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Join Mohini Dasari, a general surgeon. She shares her personal journey through the demanding world of surgical training, touching on her experiences with mental health challenges, the difficult decision to leave a prestigious transplant surgery fellowship, and the lessons she’s learned about prioritizing well-being in the medical profession.

Mohini Dasari is a general surgeon.

She discusses the KevinMD article, “The untold struggles of a surgical fellow.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Mohini Dasari. She’s a general surgeon. Her KevinMD article is titled “The untold struggles of a surgical fellow.” Mohini, welcome to the show.

Mohini Dasari: Thank you. Thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit. First off, briefly share your story and journey.

Mohini Dasari: Sure. I’m originally from the East Coast; I grew up in New England. I went to school in India for a couple of years, then did med school in Pittsburgh and came out to Seattle for residency, which is where I also did a bit of fellowship, as described in my article. And I just started a new job out here.

Kevin Pho: Perfect. And what do you do right now?

Mohini Dasari: I just started as an acute care surgeon at a community hospital, so that’s basically taking all the emergent and urgent cases that come either from the ER or from inpatients and taking care of them.

Kevin Pho: All right, so your KevinMD article, like you said, talks a little bit about this journey, so let’s jump right into it: “The untold struggles of a surgical fellow.” Tell us how your article came together, and share your story.

Mohini Dasari: It’s been quite the year, probably the most eventful year of my life, with a lot of big life changes. I graduated from general surgery residency in June of 2022. About midway through my residency, and our residency is five years long, I decided I wanted to do transplant. It was my favorite subspecialty that I had rotated on, and I matched here for fellowship. Going into fellowship, I had a daughter who was a little over one year old. I knew the fellowship was going to be grueling, hard and intense; that’s something a lot of people know about transplant. But what I just couldn’t have predicted was how family and life events, including my husband developing a pretty serious back injury that required multiple surgeries, along with the training environment I found myself in, would affect my own mental health and well-being as a learner, and how it all would coalesce into a lot of stress for me to handle.

Kevin Pho: So for those who aren’t familiar with what a transplant fellowship is like, give us an idea. When you say the training is grueling and intense, give us a picture of what exactly that means.

Mohini Dasari: Sure. I think people might be more familiar with what surgical residency is like, just from working in the hospital with surgeons. I don’t mean this to sound light about residency at all, but I really felt like residency was a lot easier compared with fellowship, and that’s saying a lot, because surgery residency is definitely not easy. Each program is different, but in my fellowship I was off two weekends a month, and otherwise I was on 24/7, whether that was for inpatient questions from the residents helping cover the service, outpatient phone calls, calls from attendings who wanted certain things done, or having to go in for cases. It was 24/7, 12 days in a row, with every other weekend off.

Time is one thing, but the other thing is that the surgeries are long, the patients are sick, there’s a lot going on, and a lot is asked of you as a fellow. You’re not only doing cases, obviously, and learning these complex operations, but taking care of and taking charge of the whole inpatient service, which can be upwards of 20 or 30 patients, overseeing the residents, and having to interface with all the attendings and all their specific needs. So it was just a lot.

Kevin Pho: I don’t want to understate this. You had already completed a general surgery residency, and you’re saying that life as a transplant surgery fellow was something even beyond what you experienced in general surgery residency. Is that correct?

Mohini Dasari: For sure. I think it was a lot harder. I’ve obviously reflected a lot on this, and on how much my other circumstances, like having a daughter and a husband going through some medical issues, contributed. But I was just never at home. I also felt like in residency I had relationships with attendings. I was there for longer, and there were other people, so it was easier to have someone cover for you sometimes if you had something to do or you had to take care of yourself. Because transplant is so demanding and difficult, and there was only me and one other fellow, your absence really can’t be covered.

Kevin Pho: And did these circumstances crop up, or were you surprised by them, during the interview or vetting process?

Mohini Dasari: One of my good friends was actually a fellow while I was interviewing and applying, so I knew I was going to be busy. But I think only when you are faced with unexpected hardships in life do you realize how much you need understanding and support from your work environment, and I think this goes beyond medicine. I obviously couldn’t have predicted that my husband was going to have a herniated disc and need three surgeries. I couldn’t have predicted that not seeing my daughter for 12 days in a row was going to have such a significant impact on my mental health. So when those things started coming up, and I found that I didn’t have the space or ability to advocate for myself because, quite frankly, the system was stretched too thin, that’s when I really started to crumble, and I don’t think I had the ability to see that before I was in it.

Kevin Pho: So tell us what kinds of steps you took before leaving that fellowship. Where did you try to turn for support as these other life circumstances were happening around you?

