Susan Orloff, M.D.
Professor of Surgery, Director and Chief, Division of Abdominal Organ Transplantation, Department of Surgery Adjunct Professor, Department of Molecular Microbiology & Immunology; Director, Liver and Kidney Transplantation, Portland VA Medical Center
When her spine was fractured in six places in a terrible biking accident, Susan Orloff's career as a surgeon seemed to be over even before it started. Her orthopaedic surgeon told her she would never be able to endure the pain of standing at the operating table for any length of time, and she might as well give up her career as a surgeon.
She was in the second year of her fellowship in abdominal organ transplantation at the University of California, San Francisco, nearing the end of a decade of training. With grit and determination she soldiered her way through a long period of rehabilitation, regaining her strength, relearning how to use her hands and to hold her head up again. She would not be denied. She was going to be a surgeon. "You can do the impossible sometimes if you just stick to it and put your mind to it," she says.
Role models have also been important. "My mom, who recently turned 86 years old, has always been my major role model. A wonderful mother of six, she double boarded in internal medicine and radiology, retiring as a professor of radiology from University of California, San Diego, at the age of 80. She is the kindest person I know."
Her grit had shown itself earlier when she dismayed a dean at the Harvard Medical School who called to share the good news that she had been admitted. She astonished him by saying, "I'm gonna have to think about it. Could I call you back tomorrow?" She had already been accepted by the UCSF School of Medicine and wasn't so sure that she wanted to leave the West Coast. She consulted her father, the chair of surgery at the University of California, San Diego, and one of the founders of its medical school. "You really should go to Harvard," he advised. "It will open doors for you."
"I think that I can open my own doors," she countered, "and I really want to go to UCSF." Which is what she did.
Later when she applied for a residency in surgery at UCSF, the department chair, Paul Ebert, challenged her. "Why would you want to go into surgery? Why wouldn't you go into radiology or anesthesia? Those are much better careers for a woman."
"Thanks," she told him, "but I'll take that risk." She plunged ahead, was one of two women chosen for surgery residencies at UCSF that year and, she says, "I've never looked back."
Never Give Up
"Stick to your values and stay focused on the things that will bring you a sense of satisfaction in the work you're doing."
Dr. Orloff's dedication to keep on keeping on has shaped the way she practices medicine. She will not accept failure. Dr. Orloff completed high school in three and a half years, worked on neuroendocrinology and peptide biology research at the Salk Institute in La Jolla during high school and college, graduated magna cum laude from UCSD in biology carrying a Phi Beta Kappa key, and with honors and an Alpha Omega Alpha key from the UCSF School of Medicine.
After graduating in 1984, she opted for a residency in internal medicine. She did rotations at San Francisco General Hospital, putting her on the front lines in the battle against the AIDS epidemic, which at that point was at crisis proportions.
"This was in an era when we couldn't help these patients," she said. "The medications themselves had side effects that sometimes killed them. One night I was very sad after I'd lost my sixth or seventh AIDS patient, a young guy in his 20s. I felt like I wasn't accomplishing what I had set out to do, which was to help people. And I happened to walk by the operating room, where the surgeons were taking out a very inflamed appendix, from a young and very ill man – they're really doing something for someone, I thought."
Shortly thereafter, she embarked on her residency in general surgery at UCSF. For the next seven years, she developed and honed her skills, largely under the tutelage of Haile Debas, M.D., an internationally renowned gastrointestinal surgeon who, during most of the time Susan was there, chaired the UCSF Department of Surgery and later served as dean of the medical school and UCSF Chancellor. He was to become the person Susan looks back on as her principal mentor.
"He's one of the most gracious human beings I've ever known as well as one of the most intelligent and committed – he epitomizes integrity and vision, all the things I value. I think of him as my second father, and my son Jackson's third grandfather."
She worked for two years in Dr. Debas' laboratory looking at the enterogastric reflex and how it affects the hormone physiology of the stomach, intestines and the rest of the body. She learned how to do intestinal transplants and microsurgery working with Bernard Jaffe, M.D., on a visiting fellowship that Dr. Debas arranged at the State University of New York Health Science Center at Brooklyn.
"Solicit help when you need it, but promote teamwork, which is very important because effective teamwork benefits everyone on the team."
Then she zeroed in on a study of the liver, the organ that would become the prime focus of her career. "It's one of the core organs that sustains life. I'm very liver-centric." To steep herself in the anatomy of the liver, she did a two-year stint as a fellow in abdominal organ transplantation at UCSF preparing for every possible surgical procedure involving the liver and biliary tract. Transplantation surgery attracted her because it offered some redemption for tragedy, the death of someone usually in the prime of life. One donor could offer an extension of life for other people.
Did she encounter gender issues as a resident in the testosterone-fueled confines of the operating room? Sure, she says. There were instances of unwelcome flirtations and surreptitious groping by male faculty members who held power over her and of rejected suitors who thwarted her projects.
