself to the fellow and I said, hi, I’m Susan Trocciola, I’m your new intern, and he goes, ” oh, a chick are you going into plastic surgery?” And I was like, hmph, and then I’d loved it, and he’s like, oh, you’re never going to keep being interested. So one of my other fellows said, when I finished the rotation, if you’re really interested come back and scrub cases when you’re on other rotations, so I did. And I just fell in love with cardiac surgery and that’s kind of how I became a cardiac surgeon.

[00:02:47] Dr. JB: So I wonder, in the beginning you said, “oh no, I’m not interested in surgery at all,” when you entered medical school, why were you anti-surgery in the very beginning?

[00:02:56] Dr. Trocciola: I mean, I think there were a lot of stereotypes. I think it was probably before ER came out, or maybe it was about the time ER came out, and kind of surgeons were portrayed in the media to be like antisocial, not very friendly, not very caring. I mean, I think I fell for a lot of stereotypes because I didn’t have any doctors in the family, I didn’t know otherwise. So I just kind of fell for that stereotype, it’s like surgeons are not caring, which is not true, but that’s what I thought. So I thought well, I’m a caring person, I can’t be a surgeon.

[00:03:26] Dr. JB: Little did you know.

[00:03:28] Dr. Trocciola: Little did I know, that’s right.

[00:03:29] Dr. JB: All right. And then how did you feel with that comment when that surgeon said, “oh, are you going into plastics?”

[00:03:35] Dr. Trocciola: I viewed it as a challenge. That like he identified me as being female and then therefore, even though plastics is not necessarily a female position, but he thought like I would never be a cardiac surgeon, and I kind of viewed it as a challenge. Like, I’m going to show you. And what I didn’t realize, and I forget the numbers, but that was 2001-ish, I mean, there were very few, there were like, I think less than a hundred women board-certified cardiac surgery in the entire country at that time.

[00:04:00] Dr. JB: Oh, wow.

[00:04:01] Dr. Trocciola: So, it was really uncommon, it wasn’t just him being sexist. It was really uncommon to be a woman in cardiac surgery. And it’s still, I would say the majority of hospitals I worked at, I’m usually the first woman cardiac surgeon that most people have ever met. It’s fairly uncommon to this day.

[00:04:17] Dr. JB: So the numbers have not increased that significantly?

[00:04:20] Dr. Trocciola: They’re increasing. I mean, they definitely increased, but– and I don’t know the numbers– but in especially cardiac, I think a lot of women going into thoracic, lung portion, but not as many are in cardiac. And as I said, there’s just lots of places in the country where they’ve never had a woman cardiac surgeon. It’s certainly not close to 50-50 at all.

[00:04:37] Dr. JB: Okay. so tell us more so about your training and beyond.

[00:04:41] Dr. Trocciola: So my training was good. I mean, I always say, you know, I went to NYU for cardiothoracic and we had two woman surgeons and I feel like they kind of buffered us because I wasn’t treated any different during my training because I was a woman, it was just kind of like because they buffered us. They didn’t allow people to treat us differently. But then I went, actually I went down to Texas for a year with this very famous surgeon, Joe Coselli, who also had trained many women. So I was buffered. So it was hard then when I got into the real world and I saw there’s a lot of sexism still, there’s a lot of it’s still a boys club, people still talk inappropriately in the OR, I mean, I’ve had people say to me, women shouldn’t be cardiac surgeons.” I’ve had other cardiac surgeons say that to me, ” women should not be cardiac surgeons.”

[00:05:24] Dr. JB: And what’s the reasoning behind that?

[00:05:26] Dr. Trocciola: They don’t give it one. They just say, “I just don’t think it’s a job for women.” So there’s still a lot of sexism, I think it’s just not talked about, kind of the things you have to put up with in the OR, you have to put up with people talking inappropriately. I don’t put up with it, but yeah, there’s still quite a lot of sexism. I think probably because it’s a high paying career and that’s why the boys want it to still be the boys, and they’ll all say, they will all say yes, we want to have women in it, but I think it’s just new.

[00:05:52] Dr. JB: So when you’re in the OR, how many other surgeons are there?

[00:05:56] Dr. Trocciola: It depends what part of the country I’m in, like right now I’m working in California, there has to be two surgeons, but most places I’m the only surgeon. And that’s one of the things that really appealed to me about cardiac is it’s a big team and I liked being kind of the captain of the team. So it will be me, a first assistant who will help me, either a certified first assistant or physician assistant, I’ll have a tech that hands me the instruments, I’ll have a nurse that goes around the room, I’ll have one or two anesthesiologists, and then I’ll have someone that runs the pump. And I love, I love having a team, that’s one of the things I really like about cardiac surgery. And now it’s getting more common where sometimes it will be an all woman team, but certainly when I first came out, it wasn’t.

[00:06:35] Dr. JB: So I guess I wonder, when you say that there’s still some inappropriate conversations happening, who in the team is leading that conversation then?

[00:06:44] Dr. Trocciola: Usually it’s another male surgeon.

[00:06:45] Dr. JB: Hmm. Okay. Got it.

[00:06:46] Dr. Trocciola: So it’s usually, if I get asked to help on another case or they come help me, it’s usually the male surgeons that are saying inappropriate things.

[00:06:55] Dr. JB: Got it, got it, got it.

