In honor of Women’s History Month, Whitney Herter, PA-C, BS, a senior instructor in surgical oncology at the University of Colorado Department of Surgery, talked with Elisa Birnbaum, MD, professor of GI, trauma, and endocrine surgery, about her illustrious career.
Birnbaum worked at Washington University, Barnes-Jewish Hospital, and St. Louis Children's Hospital in St. Louis before coming to the University of Colorado, where she is part of the UCHealth University of Colorado Hospital’s Multidisciplinary Women’s Pelvic Health and Surgery Clinic.
The following transcript of their conversation has been edited for clarity.
Whitney Herter: Hello, my name is Whitney Herter, and I am a physician assistant in the Department of Surgery at the University of Colorado School of Medicine. In honor of Women’s History Month, we are celebrating “herstory” by interviewing women within our department and inviting them to share some of their experiences as women.
Today I’m talking with Dr. Elisa Birnbaum, who is a professor in the Department of Surgery. She’s a colorectal surgeon, and I have had the pleasure of working with her in the University of Colorado Cancer Center for several years. She’s shared many of her stories with me. These stories have inspired me as a woman in medicine, and I thought it would be valuable to share more.
So hi, Dr. Birnbaum. I just want you to introduce yourself, tell us who you are, how long you’ve been practicing medicine, and what other things you might like to do outside of the hospital.
Elisa Birnbaum: Hi, my name is Elisa Birnbaum. I have been a physician since 1985, when I graduated medical school, and a surgery resident from 1985 to 1990. I finished my fellowship in 1991 in colorectal surgery, and I have been a surgical attending since 1991. I had originally planned on leaving St. Louis after my fellowship, but they offered me a job.
I stayed; it was the best job in the country at the time, and really for 27 years, it was the best job that I could have ever had. And then when my children graduated high school, I moved to the University of Colorado, where I joined the faculty, and it has been wonderful here.
What I like to do in my free time? Well, as I have more and more free time, I like to do more and more things outdoors — gardening, skiing, riding my bike — and then indoors, reading, baking bread, and making ice cream.
Herter: Can you elaborate on what made your job in St. Louis the best job at the time?
Birnbaum: Well, if you think about the year that it was, when I graduated medical school in a class of at least 200, maybe 250, there were only two women, myself included, that went into general surgery that I can recall. So it was not a time where there were a lot of women in medicine. And I did my surgery residency in New York between 1985 and 1990, at the height of the AIDS epidemic, and prior to an 80-hour work week.
It was probably one of the more stressful times of my life, from physical and mental stress, just getting through the day. And when I chose to do colorectal surgery, I chose it for a lifestyle choice. I loved all aspects of general surgery. But for me, I wanted a job that included both inpatient and outpatient procedures, minor procedures, major procedures, the whole gamut, men and women. And colorectal surgeries fit that desire. At WashU, it was a very busy program, and they allowed me to do what I wanted to do pretty much the whole time I was there. We grew a program of increasing our cancer numbers, increasing our IBD numbers, and increasing our benign anal-rectal pelvic floor numbers. And it was great. And then when I moved here, the aim was to grow a program primarily for pelvic floor surgery, and they have allowed me to do that, and it has been a wonderful experience, increasing the numbers and doing the operations that we do. It’s really an honor and a privilege to be able to take care of patients in this way.
Herter: We’re grateful for your service of our patients. I miss working with you really closely a lot. I miss working with women in my in my role.
So can you describe the time or the moment or the feeling when you knew you wanted to become a surgeon? If you can remember that feeling.
Birnbaum: Yeah, I was thinking about it. I think must have done internal medicine first. And I found it incredibly unsatisfying, because it was management of patients and doing very critical things, but the progress was very, very slow and not visual.
I did general surgery, and I was on a service with a notoriously demanding surgeon. And at the time, he did both adults and pediatric surgery. And I remember watching him sit at the bedside of a kid he did an appendectomy on. The kid had appendicitis, he operated on the kid, and he sat down to talk to him postoperatively. And he sat at the side of the bed and just talked to the patient as a regular person. And it was at that moment that I realized that you could be a technician as well as a caring physician all around, and yet you get immediate results. So that’s really where the switch came for me, where I realized that general surgery wasn’t just about taking care of the surgical problem, but it was also communicating with patients.
Herter: Having a class of only potentially two women who applied to surgery residency in your medical school — I know you well enough to know you’re a competent, strong woman, and that probably existed when you were in that setting, too. But did that ever feel like a barrier, that there weren’t other examples?
