I am a surgeon. A woman surgeon. And I’m pushing 50. To pile on, I am an Orthopaedic Surgeon, and only 6% of us are women. The vast majority (94%) of my field is made up of white (and some Asian) men.

I grew up as a pleaser. That is actually a personality type. It means that I was intent on avoiding disappointing others. It means that I wasn’t asking for too much. This is literally the description of my former style of collaborating, learning, working, socializing, and leading. I smiled pretty. I deferred to my leaders. I was polite. Socially adept. Always eager to learn. Moderate when expressing myself. Hesitant to contradict. Curious. Accepted feedback as doctrine without question or pushback. Oh, sure, I got edgy and even rude in the middle of the night on call. The nurses in Houston, Texas in the 1990s were not familiar with women as orthopaedic residents. Although some became close friends, many were not good to me, especially after hours. And the shame I felt about conflict and behavior the next morning would break me. Likeability trumped almost everything.

And then I hit middle age. Slowly but surely I (mostly) stopped caring about pleasing. I wanted more out of my relationships, career, medicine, and patient care. It was more than just about ME. I recognized that my profession as a whole was losing respect, that doctors were faring poorly emotionally, and that patient care was getting affected by this. It was and is a macro issue in healthcare for more than the last decade. And I no longer could afford the luxury of hanging back, being moderate, and pleasing people for a living.

During my younger years, I was elevated on a national stage in my profession of Orthopaedic Surgery. I served on the Board of Directors of a small but influential society as a member at large and then as the Communications Council Chair. Next, I served on the Board of Directors of a large and mightier organization. My story was that of an up and comer. The ascent was expected and clear.

Once I reached my mid 40s, I shed my compliance. My interest in drawing women and underrepresented minorities to my male dominated field became a drive and a passion. I launched my social media persona, @mymomthesurgeon, to document my ability to be a mother and a surgeon all at once. I listened when Sheryl Sandberg told me not to pull the ladder up behind me, when Madeleine Albright told us that “there is a special place in hell for women who don’t help other women.” There were conflicts, not everyone was in agreement about accepting all that goes along with women as truly represented in our field. I ruffled feathers. I spoke louder. I took up more space. A dear friend and mentor gave me the highest compliment, she told me that every woman leader in our field faces a time of shedding the persona of a “Darling.” She welcomed me to the Big Girl’s Club. She looked at me with respect and empathy, as I left the easier path behind.

Things came to a head for me in late 2019. I was on a trajectory to be considered for the big job of leading a little society. In the months leading up to this, I made a move that I believe took me out of the running.

One of my greatest accomplishments during my “Darling” phase was being included as faculty for a coveted course. There were few women at that time, and I could count us on 1 hand in those days. I worked incredibly hard on my lectures, I gave my true all to this prestigious commitment. I was warned by the 2 male surgeons in charge that women were rated poorly as faculty. They offered to coach me on my lectures, and of course I took them up on it. They were the elite, the masters. And I was grateful for their time and attention. I was asked back year after year. The sailing was smooth.

Medical societies have an incredible reliance on industry sponsorship. The regulation of this relationship has become appropriately strict over the last decade. I never took the opportunity to consult and accept income for industry relationships. It has always been a conscious decision for me. However, there is gender disparity when it comes to physician consultants to both pharmaceutical and medical and surgical device companies. Industry is learning to accept and welcome women into the leadership ranks of our field. I have received education, attended courses, even lectured at industry sponsored and funded courses. But that has been my line in the sand, I have not accepted money for my consultantship.

The incident that outed me as a driver, and not a pleaser, was one that was simple. A representative of a sponsoring surgical device company was dismissive and unresponsive to me. The details do not matter. What does matter is that she was deferential, responsive, incredibly friendly, and full of respect for the men who preceded me in this role. The tone was set before we even met in person. She left my emails unanswered and cancelled a phone meeting with little notice (I had inconvenienced patients to prioritize this meeting). In person things did not improve.

Upon meeting in person, my younger “Darling” self would have made friends, complimented her on her hair or shoes, and charmed my way into a friendship. But I made a decision. I had a direct and honest conversation that was not sugarcoated. I was not kind. But I was not unkind. I asked for accountability.

My peers and leaders, almost all men, were stunned. How could they navigate this? They had a choice to make. Industry funding or support me as a woman who was no longer playing the role of the pleaser. I’m not sure I understood then or understand now which choice they made. I’m not sure they understand which choice they made. I am not even sure who “they” are. What I do know is that the rumors continue, and that the story about me and my decision to stand up and not shrink away that day has been amplified and described as “she lost it.” I also know that if I were a man, this disrespect, lack of responsiveness, and lack of preparation would not have occurred. Furthermore, a male surgeon who stands up for himself when treated poorly, the map is drawn differently. Men are viewed as powerful, charismatic, and strong when they stand up to conflict. I was painted as emotional, a criticism largely reserved for women.

I also know that if I had chosen to back away, to stay hushed, to smile pretty, this behavior would continue to fester and be directed at the women coming up behind me. And I think I would be in line to lead this society, although I cannot be sure of this. So if I had a time machine I would not go back to change anything about this incident.

I am getting used to my new voice. I have come out of a black and white muted filter into full color. I am no longer a Darling. And now my biggest challenge is in mentoring and advising those coming up behind me. I hesitate to guide them to ditch the “Darling” phase. It was so comfortable there. But I just don’t think we can accomplish enough, or much at all, from this place. We can continue to catch bees with honey. But that cannot be the only arrow in the quiver. If this means I have invited a glass ceiling to appear over my head, so be it.