[00:06:56] Dr. Trocciola: And then I guess people are afraid. And then the other thing that you see, I mean, I don’t mean to complain, but the male surgeons are allowed to yell, the women are not. So men can yell in the OR, if woman yell, I get called in to administration. But yeah, no, I mean, like if it’s my OR, I run the OR. So if a tech or an anesthesiologist was having something inappropriate, I would cut them off right away. So it was more kind of early out in my career, when working with other surgeons, but now, like even now, if another surgeon came into my OR and started talking inappropriate, I would shut that down. But I hadn’t prepared for that in residency because it just didn’t happen at NYU. So I kind of didn’t know what to say, but now I know what to say. I’ll shut it down immediately, but yeah, I think there are different standards and again, people will say no, but it’s kind of a secret. I mean, I think the greatest example is there’s an organization for women in cardiothoracic surgery, but guess who we let in the group?

[00:07:54] Dr. JB: Men.

[00:07:56] Dr. Trocciola: Men. Men. So when you go to those meetings, men are allowed to come in the room because people are so uncomfortable with women in heart surgery meeting without the men.

[00:08:06] Dr. JB: And are there men that go into that room, even if they have permission to?

[00:08:12] Dr. Trocciola: They have permission to.

[00:08:13] Dr. JB: I know, but do men show up?

[00:08:14] Dr. Trocciola: “Oh, head of surgery at prestigious university, he really wants to join, this is great support.”

[00:08:19] Dr. JB: Got it.

[00:08:20] Dr. Trocciola: And it was only, and I only realized that that was not quote unquote normal when I started to join these other woman organizations with non-surgeons and I realized that women in medicine can gather without men. But it still doesn’t happen in cardiothoracic surgery.

[00:08:39] Dr. JB: To this day?

[00:08:40] Dr. Trocciola: To this day. Yeah, because, “hey, he is chairman at X university, so why not have his support?”

[00:08:48] Dr. JB: Okay.

[00:08:50] Dr. Trocciola: So, yeah, I mean, so, and again, I think thoracic is different, I think cardiac, I think is harder. It’s just harder. And again, maybe in academics, it’s easier because they’ve had women, but when I go to these smaller hospitals where I’m the first one, it’s harder.

[00:09:06] Dr. JB: And so is it just that the surgeries are super long, I’m just trying to figure out, like, what is it about cardiac?

[00:09:12] Dr. Trocciola: It makes a lot of money. In my opinion, it makes a lot of money. That’s what it is. I mean, I think a woman is perfect for it, there’s fine sewing, there’s intellectual, but I think it makes a lot of money and it used to be– it still is– long hours. I don’t think it’s very conducive to having a family because the training is very long. You work 18-hour days in training, so I think there’s lots of things that make it harder to be a woman in cardiac surgery, rather than in breast surgery or plastic surgery where there’s more elective time.

[00:09:45] Dr. JB: I wonder–

[00:09:45] Dr. Trocciola: And again, women are getting in the field, but it’s kind of something that just is not talked about as much, which is unfortunate.

[00:09:54] Dr. JB: I wonder if the same thing applies to like neurosurgery?

[00:09:59] Dr. Trocciola: Well, the same thing certainly applies to, yes, I’m sure it does, and orthopedics. And in fact, there is an organization in orthopedics of women that have started talking about what happens in the OR and these women are sharing their stories on social media, it’s called Speak Up Ortho, and you would be horrified at the things that these women have gone through. Complete sexual abuse, men feeling them up, men kissing them. I mean, awful, awful, awful stories.

[00:10:26] Dr. JB: Wow.

[00:10:27] Dr. Trocciola: Yeah, Speak Up Ortho, it’s called. And, but again, it’s a high paying field that’s majority men, I think the same thing happens in neurosurgery, I think the same thing happens in orthopedic surgery, you know, all these high paying, I think those are the three highest paying fields: neuro, cardiothoracic, ortho.

[00:10:43] So, yeah, as I said, I mean, I can’t like– and again, I think in cardiothoracic, it’s not talked about much, but orthopedics, it started to be talked about. And even orthopedics, they recently realized that there was a document that was being shared by all the people that were applying for residencies, and apparently they were total sexist and racist comments on there.

[00:11:06] Dr. JB: Wow.

[00:11:09] Dr. Trocciola: Yeah, so…

[00:11:10] Dr. JB: And when was that?

[00:11:12] Dr. Trocciola: This last year. Last year.

[00:11:13] So it’s kind of a secret, but you know, now that I’m talking about it, I probably won’t get any more jobs.

[00:11:21] Cat’s out of the bag.

[00:11:23] I mean, I think we have to talk about it, cause I think that’s the only way it’s going to change is if we talk about it.

[00:11:27] Dr. JB: That’s absolutely correct. Absolutely correct.

[00:11:29] Dr. Trocciola: You know, and that’s why when they said, “well, we’re bringing you before the committee because we didn’t like your behavior,” I turned to those female residents and I said, ladies, that’s because I yelled. Because I wanted them to see that. So yes, I do think it happens. I don’t think it happens in medicine, pediatrics, or ER, because I think those fields are 50-50 now, so you wouldn’t get away with it.

[00:11:50] Dr. JB: Wow. And so you survived all of those experiences and you are holding your own as a cardiothoracic surgeon.

[00:12:04] Dr. Trocciola: Right. And I, I say I survived for that and I love what I do. And my pa– yes, it’s been hard, and as I said, now I feel like I can deal with that stuff. I mean, my patients love me. My referring doctors love me, the cardiologists. I mean, I love what I do. Like there is nothing better than leading a team to a dissection where you’re telling the family the patient has a 25% chance of not getting out of the OR and that patient goes home a week later. I mean, that’s the greatest feeling in the world.

[00:12:30] Dr. JB: Wow.