The surgical suite was a much different place then, she says. "There were attending surgeons who expressed anger overtly, had temper tantrums, threw instruments across the room, yelled at the OR staff, used swear words. That kind of behavior was accepted and at times was the norm. I didn't feel it was ever directed at me and it didn't really affect me. I just did my job."
But there were sacrifices. "I didn't even dream of having a family during my residency. There was no time, and, really, no woman resident had children. It wasn't talked about or even thought about, nor was it in the least bit an acceptable option."
Fast forward to the present. Dr. Orloff is now married to Dr. Robert Hart, professor of surgery and orthopaedic spine surgeon at OHSU, and they have Jackson, their 9-year-old son, and their daughter Annie, who recently graduated from the Juilliard School in New York as a cellist, and she is matriculating at Mt. Sinai Medical School in 2013. "I would have loved to have had more children, but I'm fortunate for the children I have," she says. "I am also so fortunate to have a husband with whom I can relate to on so many fronts: academic, musical, political, intellectual, and personal."
But a balanced family life is still difficult to maintain given the 80-hour work week that she clocks, and her husband's time commitment to work is not far away from this. "Fortunately, I have a very supportive Chilean Nanny family, without which, I could not do what I do." She takes Jackson on hospital rounds with her every weekend – something she has done since he was three months old. "He cheers the patients up and gives them a youthful hope." But she concedes that she bent over backwards to maintain her schedule equitable to all of her work partners, so as not to appear to be any less dedicated a surgeon/colleague because she was a woman. "It was a difficult transition for me, not to be at home and not to see Jackson as much as I would like to."
Career at OHSU
"Figure out creative ways to serve other passions in your life besides work, whether it's your family, athletic pursuits, the enjoyment of nature. Play as hard as you work and maintain a healthy balance between the two."
Dr. Orloff arrived at OHSU 17 years ago not long after completing her transplantation fellowship at UCSF. She was drawn here in part by Portland's progressiveness and its proximity to the ocean and mountains, as well as a local childhood/college best friend who was a Portland anesthesiologist, as well as a brother who taught school and surfed on the Oregon coast.
Her first few years at OHSU, however, involved instances of gender and financial discrimination by male colleagues, particularly her immediate supervisor in transplantation, who paid himself a salary eight times more than he paid her, despite an equal work load. She perceived that a couple faculty members, in particular, were trying to thwart her successes. But instead of resigning herself to the treatment, she sought the leadership of the transplantation division to create a change in the professional culture and "make it fairer for everybody."
Today she wears a multitude of hats. She is professor of surgery and director and head of the Division of Abdominal Transplantation with a joint appointment in the Department of Molecular Microbiology & Immunology. She is former vice chair of research in the Department of Surgery. She is director of the Liver and Kidney Transplantation Program at the Portland VA Medical Center. In addition, she runs an NIH-funded lab studying the mechanisms and genomics of cytomegalovirus (CMV) virology and its effects on transplants. She has co-authored over 90 peer-reviewed papers and 18 book chapters. She serves as a reviewer for 16 medical journals and sits on the editorial board of three. She is on the Board of Governors to the American College of Surgeons, she is the Chair of the American Society of Transplantation Liver-Intestine Community of Practice, the UNOS Region 6 Regional Representative to the Liver/Intestine Committee, as well as a member of the Executive Councils of the American Hepato-Pancreatic-Biliary Association, and the Society of University Surgeons (SUS). She is the chair and founder of the SUS Committee for Global Academic Surgery (SCGAS). She is also past-president of the Portland Surgical Society.
Did she adopt any particular strategies to climb to the top of her profession? "There really wasn't any calculation," she says. "I just worked hard and stuck to my standards and did what I felt was the right thing to do for the patients and the people around me." With that formula, Dr. Orloff has found success in academic medicine.
Lessons Learned, Lessons Shared: Advice from Dr. Orloff
Dr. Orloff's advice to young women in academic medicine:
- Stick to your values and stay focused on the things that will bring you a sense of satisfaction in the work you're doing.
- Figure out creative ways to serve other passions in your life besides work, whether it's your family, athletic pursuits, the enjoyment of nature. Play as hard as you work and maintain a healthy balance between the two. Little by little, start doing the things again that you used to love doing before your career began to consume all your time. This has been the most difficult thing for me to accomplish and I am still working on this!
- Don't overbook yourself. Be wary of taking on too many commitments, serving on too many committees, volunteering for too many projects – another area where I am deficient and needs constant work.
- Solicit help when you need it, but promote teamwork, which is very important because effective teamwork benefits everyone on the team.
- Don't underestimate the value of perseverance and tenacity. You may often feel discouraged, even overwhelmed, but keep plugging away. If you're being true to yourself, you're on the right path and you'll get there.
- One more, if I may: Musician Dr. John sings a song, also recorded by Sam Cooke and Aretha Franklin, written in 1944 by Harold Arlen and lyrics by Johnny Mercer, and it rings true for any pursuit in life. "Accentuate the positive, eliminate the negative, latch onto the affirmative, and don't mess with mister in between" – of note, I sing this song on rounds – not well – but I try to get the point across, and I hope that I do!
Article written by Harry Lenhart