Mohini Dasari: I’ve been pretty transparent about this: When I came back for my chief year of residency after I had my daughter, I had pretty severe postpartum depression, and I started seeing a therapist, and I’ve stayed with that therapist even to this day. So I had therapy once a week, an hour once a week, where I could vent and talk and have someone whose job it was to help me figure out what I was dealing with. But it always felt like damage control; I was just trying to cope and survive. So that was one of my outlets. I talked to friends and to attendings from residency, too.

But a lot of the difficulty was that I didn’t feel like there was space for me to talk about my personal struggles within my program. Part of it was that I didn’t feel like I had a person I could turn to in that capacity, and part of it was that everybody else was so stressed and overworked that nobody had the bandwidth to deal with me and my issues, which I understand. That’s when leaving started becoming more of a real possibility, because I didn’t see any other way to make things work.

Kevin Pho: Did you bring these issues up with your fellowship program or the hospital?

Mohini Dasari: To lesser degrees. I let them know that I was having child care issues, because my husband literally couldn’t lift my daughter because of his back, and she’s 20 or 30 pounds. The response was always pretty matter-of-fact, like, “OK, do what you have to do.” But I didn’t really feel like I had a community, someone to check in on me and say, “How are you doing? Are you OK?” Maybe that’s the sensitive and emotional part of me that wanted that and craved it, but I had that in residency. So that transition was a challenge for me, coming from a community and an educational environment where attendings checked in on you and cared about you as a person, into an environment where I felt I had to hide that side of myself.

Kevin Pho: Because I would think the fellowship program would be more empathetic to your situation, since your leaving the program would make things difficult for them as well.

Mohini Dasari: I didn’t really talk about leaving openly with people until I felt like I had no other options left, but I tried to let people know what was going on at home as much as I could. People would never ask or check in, and when I said I needed to go do X, Y or Z, instead of saying, “Oh, of course, go take care of your husband or your daughter,” it was always, “Well, when are you going to be back?” or “Well, you can’t miss this case,” or “Well, this is happening.” So it just wasn’t the right environment for me to advocate for myself, because the message was always, “Well, this is the priority.”

Kevin Pho: So it sounds like there was implicit, or even explicit in your case, pressure to focus on the work at the expense of everything else.

Mohini Dasari: I think so, and I think that extended not just to me; I saw it affecting all of the surgeons. So in some ways I don’t blame the attendings. I think it’s a systems issue. At the same time, I feel very strongly that, as physicians, we need to look out for each other, and I didn’t feel like anybody had the capacity to do that.

Kevin Pho: Now, talking to your fellow surgeons and fellows, is this something particular to this specific program, or would you say it’s systemic, nationwide?

Mohini Dasari: It’s tough, because I only have my experience here. I don’t think it’s just this program, and I don’t even think it’s just this specialty. There are surgical specialties, like cardiothoracic, transplant and vascular, that are just known for being more demanding and more intense. But I think this is something I’ve seen and heard about in other locations, and again, it’s often when systems are stretched so thin, with so many cases to do and not enough people to do all the patient care that needs to be done. I think that’s kind of a perfect breeding ground for this kind of thing.

Kevin Pho: Is there anything you would have liked to see? I alluded to this earlier, but what specifically would you have liked to see?

Mohini Dasari: Honestly, when I was bringing up what was going on at home, and when there were cases someone else could have helped cover so that I could have gone and attended to some things at home, some grace and understanding was all I really wanted. Instead, unfortunately, there were a lot of punitive comments, like, “Well, we expect you to do X, Y and Z,” and it felt very much like they were almost turning a blind eye to what I was alluding to at home. At the end of the day, I decided, “This is too strict for me. I need more understanding.” I don’t know how to implement that on a systematic scale, but I really think seeing trainees as individuals who have lives outside the hospital is important.

I had one attending tell me, “For the next two years, you’re just going to have to forget your family, forget your friends, forget everything and just learn transplant.” That was something someone said to me, as a mother with a child. I just don’t think that’s right, and I don’t think you have to do that in order to be a good transplant surgeon. I don’t think so at all.

Kevin Pho: So when you told the program that you were going to leave, what was their response?

Mohini Dasari: It was pretty muted, honestly. One person told me they had kind of expected that I was thinking about it, which surprised me, because I had never told that individual anything about my thoughts about leaving, so I’m not sure whether a rumor had come up or something. Another person just said, “OK, I’m not going to ask you more questions. I’m sure this was hard enough for you.” But I almost wanted them to ask me, “Why are you leaving? What’s wrong? Can we do anything to make you stay?” Nothing like that happened, and that almost validated me more, in a way, that it was the right decision. It kind of feels like breaking up in a relationship: If the other person doesn’t want to look for a way to make things work, then maybe it’s best to part ways. That’s kind of how I felt.