[00:12:31] Dr. Trocciola: So don’t get me wrong, I love what I do and would I recommend another girl go into it, a woman? Absolutely. But yeah, so I was doing all that, I was learning to advocate that, and then I was about three years out in my, out of my last fellowship when I started to feel like a fullness in my breast.

[00:12:49] Dr. JB: Okay.

[00:12:50] Dr. Trocciola: So at first, I just thought it was changes for my period, that all peoples periods can change. But I kind of knew in the back of my mind, something else was wrong. I had an aunt that had breast cancer in her forties and died, so I was very, very scared of it. And then my nipple inverted, which all physicians learn is a sign that I had cancer. And so then I knew I had cancer, but it still took me probably another two weeks before I went to the doctor. I finally went and I got a mammogram, and that was again, one of the most traumatic experiences of my life, because the tech that did the mammogram and the ultrasound literally called the woman next door, the other tech, and said, come over and look, look that’s breast cancer. Did you see that? Like she was excited about what she saw. It was awful.

[00:13:37] Dr. JB: Wow.

[00:13:37] Dr. Trocciola: And so I was by myself in, I was actually working in Florida. And so I walked out that day and my, one of the women I had trained with is a breast surgeon up in Massachusetts, so I called her and I said, it looks like I have breast cancer. When can you see me? And she said, “when you get here,” and then I flew to Boston the night. And I had a pretty large tumor and I remember this woman, Michelle, when she walked into the room and she took my clothes off and she saw the tumor, I could see the look on her face was like, oh, this is bad. And my sisters were there and my best friend was there and I whispered to her, what do you think the chance of stage 4, stage 4 means it’s like, you can’t survive, you don’t survive longterm. And I said 50%, and she looked at me and she said higher. And I always say that was the day my whole life changed. And so she did a biopsy and then she sent me for scans, and then that really was a day, when I was waiting for the CAT scan to find out if my cancer had spread, all I could think about was why did I work so hard? Why did I work all those 18-hour days to die in my forties? So my whole life changed, and thank God I didn’t have stage 4, but I did have a big tumor, so I had to have surgery, chemo, and radiation and I just changed my, um, what I do, you know, I don’t, I don’t work as much now. I do something called locums, which means I don’t work full time, I take time off, and I do that because I realized life can change in a heartbeat.

[00:15:04] Dr. JB: In the blink of an eye.

[00:15:05] Dr. Trocciola: Yep. In the blink of an eye. And you think when you’re in your thirties and forties, okay, I’ll do an extra fellowship. I’ll stay late. I’ll work hard because you think, okay, when I’m in my fifties and I’ll go on nice vacations, and when I’m in my sixties, I’ll retire and I’ll have a big house, and I’m in my seventies, I’ll go on more nice vacations. But when you’re in a CAT scanner in your early forties, and your friend has told you, you probably have stage 4 disease, you don’t think about vacation, you think about why did I work so much?

[00:15:37] Because I was the one in my training, I didn’t have kids, ” oh, my kid’s sick.” Oh, I’ll stay, don’t worry, that’s okay.

[00:15:44] “Oh, my mom’s coming for Christmas.” Oh, I’ll work Christmas, that’s okay.

[00:15:47] I just always volunteered and I have a false image that no one could be, was as good as me in taking care of my patients. So, I didn’t trust anyone to take care of my patients. So I thought, I was a patient, I got to stay in the hospital, I’m like, do I do that now? Yes. But now I realize there’s a call schedule for a reason, because other people can do what you do. So, you know, really changed my life.

[00:16:08] Dr. JB: Wow. Well, I’m so happy to hear that you’re in remission.

[00:16:12] Dr. Trocciola: Yes. I’ve been in remission for six years.

[00:16:14] Dr. JB: That’s amazing.

[00:16:16] Dr. Trocciola: Yeah. Yeah. But yeah, it just, as I said, it changes your life. You realize– for me, I realized there’s more to life than work. And as I said, I love my job and there are nights that I stayed there all night taking care of a sick patient, but I don’t always stay there taking care of a sick patient. I think I’m more patient, or I understand patients more. I mean, one of the things I hated when I had to go get my chemotherapies, sometimes I would wait to see the oncologist for an hour, an hour and a half, and no one would tell me there was an hour and a half wait. So now if I’m running behind, I don’t say, “oh, she’s running behind,” I say, “tell them it’s an hour,” because I just had, like as a patient, okay, you can all wait an hour, but when they say running behind and they don’t know if they’re going to wait an hour and hour and a half, it’s the worst feeling in the world. So I, I’m now, very specific with my staff, let them know it’s going to be an hour, let them know it’s going to be 20 minutes, let them know.

[00:17:07] You know, and I tell my patients if I have them scheduled for surgery, I’ll say, look, I’m on call tonight, if I’m up all night doing an emergency, you will not have your heart surgery tomorrow because sometimes I’ll have to cancel. And then the other thing I’ll do is if somebody calls me, “I have a patient, I think they have lung cancer, when can you see them?” I see them that week. I’d never, I try never to make a patient wait more than that, because I know it’s the worst feeling not knowing your plan when you have cancer. ” So, I always try to see them. So yeah, I think it’s changed how I practice as well.

[00:17:38] Dr. JB: I know you mentioned that you felt the lump on your breast, but then you waited two weeks.

[00:17:44] Dr. Trocciola: Yes.

[00:17:44] Dr. JB: Why did you wait two weeks?

