Transplantation: You were born in Barbados and moved to the United States at the age of 15 years. What motivated your family to move? How challenging was the integration into a Brooklyn public high school?
VS: My parents, my mother in particular, had a passion for education and knew that I wanted to be a doctor. My mother wanted more for us than Barbados had to offer, so she saw an opportunity and followed her heart. Some of my older brothers went to England before Barbados gained its independence but my mother decided to move to New York.
Attending high school in Brooklyn was a tremendous culture shock! I had few friends, was unfamiliar with the curriculum, and taking multiple-choice tests. Our testing in Barbados was more problem solving and essay writing, with subjects as English Literature, Latin, Scripture, and European history. I learned to stifle my desire to learn because if you were timid like I was, you were beaten up and forced to do other students homework!
Transplantation: How was your interest in medicine shaped and who have been mentors early on? What kind of mentorship and opportunities do you wish you had received?
VS: I had an assignment at a young age to write an essay on “My Career”. Even at age 10 years, I wanted to help others, learn about what makes you sick, but most importantly, I wanted to be my own boss. I saw the only doctor I interacted with at that time, my pediatrician, and he worked for himself. That’s what I wanted to do.
My mother was my first mentor, in that she pushed me to do what she knew I was capable of doing. She provided us with the opportunity to excel, and constantly reminded us of the hard work and responsibility that goes along with it. As I entered college, my biology teacher, Mr. Smith, provided advice and guidance, but with constant encouragement to strive for excellence.
I think about those students in high school who, like me, were told to not consider going to college. This was an unacceptable option for my parents, who had high expectations for all of us, especially me. I was going to college as long as they set the rules. My high school counselors fell short of providing the encouragement, and definitely had low expectations of many of the Black and Caribbean students. Few of us as students of color went on to college, but without their help.
With little advice, I applied to 2 colleges in New York City that were close to home. I knew little about loans, but was aware that my parents could not afford to pay for me to go to college. As my Mom would say, God made a way, and I was granted a full 4-year scholarship to a nearby university. It was truly a blessing!
I often think that the lack of encouragement for advanced education from my high school teachers/counselors may very well have jeopardized my career, and my life may have turned different altogether for that matter. I thank God for my strong family support and the belief that I could succeed.
While I did well in college, I often wished I knew more about other colleges and universities outside of New York City, and that I was given the option for applying to other locations. However, I have to believe that God has a plan for each of us and my outcome could have been very different. I am grateful for experiences I have encountered throughout my education, good and bad, all increasing my determination to succeed.
Transplantation: You enrolled at the Medical School of the Columbia College of Physician and Surgeons in 1977. How many of your fellow medical students had been female and black at the time? What motivated you to become a surgeon and then later a transplant surgeon?
VS: We had 5 black females and 5 black males in our medical school class of 148 students. I honestly do not recall how many students were female, but I think it was nearly one third of the student body.
I was smitten by surgery the minute we started our gross anatomy class during the first year. Oh, what excitement to be able to do dissections, learn about the different muscles, nerves and the ability to cure someone just by surgery. This was where you could find me late at night—in the anatomy laboratory, learning from our cadaver, Suzy, as we called her. I met the first female surgeon as a medical student during my rotation at Harlem Hospital Center: Dr. Barbara Barlow, Chief of Pediatric Surgery, and I wanted to be just like her. She maintained her femininity, poise, and demeanor in a way that conveyed confidence and trust, in and out of the operating room. She became one of my mentors, and taught me the fine skills of surgery. When an opportunity arose later to work with Dr. Hardy in transplant surgery, she was instrumental in providing me with my first research experience.
In an interview at Children’s Hospital of Pittsburgh, I met with Dr. Mark Ravitch. He suggested a 2-year research fellowship in transplantation with Dr. Thomas Starzl. This would give me that competitive edge to get into the pediatric fellowship program in Pittsburgh. I came to Pittsburgh and ended up as a transplant surgeon instead.
Transplantation: In 1989, after a transplant fellowship at University of Pittsburgh Medical Center (UPMC) you became the first black transplant surgeon. Can you share that experience with us?
VS: I became a fellow in 1986 along with 9 others that year. I was there because Dr. Ravitch had spoken to Dr. Starzl regarding my need for more research in transplantation. This period would supplement my initial 6-month research fellowship as s third year resident with Dr. Hardy in New York. I did not give my position in transplant too much thought initially as this period was only meant to be a stepping stone to my goal of being a pediatric surgeon. It was hard work, sleepless nights and random midnight rounds with Dr. Starzl. As a fellow, you were either flying out to retrieve organs or doing a complicated transplant with one of the senior attendings. Back in those days, some patients felt uncomfortable with having a black female surgeon. I had to learn to not feel rejected because of their ignorance, but to embrace my skills, and realize it was their loss by not having me as their surgeon. On several occasions, the senior attending would make it clear that I would be the operating surgeon. Many of these patients later stayed in touch with me for many years after their transplant. I had won them over by saving their lives.
It was not until my third year in Pittsburgh as a junior attending that word spread about me being the first black female transplant surgeon. Realizing that there were no others before me was a daunting acknowledgement: many women had paid a price for freedom, to get an education, to attend medical school, and even to become a surgeon. I was now a transplant surgeon—first in my family to attend college, and first to be a black transplant surgeon. Such a status never meant much to my parents, I was just following God’s plan for my life.