Kevin Pho: Oh. And, you know, on this podcast, and I’m sure in a lot of other physician groups, we always try to say that physicians are more than their degrees. We are mothers and fathers, and we have lives outside of medicine. But it sounds like there are still many areas within medicine that cling to the way of thinking where medicine is your life, even at the expense of your family. Is that right?

Mohini Dasari: I think so. I was actually having dinner with some colleagues just last night, talking about how, in surgery especially, there’s still so much of that. You get a badge of honor for being tough: “Oh, I stayed up operating 36 hours in a row. I’m so amazing.” I think that’s slowly starting to fade away, but that culture is still there, and as long as it’s valued as a badge of honor, I don’t think we’re going to be trending in the right direction.

Kevin Pho: What do you think it’s going to take to change that culture?

Mohini Dasari: I think a lot of it is just having newer generations of people come in. I’ve met medical students more recently, and they’re even more attuned to these issues of work-life balance and wellness than I was when I was a medical student, so I think the natural course of time will help change things. But I think this is also why I feel strongly about sharing my story. I was listening to another one of your podcasts, with a woman surgeon who left academia for community practice, and I think the more people share these stories about the realities of why we leave, the better. That transparency is going to be important.

Kevin Pho: So tell me some of the reactions you received after sharing this story.

Mohini Dasari: It was overwhelmingly positive, and honestly validating, because this whole experience was pretty isolating, and I felt like a failure for giving up on something. I think a lot of us who go into medicine are very driven, type A. We don’t like to give up, and so putting this all out there was very vulnerable. I was shocked by how many people reached out and said they really resonated with parts of my writing, and that’s my reason for sharing: I don’t want people to feel alone.

Kevin Pho: Now, if you were to do this journey all over again, is there anything you would have done differently?

Mohini Dasari: That’s a really good question. In some ways, I think I still would have applied to transplant, because I liked it. I can’t say I wouldn’t have done that. But I struggled a lot during the seven months I was a fellow, and I did a lot of self-gaslighting, telling myself that I should have been stronger and put up with it. I think I would have advocated for myself sooner, and probably left sooner.

Kevin Pho: Now, you have the perspective of a general surgeon and of seven months as a transplant fellow. Speaking from that perspective, there are a lot of other people who I’m sure are in situations similar to where you were. Tell us what kind of advice you have for them in those specific situations.

Mohini Dasari: I can’t overstate the importance of putting your emotional well-being and mental well-being first. I honestly feel like everybody in medicine should have a therapist. And if you are feeling overstretched, pay attention to that. It’s not going to get better; it’s going to get worse if you keep shoving it down and ignoring your needs, not just for sleep and food but for time with family and whatever it is that rejuvenates you. So I think not denying yourself what you need is super important, and if your training environment can’t give it to you, and you’ve tried to advocate for yourself the best you can, then consider other options, because ultimately it’s your life.

Kevin Pho: Now, how difficult is it for a surgeon to do that? Because, like you said, this mentality and culture are already ingrained, and it’s very difficult to do what you just described. How can young surgeons take care of themselves first within that surgical education environment?

Mohini Dasari: I think residency programs are getting a lot better at cracking down, not only on work hours but on helping residents get to therapy appointments and things like that, so I want to acknowledge that there are positive steps in the right direction. But residents, and I felt this way too, feel bad taking an hour out of the day for themselves. So lean into that: Senior residents can support junior residents, and we can systematically try to help people get what they need, whether that’s getting to an appointment or getting home early to see a kid they haven’t seen in three nights. I think looking out for each other, and getting help when you feel like you’re not doing well, are two of the tips I’d give.

Kevin Pho: We’re talking to Mohini Dasari. She’s a general surgeon. Her KevinMD article is titled “The untold struggles of a surgical fellow.” Tell us some of the take-home messages that you want to leave with the KevinMD audience.

Mohini Dasari: I would say that whether you’re finishing a program or finishing any sort of pursuit in medicine, don’t try to prove anything to anyone. Just make sure you are happy and feeling fulfilled in your life, because if you’re not, it’s time to reevaluate where you are and your priorities. Making big changes is scary, but having done it and being on the other side of it, it’s so worth it. I’m in such a better place than I was. So I just want to tell anybody who’s listening that even if it’s scary, it can be one of the best things you can do for yourself, and I’m happy to talk to anybody offline about going through things like this.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Mohini Dasari: Thank you, Kevin, for having me.