[00:17:47] Dr. Trocciola: You know, it wasn’t a conscious, it wasn’t like, oh, hum, hum, hum, let’s wait. I was scared of dying. I was scared of dying. I was scared– I associated breast cancer with death because the only person I knew that had breast cancer was my aunt and she died young. So, and I think your body does it as a defense to protect you, but it’s interesting in medicine, when we have a patient come in with like a huge breast mass, it’s going through the skin, people are like, oh, how could she? But I think your body does it as a way of defending itself. And it’s just, you’re scared, you know, you’re scared. And my message to people is don’t wait, don’t wait. But my message to people in healthcare is have some compassion for that patient that waited because they may have trauma associated with whatever it is they waited for, and that’s why they waited. But as I said, I think the mind has the ability to just to, to be in some denial. I was scared, and I couldn’t figure out the mechanics of it. I was traveling for work, and even when I tried to make an appointment for a mammogram, they said I had to have a referring doctor. That was hard, you know, so you understand why people that aren’t as educated as me have a hard time getting through the system.

[00:18:53] Dr. JB: Because you had a hard time getting through it a little bit.

[00:18:56] Dr. Trocciola: I mean, and I was lucky. I was able to call my friend and say, “can I come up?” And she saw me the next day. Otherwise. I mean, even then when I do get treated in Massachusetts because I didn’t have the right insurance, I think I had to wait two weeks to see a cancer doctor. I mean, luckily she had given me a plan, but I still had to wait. So yeah, you see why patients have a hard time navigating the health system. And then the other thing that I think is really important is, what other people help you? I mean, my sisters were so like overcome with sadness, but like my insurance, I didn’t have great health insurance, so that was my sister’s craft, get me a good health insurance that will cover the hospital I want to do. And she did. Let people do those things. It’s a lot, if you’re the patient, it’s a lot to go through. You have to have other people that are listening to you, taking notes, helping you make those decisions, cause it’s as I said, I’m educated, I’m in medicine, but it was still hard for me.

[00:19:47] Dr. JB: Asking for help is one of the most difficult things that we have sometimes as physicians.

[00:19:53] Dr. Trocciola: Yes, it’s very hard. It’s very hard. And making time for it. I mean, I kept working while I should have just said, I mean, once I had a diagnosis, I left work, but I couldn’t figure out how to get a mammogram while I was travelling. So I should’ve called them and said, I can’t come to Florida because I have a health issue, but I didn’t. I was afraid, oh, I won’t get another job. Now I do, but then, I was afraid to tell them, look, I’m going to be a week late because I need to deal with a health issue. I didn’t do that. But now I do, I do it all the time. I will have an assignment and I’ll say, look, I can’t make that assignment because I have to deal with a health issue and I need to get an appointment, but making time for one’s health again, we think we’re invincible, we made it through college, we made it through night school, we think, yeah, we think we’re invincible.

[00:20:37] Dr. JB: But meanwhile, we’re dealing with patients every day, some that are even younger than us, that are dying.

[00:20:42] Dr. Trocciola: Correct. But it’s easy to think “that’s not going to be us.”

[00:20:45] Dr. JB: Exactly.

[00:20:47] Dr. Trocciola: Right? Because we think they look different than us, they’re not as educated as us. Yeah. I mean, I certainly didn’t think I was going to die early when I went into, when I, before I had cancer. Now, even now the way I save my money, I mean, I have a very careful plan to save for retirement, but I enjoy my life now. And my financial planner knows that, she knows that, like she can’t tell me all my money has to go towards retirement because what if I don’t make it to retirement? What if my cancer comes back? So I want to have enough to retire, but at the same time, if I want to take time off and go on a trip, I go on a trip. So it’s a, it’s a balance that I have, that I don’t think I had as much before as like, I just put things off before, I thought, you know, I thought I would have children and I kept saying, oh, I’ll do it after this, after this, after this. Then you get cancer, and guess what? You can’t have children anymore, so… My message to people is don’t, don’t put all of life off. Doesn’t mean don’t work hard, and I always tell my team, this is somebody’s mother. This is someone’s son. I don’t care if he is a homeless drug addict, this is still somebody’s son and you treat thim with respect. And when you’re at work, you work your tail off. And if that means you can’t eat lunch, you can’t eat lunch. But if there’s someone covering you at night, you can leave, it’s okay. As I said, it’s a hard balance to do.

[00:22:02] I mean, I think emergency medicine does it better, because you guys are better shift workers. I don’t, I think in surgery, we don’t think of ourselves as shift workers, but it’s okay to let someone else help or take care of your patients.

[00:22:12] Dr. JB: But again, you were, I remember you mentioned in the beginning that when you were first diagnosed, you thought, why did I work so hard?

[00:22:21] Dr. Trocciola: Yep. Yep. All I thought was why did I work all those late nights? Because I did, I mean, I sacrificed a lot. I did, my training, general surgery was seven years, cardio was three, I did an extra year of aortic, I mean, I, I just kept putting things off and, again, would I do it again? Yes. But I don’t think I would have volunteered as much to work extra shifts. And they’ve changed training too, but I think, you know, I delayed a lot of gratification in my thirties thinking I would have the rest of my life. Now I’m hoping to have the rest of my life, but you know, I mean, one of the advantages I do locums, which means I travel for work, I took 12 weeks off last year. I had two elective surgeries. I wanted to spend time with my nieces and nephews. I made plenty of money. Could I’ve made more money not taking twelve weeks off? Yes But at the end of the day, is it going to matter if I make an extra 20 or $30,000? No. On my death bed, am I going to go, “oh shoot, I wish I had made that extra $30,000?” No, it’s not gonna matter. Yeah, but it sounds like, it’s definitely something I struggle with still, you know, taking time off. But for me, having a balance is really important.