Birnbaum: The barrier at the time was really access. And by that I mean, there was not one single person who encouraged me to go into surgery, other than a gastroenterologist, who, when I talked to him and told him that I was interested in going into surgery, he said, “Great field, you’re going to have a rough time, but go for it.”
Everyone else told me that I should not apply, that I would not succeed, that I didn’t have the personality, that I didn’t have the pedigree, etc., to go into surgery, and yet they were encouraging the guys in my medical school class to go in, and they had very similar backgrounds. So those were difficult access points.
I did go to a general surgery residency, LIJ, which is now Winthrop in New York. We had four chief residents — there were two of us that were women, and there were two guys. They were incredibly female-friendly in the program. I think that they realized, as we competed at the same level as the men and operated just as well as the men, that they were not going to ignore either me or Terry Benacquista, who was the other woman. She went into plastic surgery and is still in New York, and I opted to go into colorectal surgery partially because I was encouraged by the gastroenterologist in medical school. I think that what we forget is that the things that you say have huge impacts on people’s career choices. I did go back to medical school, and I did thank the gastroenterologist for being the only person who supported me.
Herter: So he was a male. Have you had female role models? In my mind, you’re the pioneer — you are one of the females. But did you have role models or mentors that were female? And what did you learn from them?
Birnbaum: When I got my boards, I was somewhere around the 27th woman boarded in colorectal surgery in the country, something like that. There were people that were nationally known, at Lahey Clinic and at Minnesota, that were women who were very supportive of the other women in colorectal surgery nationally. I think it was difficult; even at Washington University, there were very few women on faculty. In fact, other than a breast surgeon, I was the only other female faculty for a while. And then over time, they recruited more and more women, and more and more women were in medical school and going through residency. I have a large group of friends that are women in surgery. But my most of my mentors were very open to promoting women. My work colleagues were tremendous at WashU and here.
Herter: But mostly men. It sounds like the women were colleagues.
Birnbaum: It’s fascinating because in colorectal surgery, when I first started, we would have a women’s lunch, and we had one table with all the women in colorectal surgery in the society, sitting in one and then two tables at lunch. And it has now grown to be an entire huge room with multiple tables of women, from medical students interested in colorectal on to senior faculty. So it’s just exploded. But initially when I started, no, there were very few. I think in my residency, having another woman who was friendly, and we basically lived together for the five years of residency, was extremely helpful.
Herter I feel like that kind of speaks to what we’re doing. What we’re trying to do in DEI is include people so that others will come, too. But clearly, you’ve also mentored women, so you’ve done your part to help grow the female side of things in colorectal surgery.
Paint a picture of what it felt like entering your first years of surgical residency. What were some of the conversations that were taking place? What did that feel like?
Birnbaum: I did my surgical residency in New York in 1985. If you really understand the time, it was in the heart of, the peak of, the AIDS epidemic. The emergency rooms and the wards and the floors were filled with patients with a disease that was incredibly life-altering and devastating and somewhat scary, because there was no treatment for it. So the medicine wards were completely full, and the surgical wards were very busy taking care of surgical problems, as well as problems that are normally taken care of on medicine.
At the time then, it was before Libby Zion, before an 80-hour work week. We were working 100, 110 hours a week, and it was physically and emotionally exhausting. We just did what we did. You’d get up, you had to do this. And oh, by the way, we didn’t have computers. So this was all done via phone calls, or paper charts, or drawing blood and running down to get the slips of paper yourself with the lab values written on. This was just a completely chaotic time.
I think what we were just trying to do is survive and not mess up and shine light on — whether you’re a woman or not. I think that became almost secondary. You just wanted to succeed and wanted to do right for your patients. It might have helped, because we were so overwhelmed with the volume of patients and what we were doing, it didn’t really matter. It did help that I had three of the best co-chief residents that I could have ever asked for. Completely different personalities, but we were completely supportive of each other and worked as a group. And that is one of the reasons why we were able to succeed. There were definitely times where you just wanted to go to sleep and go, “I can’t do this anymore.” But it was really balanced by other people who then took over for you if you were really exhausted.
Herter: Yeah, I feel like just going through that with other people kind of levels the playing field.
Birnbaum: The closest time to it has been in the past few years during COVID. Especially at the beginning, where things were not really well understood, what was going on, and random illnesses could be fatal. And yet you look at the residents that were working during that time — they worked. They got up in the morning and they worked, and they were supported by each other and by the community around them.
Herter: Sick people too, in both cases. Like really sick.