However, there seemed to be a “boys club” that may have excluded female fellows (there were 3 of us, with 2 remaining by the second year). Since I was rarely invited to these bonding sessions, I am unsure if any of the other females were part of the group. Some of the male surgeons in our group were very supportive during my fellowship years, and a few of us gravitated to pediatric rotations at Children’s Hospital, where we chose to spend most of our time. This kept us out of the main path of Dr. Starzl, our Fearless Leader, who would seek out the fellows at midnight to make rounds on the numerous patients on adult service. While it was an awesome opportunity to learn, you had to be up to date with all the patients and be ready with the answers even at 1:00 AM.
Dr. Richard Simmons, then Chair of the Department of Surgery had initiated living donor kidney transplant program. As I transitioned to an assistant professor of surgery, I worked essentially with Dr. Ron Shapiro, and focused less on livers, and more on kidneys. He was a delight to work with, and treated me with respect as a colleague and a friend.
As I recalled, the Department of Surgery also had no other female surgeons until Dr. Suzanne Ildstad joined as a pediatric surgeon in 1988. Women in surgery were few and far between back then. It was and still is a lonesome profession especially for women and even more so for women of color.
Transplantation: Your research has focused on the access of black patients to dialysis and transplantation. What would you consider key in achieving equity for the access to transplantation? What are some of the biggest challenges that all patients face?
VS: African American patients have in the past faced disparities in access to kidney transplantation, either by late referrals or by not being referred at all for transplantation. Knowledge is power! With more education about treatment options for ESRD, understanding the advantages of an early referral and listing, more patients of color have taken advantage of transplantation as a lifesaving option. More work, however, still needs to be done in educating the general population on the importance of organ donation and transplantation, and more so around the advantages of living donation. I still see patients with late diagnoses of renal failure and the need for urgent dialysis. Some of this is inadequate access or no access to appropriate healthcare and early diagnosis. We still need to fix the much-needed healthcare system in a way that provides equal access for all, regardless of socioeconomic status (but that is another topic altogether).
Patients on dialysis listed for a kidney transplant face long waiting times and increased risks of death on dialysis. This is unfortunate as we continue to struggle to increase the rates of organ donation. The continued challenge for all patients will be to stay healthy on the waiting list while focusing on finding a living donor that will provide them with the wonderful gift of life and excellent outcomes, thus avoiding increased morbidities on dialysis.
Transplantation: Pregnancy after transplantation has been another research interest. How can we optimize the care for pregnant transplant recipients?
VS: Pregnant transplant recipient should be managed by a transplant nephrologist knowledgeable of the potential issues that could complicate the pregnancy and the graft during these months. Educating all nephrologists about on the potential risks with pregnancy after transplantation is very important especially if the patient is no longer connected to a transplant center.
Transplantation: What are your secrets in mentoring? What is the best advice you have for transplant surgeons in training? Do you have specific advice for aspiring female black transplant surgeons?
VS: I have always had a love of teaching and it’s also very important for someone in my position to reach back and bring others along. My success is due in part to the many others who broke down barriers, and pushed ahead despite the obstacles they faced. I was told in medical school that I “would not make it” as a surgeon. Here I am today. I take advantage of opportunities to volunteer in women’s professional organizations, attend middle and high school career day sessions, and attend as many invited sessions at various mentoring opportunities. My goal is to encourage, educate and empower young women to aspirate to achieve their goals and to seek out positive reinforcement that would help build their self-esteem and determination to succeed.
My advice to other transplant surgeons in training is to never doubt yourself or your capabilities. You have chosen this field because of your love for surgery and transplantation. While others may question your level of surgical skills, know that women can make better surgeons, with equal or better talent and accomplishments. Early in my career I was seen as “not as tough, both mentally and physically”, but that was quickly proven incorrect. Women are resilient as we often need to be, and can carry that resilience capacity when needed into our careers as surgeons.
The numbers of African American female transplant surgeons continue to increase each year, creating more role models for those young students who aspire to become transplant surgeons. My advice to them would be to seek out mentors, perhaps more than one and make connections through your volunteer opportunities or professional groups, because the more people you know, the more possibilities that those connections will pay off when needed.
Transplantation: Talking about accomplishments and challenges: What do you consider your biggest accomplishment, your biggest regret and/or failure, and your single biggest challenge?
VS: My biggest accomplishment is being the mother of 2 daughters, who are now 2 wonderful young ladies. Being pregnant as a junior attending was most challenging. No big regrets, but a preference would have been having my children at an earlier age when I had more patience and time to spend with them.
My single biggest challenge is getting enough sleep. No matter how hard I try, I seem to have so much to do that I hardly make it to bed before midnight. Having to take call every other week makes it even more difficult to catch up on sleep. As I get older, I am feeling more sleep deprived (smile!).
Transplantation: Balancing professional life and private responsibilities is most relevant. How did you manage to achieve this balance?
VS: I love being a transplant surgeon, but when I go home at the end of the day or night, I still have to take on the responsibilities of being a wife, mother, sister, and now a caretaker for a young Sudanese student and her infant child. It is what I do, it is what my husband and I have always done: be there for those in need.
To maintain that balance, I do most of what I need to do online, late at night, and I multitask. I am completing this interview between clinic patients and my next appointment. Bills might get paid at the next faculty meeting, or on my next train ride to a conference. As women, we find a way to get things done!
Transplantation: What interests do you have outside of transplantation?
VS: I love to cook, read, travel, and get massages. Now that our children are out of the house my husband complains that he only gets a great meal on Sundays, but if I cook, it is special. I love to travel, see new places as often as I can. In fact, I plan my next vacation right after getting back from the previous one.
I belong to a reading club, supposed to read a new book each month. I definitely try to keep up. Whenever I travel, a book is on my list.
I have a monthly massage to relax and have someone else work on my body. It is heavenly. You should try it.