[00:23:21] And I love medicine, I mean, I think a lot of women have left medicine because they feel like they can’t do it all, but I’m lucky I found a way by doing what’s called locums that I can do both. I can be a surgeon because I love being a surgeon, I love operating on people, but I can also have a life. So I’m lucky I can do both.

[00:23:38] Dr. JB: So walk me through how you, you balance your work and life.

[00:23:44] Dr. Trocciola: I just give myself time off. And it means saying “no” to things. Means, you know, because there’s always a need for surgeons, so they’ll call, you know? Like I took all of, I took July and August off, and I had two surgeries and I got a million calls. Can’t you work? Can’t you work? And I said, no, no, no. So it’s really saying ” no,” it’s just learning to say “no.”

[00:24:05] Dr. JB: And that’s hard, because you’re not trained to say “no,” right? I remember when I was leaving residency, they said you should be the “yes” person.

[00:24:13] Dr. Trocciola: Correct. It’s hard. And especially when you get paid by the day. And if I don’t work, I don’t get paid anything. It’s really hard. But again, at the end of the day, is it, that extra money, and for everyone that extra money, it could be an extra $2000 for somebody, it could be an extra $100,000 for some people, whatever it is, whatever your dollar amount, is it going to matter? I mean, for me, I have enough money that I can buy what I want, take care of my family, my sisters and nieces and nephews, and have enough for retirement. I don’t really need more money than that. It’s learning to say no, and it’s not always easy. It’s still hard. And then, even having Thanksgiving and Christmas off, most people have to work one of the two holidays, but because I travel, I decided I didn’t want to work either holiday. And I had an offer to do locums and they said, “well, if you come to this site, you have to work one of the holidays,” so I said, okay, I guess I can’t come. That’s hard to do because I didn’t have another job, but you know what? When I went back to them and said, well, I guess I can’t come, they came back to me and said, ” okay, you don’t need to work either holiday.”

[00:25:14] Dr. JB: Look at that.

[00:25:15] Dr. Trocciola: It’s figuring out what’s important to you, ’cause I think for everyone, and it turned out the surgeon that’s working doesn’t even celebrate Christmas, so it’s okay that he’s working Christmas, you know, it’s figuring out what’s important to you and being very clear about that.

[00:25:28] I have a mom with Alzheimer’s, so I’m very clear. I have made the decision to see her once a month because that’s what I’ve made the decision to do. For other people, it may be going to their kid’s soccer game, but it’s deciding what is important to me and making that time. But as I said, it’s more about saying “no” than saying “yes.”

[00:25:47] And it’s helped me, like I also work with someone, so I have a budget. I have a certain, you know, I know what I spend and I know what I need to earn, so that has helped me rather than… I think before I had a financial person helped me, it was not as random, but now I know I have a target of what I want to earn each month. And if I earn more than that, I say, okay, I can take more time off or I can use that money to buy something, and if I earn less then I say, okay, I got to work a little more next month. But I guess kind of listing what’s important to you and knowing that that’s important to you, and just sticking with it. It’s not, not always easy. But I think before I had cancer, I couldn’t do that at all. I just worked all the time.

[00:26:23] Dr. JB: Yeah, that was gonna be my question for you. Do you feel like, without that experience of being a cancer survivor and the way that you see life now, would you be seeing that today?

[00:26:34] Dr. Trocciola: Oh no. No. I would never. Cause I would be like an extra, you know, X number of dollars, I can buy a new computer, I can buy another car. No, I, I, yeah, it’s very hard to see that, but again, I just thought I was going to, I thought living to 80 or 90 was guaranteed because I looked at my grandparents and they lived to their eighties or nineties. So I, I just said, I’m going to live to 90, I got plenty of time to go on vacation. Plenty time to buy nice cars. Plenty of time to take time off. I can earn X number of dollars if I work an extra week, but then you realize life is not guar– even if you’re not a cancer survivor, I mean, we all know that for medicine, life is not guaranteed for any of us.

[00:27:12] Dr. JB: Nope.

[00:27:13] Dr. Trocciola: But I don’t know how you get that message if you haven’t faced cancer or another kind of deadly diagnosis.

[00:27:19] Dr. JB: Well, I think now with COVID helping people realize that there’s no guarantees in life,

[00:27:26] Dr. Trocciola: Right. Yep. Yep. I agree. I agree because you appreciate time as, you realize you might not see people. I mean, before you could see people whenever you want. Now with COVID, you can’t. So yeah, no that’s changed. Yep. It definitely has changed. So, am I glad I had cancer? No. But am I a better person now? Yes. Definitely.

[00:27:47] Dr. JB: And even going back to that, how you learn, I mean, you suspected it, right? You’re like, I think this is, but that experience when you had your mammogram and you were informed that way.

[00:27:59] Dr. Trocciola: Oh yeah, right.

[00:28:01] Dr. JB: Were you able to address that, or…?

[00:28:04] Dr. Trocciola: No, and I always say one day I should write a letter to them. I know. But I address it by the way when I have a staff, making sure they treat patients with dignity. My staff knows if a patient calls me, they’d better get that message to me. And yeah, if that was my staff, yeah, if that happened now, I would write it up. But I think I just have a much better realization of what anyone says to a patient can have such huge weight and you just don’t know. I just say, you don’t know what anyone’s been through. I mean, no matter if you’re rich or poor, black or white, you don’t know what experience you’re going through, but yeah to find joy in someone else’s having a cancer is pretty awful. Pretty awful. And I have the report, so yeah, maybe, maybe this year I’ll write that letter.