Birnbaum: I have to say, I think COVID patients were even sicker. Watching someone die of AIDS is tragic. The ventilator, and the communicable transmission of COVID, I think made it a little bit more scary. We knew fairly quickly that the transmission of HIV/AIDS was not from coughing and things like that. Breathing next to somebody; being in a room with somebody. I think COVID itself is a lot scarier, certainly to laypeople, but even within the medical field.
Herter: You didn’t know that PPE was actually going to work either. That was scary.
This is somewhat of a personal interest question that I didn’t list on there, but not only were you a pioneer woman surgeon, but you had four kids. That’s not easy to do today. Can you talk a little bit about what that was like?
Birnbaum: Yes, I have four kids. I got pregnant during my fellowship and delivered the first couple months when I was an attending. I had tremendous partners who were very supportive of that, so that made it easy. There was no concept of maternity leave at that time; certainly no concept of paternity leave. That was early on in the introduction of women in surgery. I only had three or four weeks of maternity leave with one of my kids.
Herter: That blows my mind. That was probably with your first kid too. And there’s so much with the first kid. You just don’t know how to handle yourself.
Birnbaum: I took five weeks with him. I was only going to take four, but I did an extra week because I was still exhausted. My legs were so swollen, I couldn’t put shoes on.
Herter: Yeah, three months didn’t feel like enough. I took five with my last one, and I was like, “Wow, I am actually ready to go back. This is great.”
Birnbaum: You know, I’ve watched on some women surgeons’ Facebook sites, and they’re all ages in this group. Some of them are like, “I’m going back at three months, and I’m afraid my kid’s not going to remember who I am.” I’m like, “Well, they'll only forget who you are if you’re not present in their life.” I think there is a level of bonding and touch and whatever, but I’m not sure that it’s imprinted on the kids who’s doing the touching for them. They just want to feel loved. And if you’re there for their life, these trying-to-be-there-for-their-life moments … I don’t know. It’s harder on you. But my kids grew up fine.
Herter: Yeah. Love and to be fed, that’s all they need.
Birnbaum: I’m sure you have friends who the moms are home 24/7. So it doesn’t really matter, right?
Herter: No. Right. Exactly. You start to learn and you don’t have control over any of it. You just have to let go of control.
Birnbaum: Yeah. It is what it is. But just because you’re home with them doesn’t mean that A, you’re home with your kids, and B, that your kids are going to turn out just fine.
Herter: Yeah. I had a working mom. And I feel like that was good. It was good for me to see her that way. As a female, it was good to see my mom interested and engaged in her work.
Birnbaum: In having the kids, I was very lucky in that I was able to go through all the pregnancies without any major issues. Physically exhausting, and I think that if you talk to my residents at the time, it was also an emotionally taxing period. I think that to make improvements in surgery, to have a better understanding of what it was like to be pregnant, I think we’ve made a lot of progress in that. I had no support. I had no support within the department of surgery, I had no support within society; they just expected you to have kids and not be stressed out. The job itself was stressful, being pregnant was stressful. It was a difficult time. And there was no one to say, “Hey, back off on your clinical stuff. You need to take time off.”
Having said that, though, I made it through the pregnancies. My kids are graduated. My oldest is a surgery resident; my youngest is a lawyer. They’re all over the place, and they’ve been great. Having kids is great. I made every effort to try to make it to their concerts, football games, cheerleading events. Sometimes it was hard. Sometimes I had to stop a day in the middle in order to go see these things. I certainly missed a lot of the school events when they had them in the middle of the day, in the middle of my operative schedule, you just can’t stop. But my kids, I think they have a good understanding of what it’s like to work, and I don’t think they regretted much.
Herter: I feel like that will be interesting for them to ask about as they start to have families, too.
Birnbaum: It would be nice, but so far none of them are having them. I would like grandkids.
Herter: No pressure on them. They’re doing awesome things.
Birnbaum: You could send this to them and ask them, say, “She’s supposed to be a grandmother.”
Herter: I'll send this to you. You can say, “Look, I did this cool interview.” I hear being a grandmother is really amazing. So no pressure, kids. No pressure.
OK, let’s see. Two more questions. Hopefully we’ll make it. What have been your biggest career challenges and successes?
Birnbaum: Career challenges? That’s so funny. I think my biggest career challenge was to give myself a little grace. And by that I mean, there was a time when I was early in practice when I wanted to be everything. I wanted to be a great surgeon; I wanted to be a great mother. I was in academics, and so we had to publish and try to come up with research projects, etc. And I realized that I couldn’t do it all. And so I had to really sit down and have a conversation with myself and decide where I had to give a little.