[00:28:47] Dr. JB: Yeah, I think it’s just an opportunity for them to learn. I’m not sure if this was a new trainee or…

[00:28:54] Dr. Trocciola: No, wasn’t new. No, I mean, she was brought in a new trainee, she was like– and then she told me I had bilateral breast cancer, which I didn’t. It was awful, so I think what I do do is if somebody is really good now when I get a mammo, if I have a really good tech, I will say to them, ” you’re really good,” you know, like if they say to me, okay, I’m going to leave you in this room, it’s going to probably be a little while because the radiologist’s behind, I’ll go, “thank you for telling me.” So I try to reinforce people that are really good. When I see kind of the opposite. No one thinks about that. How was the tech to them? How was the first person, I mean, even like for me, if I go and have a surgery and I go to the, I show up and the person tells me to get undressed doesn’t tell me who they are, like, that’s so important. And now like, again, anytime I have a procedure, I then learn, like, I feel like I learn something. I never saw myself as a patient before I became a patient, before I became a cancer patient because, like I had foot surgery, which isn’t cancer surgery, but when you’re fighting for your life, you really see yourself as a patient. So like when I go see a patient, I always introduce myself, hello, I’m Dr. Trocciola, and I, like I’ll say, yes, I’m a woman and yes, I’m going to do your heart surgery. I will never walk into the patient’s room and not tell them who I am, because I think it’s important. Patients need to know who’s taking care of them.

[00:30:10] Dr. JB: Did you experience that yourself when you were a patient that a physician would walk in and not introduce themselves?

[00:30:16] Dr. Trocciola: With more, not physicians, with other people, other staff. I mean, because I was a physician, I always got pretty good treatment from other physicians, but it was other staff that, and again, for me, the worst thing was having to wait, being put in an exam room and then having to wait an hour, an hour and a half. That’s the worst, there’s nothing, like that’s an awful feeling when you’re waiting for your chemotherapy, whatever you’re waiting for, you’re anxious, so. And I think there are a lot of, I mean, there’s good studies that show patients of color don’t get believed and don’t get treated right, so I think there’s a lot of that. I think it’s hard for us to see, to feel like the patient, or to understand what patients are going through. My medical school actually did a pretty good job of that, I remember they, and I don’t know why I remember this 20 years later, but they brought us to a hospice, and I remember there was, there was someone wailing in the hallway, you know, someone had just died and the family member was wailing. And I remember the guy looked at us and he said, we don’t tell them to be quiet. That is her experience with losing her family member. And you’re right, you have to let people wail, you have to let people be sad, you have to let people be angry, because that’s all part of the experience of being sick. I mean, I think being sick, you’re never more vulnerable. Didn’t matter that I was a doctor, being a doctor did not protect me from having stage 4 cancer, did not protect me from getting cancer. Cancer happens. I mean, I’m in a group for women physicians with cancer, and we got lots of people with stage 4 in there, you realize cancer and disease has no, you know, it doesn’t matter how rich you are or how much you’re paid or how much you run or exercise, I mean, those play roles but… So, yeah, it has taught me a lot and it’s, it has made me, I think, less judgmental about patients. Not that I was real judgemental, but I’m really not judgmental. As I said, if someone comes in and they’ve neglected something and everyone’s like, “I can’t believe they didn’t do anything.” Yeah. I can. I can. Let’s not talk of it, you know, patients will say to me, “oh, I wish I had gotten this x-ray earlier.” I said, okay, you didn’t, we’re here now. Now, what are we going to do about where we are? Can’t look back. You got to just look forward. I’ll never say to a patient “well if you hadn’t smoked, you wouldn’t have got lung cancer.” “If you weren’t obese, you wouldn’t have got a heart disease.” No, you have heart disease. Let’s talk about what you can do after we fix the heart disease, but right now I’m not going to blame anything on your past.

[00:32:31] Dr. JB: The past is the past. We can’t change that.

[00:32:33] Dr. Trocciola: Right. Right, Correct. Correct. And for me, I mean, that’s the only cha– lifestyle changes, I have lost weight and I do eat healthier, and I think I just have more self-care activity because like when I got cancer, I wasn’t taking care of myself very well. I was obese. I wasn’t eating healthy. I wasn’t exercising. I was working all the time. So that’s kind of another change I’ve made for myself. But again, people that eat healthy and are thin get cancer too, but I know that that reduces your likelihood of recurrence. So for me, that has kind of been my motivation.

[00:33:05] Dr. JB: And so, we talked about your diagnosis of cancer. If we go back to your career as a cardiothoracic surgeon and, and you’re working in locums now, during this time period, have you ever experienced symptoms of burnout?

[00:33:21] Dr. Trocciola: Oh, yeah. Yeah, I have, I mean, that’s kind of, because I actually did take a full-time job after my cancer. It was in Tulsa, and then I left Tulsa, but yes, oh I definitely do. And the nice thing about burnout as a locums is if I face it, I just take time out or I leave that site. I mean, you, you get tired of being mistaken as a nurse, you get tired of not getting respect until people know you, you get tired of the male surgeons getting mad when you get the referrals, you just get tired of that. So for me, that has led me to burnout. I just feel like I’m not treated equal as a woman. I’m not, I’m not. And, and all the politics that are involved, again, the men can get away with yelling and I get, I yell and I get called in. They could have a million complications. I have one complication, again I’m called in. So that has definitely led me to burn out for sure.

[00:34:15] Dr. JB: That’s absolutely crazy, for lack of a better word, like really.

[00:34:21] Dr. Trocciola: I mean, but it’s not just one hospital. It’s every single hospital outside of academics, I’ve seen it. I did not see that in residency, but every single hospital, yeah.

[00:34:30] Dr. JB: Wow. And so was that, were you experiencing symptoms of burnout and that’s what made you decide to transition to locums?

[00:34:38] Dr. Trocciola: Yeah, definitely. Definitely.

[00:34:40] Dr. JB: And with locums, you have more control over your schedule?

[00:34:43] Dr. Trocciola: Yeah, being told I couldn’t take a day off because another surgeon was taking a day off, even though there was nothing going on at the hospital. Yeah. I mean, having your schedules so controlled, again having your surgery so controlled, being told I couldn’t leave the hospital ‘ til five, even if nothing was going on, like I was like, are you kidding me? I live five minutes from the hospital. So yeah, I definitely burnt out. I definitely burnt out.

[00:35:07] Dr. JB: Yeah, because I thought that you just have to live within a certain radius of the hospital, so as an ER doc, if I have, oh, there’s a guy who’s dissecting, I need you here right now, then you have X amount of time to get there.

[00:35:18] Dr. Trocciola: Right. But I’ve worked, I’ve worked in permanent jobs where they made us stay in the hospital, or made me stay. The men could leave because their wife had a problem. ” Oh, my wife needs to go to the car dealership, so I have to go.” ” Okay.” I have a flat tire. “Well, why you leaving? You can drive on your flat tire.” I mean, I was literally told in one job again, I’m not going to say what state, I’ve worked in lots of states. I’m not going to say when it happened, but I was literally told to drive on a flat tire, or on my spare, that I didn’t need to get my tire changed. Yet, this same male surgeon left early because his wife’s car needed work. It’s like, I’m not going to drive on the spare tire when there’s nothing going on at work. You know, I didn’t leave a patient. But so yeah, I’ve definitely faced burnout, but in the past I wouldn’t have gotten my flat tire changed. Now I do. Now I say, well, I’m getting a tire change. I got to take care of myself. And I think the thing that’s helped me is, you know, for years, I tried to find unity among other surgeons or other cardiothoracic surgeons. And while I have found some, I’ve realized, I share more with women in medicine, then I may share with women in cardiothoracic surgery or women in surgery.

[00:36:26] Dr. JB: Interesting.

[00:36:27] Dr. Trocciola: So I’ve joined a lot of women’s group, Empowering Women Physicians with Sonny Smith, the Brave Enough Group with Sasha Shillcut, you know, I have, and I, I always thought, oh, I’m different than pediatricians, oh, I’m different than medical doctors, but now I realize I share a lot with them, other women in medicine.

[00:36:45] Dr. JB: But not women surgeons?

[00:36:48] Dr. Trocciola: Oh I deal with women surgeons, but it doesn’t, I thought it could only be women’s surgeons.

[00:36:52] Dr. JB: Oh, got it. Got it.

[00:36:53] Dr. Trocciola: So, but, you know, and there aren’t that many women surgeons. There are, but there’s not a ton of women cardiac surgeons, and then, I mean, you don’t hear women, cardiac surgeons talking about the bad conditions, right? You don’t hear that, it’s still pretty hush hush. So I guess, I think I share a lot with women cardiothoracic surgeons, but I think people keep it quiet. But I have learned I share a lot with women physicians and that has helped me with burnout and recognize burnout and realize, again, I need time off. So like last year I took the part of the summer off because I had been in not ideal locums because, you know, I talked about that situation where it wasn’t my complication, I had not been in a great situation. So, but yeah, I mean, I think what has helped me not get burnt out is the ability to leave from hospitals, as a locums but yeah, I have definitely faced burnout. It’s exhausting. I think women that have a family are exhausted, and I think those of us that don’t have a family are exhausted, because it’s always, oh, well you don’t have kids so you can work late. Oh, you don’t have kids, so you can do this. And then women that have kids, you know, get told the opposite thing. So I think we all, and I think the more we realize as women and we have more in common rather than divide ourselves as women surgeons, women pediatricians, or women with kids, without kids, we all have stuff in common. We all want time with family and friends.

[00:38:13] Dr. JB: And I think that that, that also spans beyond just being a woman. I feel like everybody, ideally would want more time with their, their family and friends, but it’s learning to be able to stand up for yourself to say “no,” like you mentioned, that you set your boundaries.

[00:38:29] Dr. Trocciola: Yeah, and you know, like when I stood up to that group and said, no, I don’t, um, I’m not going to work Christmas or Thanksgiving, it was knowing that I’m a good enough surgeon that if they didn’t want me, I would find another place that wanted me. So it’s believing you’re good enough that, you know, I think people get afraid, “oh, I’ll never get another job if I say no,” you know, “they’re going to fire me if I tell them I can’t work this weekend.” No they won’t. And if they do, that’s not the place for you. Again, if a place can’t understand I have to take care of my health or I have to take care of my mother’s health, then that’s not really a place I want to work. But you have to stand up for yourself. Again, I think it’s been joining these women organizations and learning from others that you learn, that I’ve learned my worth and what I bring to an organization.

[00:39:16] Dr. JB: And the importance of community and being part of a community to help you overcome symptoms of burnout.

[00:39:25] Dr. Trocciola: Right.

[00:39:26] Dr. JB: And also get to know yourself and I think that sometimes when you’re, when you’re with other people, they can show you things that you may not necessarily see.

[00:39:37] Dr. Trocciola: Correct. Correct.

[00:39:39] Dr. JB: About yourself.