I got help with my kids, in that I had tremendous outside caregivers. That helped. I had tremendous friends who helped get my kids to and from sporting events. I realized that my strength was in being a good clinician and teaching surgery, and the academics part, I let that part slide a little bit. Not that I wasn’t involved in academics; it just wasn’t my top focus. Because I wasn’t that good at it. And I had to accept that.
Was there a second part to the question? I can’t remember.
Herter: Challenges and successes.
Birnbaum: Oh, the successes. I’m actually pretty proud of what we have created with the pelvic floor program here. It was difficult, because when I first started in practice, I wanted to do the cancers and the IBD and the diverticulitis and the laparoscopic stuff, and then robotics. What I realized was that actually, this area of colorectal surgery was something that I was good at doing. And we could create something that could grow exponentially. That’s what we did. That’s what I came here to do, and I'm really proud of it. We’ve grown this program, and hopefully it’ll be my legacy at the University of Colorado.
Herter: I think that it will. Among the many legacies, that will be one of them. That leads into that question. So the pelvic floor program is a big deal, but what other legacies do you think you will have when you’re off doing all your outdoor activities in your larger amount of free time?
Birnbaum: I’m not sure. I think that that’s a really hard question. I really try to work with the residents on a case-by-case basis of how to do things technically. How to be efficient in the operating room. How to hear about a case and figure out what is causing the problem without spinning your wheels. Without ordering a gazillion tests and labs and scans. You can really figure it out a lot of times just by thinking the process through. But I think that’s a harder thing.
From a legacy standpoint, I think creation of a pelvic floor group and a multidiscipline approach would be what I’m giving. The other part — it was very poignant at the end of the show “ER” when one of the characters left the emergency room and retired or was moving on. He walked out of the emergency room just as a new trauma was coming in. He kept walking, and the people around him kept doing it. I think that you have to understand that you’re a surgeon in a field, and once you leave, that space is going to be taken up by somebody else. That’s not to diminish what you have done and not to diminish what you have to offer, but realistically, I know that when I leave, someone else will come in and do the work that I’ve been doing, and they may do it better. And that’s great.
Herter: I just feel like this conversation is really amazing. I appreciate that you took the time to do this. I think other people are going to love hearing your voice and input.
I’ve worked with you, I don’t know you well on a personal level, but I feel like when you came and started working with our team, it was like a breath of fresh air. You’re a woman surgeon, and you are a mother, and I think our patients always appreciate that you just you tell it like it. It’s like, “This is hard. And this is what we're going to do to help you.” I always felt really grateful that I got to even be in your presence, witnessing that interaction and watching the way you care for patients.
I vividly remember this one time, you walked into the multidisciplinary clinic, I was asking about your day, and you were like, “Oh, yeah, I did a case this morning. I have another case this afternoon. I don’t even remember what the case is.” And I was like, “Oh, man. She is at a good point in her career.” You just know who you are, you’re confident and you just show up in the moment, and you’ll be just fine.
Birnbaum: I probably knew what the case was when I was doing it.
Herter: You did, 100%. But can you imagine when you were new? You probably knew every in and out.
Birnbaum: Oh, my God, I still do that. But it’s done in a different way. It’s done with a with a calmness that I didn’t have when I was younger. I’m comfortable looking at things.
I think one of the things that the multidisciplinary clinic is incredibly helpful for, and I to try to talk to the residents about this, is they have got to start looking at those radiology studies themselves. You remember, my first pet peeve was no one’s doing rectal exams for rectal cancers. It still to this day makes me nuts that I’ve gone through charts on patients with rectal cancers without a rectal exam. And yet we rely on MRI. And MRI is fine. I don’t have a problem with MRI. But if you’re going to operate on the patients, you’d better know what you’re looking at. You’d better know how to examine the patients.
I’ve handled discussions with residents. I’m like, “You have got to learn how to read a CT scan.” The problem is that there’s so little contact with radiology, except with something like MDC where you can talk to them. John will go, “Wait, could you go back and scroll back through that again? Can we look at those lymph nodes?” I’ve had many conversations with residents, and they’re reading, and I say, “That’s what the radiology report says. But did you look at the images yourself? That’s the part I think I brought to MDC, is do a rectal exam. You can’t just rely on someone else telling you on colonoscopy where the tumor is. That’s ridiculous.
Herter: Yeah, we’ve had all those things be completely wrong, and that changes the entire treatment plan.
I feel like the lucky one that I got to even talk to you. So thank you. I’d like to thank Dr. Birnbaum for sharing some of her really fascinating stories with me today, and thank you all for listening.
April 11, 2024