[00:39:41] Dr. Trocciola: Yep. Correct. I mean, again, when I had to, you know, when I took all that time off this summer, it was another female physician who said to me at the end of the day, are you going to regret another, do you really want an extra X number of dollars, or is having time off to spend– I have a lot of nieces and nephews I’m close with– time with your nieces and nephews and gardening in your house, what are you going to remember? Gardening my house. You know, the money, and the money comes. I ended up making more money, like one of my best years this year, even though I’ve took more time off this year than I’ve ever taken off. The money will come, but you have to believe you’re worth it, and then the money will come, you know? And yeah, I agree. I think they have to believe that as well.

[00:40:21] But I have just joined a lot of groups with women physicians that, as I said, I didn’t really, I didn’t know existed, really didn’t know existed until, yeah, probably after my cancer. Cause even when I was going through my cancer, I didn’t, I wanted nothing to do with support groups. Nothing. Nothing. Nope. Nope, I’m not like them. Like I was very much into, “I’m not like them.” And now I’ve learned we all share more than we think, even if I don’t look like them, even though, even if their experience is different, we all, like human emotion, as you said, everyone yearns for connectedness, family, friends, joy, love, you know, that’s what everyone wants.

[00:40:54] Dr. JB: I mean, we’re social beings.

[00:40:56] Dr. Trocciola: Right. Exactly. Exactly. But as you said, I think in medical school and residency teaches us to forget about those things, don’t you?

[00:41:04] Dr. JB: Yes, yes.

[00:41:05] Dr. Trocciola: You know, it really does.

[00:41:07] Dr. JB: And it’s so isolating though.

[00:41:08] Dr. Trocciola: Yeah. And it teaches you, like when you’re in med school, you have to learn what makes you unique. I mean, even to get into med school, it’s like, okay, well, I’m unique because I did A, Y, and B, you know, A, B, and C, but as I said, now that I’m older, I think more, how am I, what do I have in common with that person rather than what makes me different than that person?

[00:41:28] Dr. JB: Because we’re so competitive, right?

[00:41:30] Dr. Trocciola: Right. Right.

[00:41:31] Dr. JB: There’s only five slots for this highly competitive fellowship. And so you have to be like, oh, this is what makes me stand out, you know? Which ultimately serves in our detriment, and–

[00:41:45] Dr. Trocciola: Correct. Correct. Yeah, it does. And at the end of the day, I mean, you know, the reality of it was going to Cornell actually helped me in my cancer journey, but at the end of the day, if you’re going to become a doctor, you’re gonna become a doctor. You know, I don’t know. I mean, do I regret succeeding and going to all these great places? No, I don’t regret, but at the end of the day, I think it’s, what I remember more about Cornell, which is funny. I mean, top residency, but what I remember more is how much those people took care of me when I got sick. I mean, this person that saw me at Mass General, she was my chief resident. She wasn’t my a friend, I remember saying, when do you have office hours? And she said, whenever you get here, I mean, you can’t, you can’t pay for that.

[00:42:27] And I think we need to do that more for each other and for other people. That’s why I always say to my team, this is someone’s son. I don’t care if he’s in jail, this is still somebody’s son, this kid, he has a mother. You have to, it’s like, we’re just all humans. That’s what unites us all.

[00:42:43] Dr. JB: That’s right, and we lose sight of that. I think patients lose sight of that when they’re looking at us and sometimes, we also lose sight of that when we’re looking at our patients.

[00:42:54] Dr. Trocciola: Yes, no and I agree patients do lose sight. What do you mean the doctor’s not there? No, the doctor isn’t there. If I operate on someone, I will say I’m operating on you and I’m not here next week, but Dr. X is going to take great care of you. But yeah, I think we both, I think patients think we’re in invincible, we can’t make mistakes, we’re evil, it’s just about money. I think most of us went into medicine to help others. It wasn’t about money. Most of us wanted to help others, make people feel better. I mean, that’s why I still do it. As I said, I loved that patient going home that I told their family I didn’t know if I could get them through their surgery, and then they go home. I mean, there’s nothing better. There’s someone on Facebook whose father, I took care of their lung cancer years and years ago, and I think, I don’t know. I remember the oncologist coming to me and saying, I know this is not the textbook thing, but will you give him a chance? And I did. And every year his daughter writes me on Facebook, my dad is still here thanks to you. I mean, there’s nothing better than that.

[00:43:52] Dr. JB: Yeah.

[00:43:52] Dr. Trocciola: At the end of the day.

[00:43:54] Dr. JB: Wow. You know our time, man, this time has gone by so fast.

[00:44:00] Dr. Trocciola: I know.

[00:44:01] Dr. JB: And since we’re nearing the end of our time together, do you have any words of wisdom for my listener?

[00:44:10] Dr. Trocciola: Find what you love and do it, you know, like I love cardiac surgery and I think that has gotten me through putting up with not great environments, being treated, at the end of the day, I love what I do. So find what you love, find what you love and do it, and the money, in my opinion, the money will follow.

[00:44:27] And then, make sure don’t forget about having a life either. If you want to be a mom, have children. If you want to take time off, take time off. Want to go on vacation? Go on vacation. If the organization you work with doesn’t understand why you need to take time off because your sister’s sick, maybe that’s not the right organization for you to work for. You know, like take that time, take the time to be there for people is really my message, because at the end of the day, that’s all that matters.

[00:44:54] And I would tell people to go into medicine. I mean, there’s a lot of people that are burnt out and say, don’t go into medicine. I would do it in a heartbeat and I would recommend it in a heartbeat because I love, I love what I do.

[00:45:05] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some. Each one, teach one. I’m done.

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