S2E23: Balancing Confidence with Humility

Leen: It's fine.

Harjit: Since when do you not listen?

Leen: Since now, honey.

Harjit: She does. We don't have Bushra in here. She'd give us all the sass.

Okay. So today, in the studio, we have Rosemarie Serrone. Okay. Let me do that again.

Today, in the studio, we have Rosemarie Serrone. She's a cardiothoracic surgery fellow, who I met when I first started third-year. And, Rosemarie, I think it's really cool that you could make it to our podcast, especially because it's called "Bundle of Hers." And I feel like it's really fitting that we have some either cardiologist or cardiothoracic surgeon fellow come and actually have a conversation with us. So thanks for taking out the time.

Rosemarie: My pleasure. Thanks for having me.

Harjit: So I just want to first start out with how we basically met. I remember when I was an undergrad, I shadowed Dr. Selzman. And this was, I think, like six or seven years ago. And I just remember that moment of shadowing him and seeing open heart surgery was very impactful for me for choosing medicine.

So we're only required to do eight weeks of surgery, but I had elective time, so I thought it would be very fitting of me to go back into that space and that's where I first met you. And it was also your first time in Utah as well, right?

Rosemarie: That's right. I had just moved to Salt Lake City from Phoenix, Arizona. I just finished general surgery there. And so, yeah, I met you my, like, second week in or third week in here.

Harjit: Yeah. I actually really enjoyed that service. We actually didn't really have that much OR time together because it was a slow week, but in the end of the week, we got to see a bilateral lung transplant, which is I think one of the most memorable things I've experienced in my whole life.

There was something very specific in that week I was with you that has struck me and I really wanted to record with you for a long time, because you also are one person that stuck out to me in my entire journey of third-year. And I think the biggest reason why is that you really cared for your patients. And even though I only saw you I would say maybe two hours in a day because we rounded together, that was something that I noticed.

And another thing is you always used everyone's name. I don't know if you know this, but people don't often do that. Is that something that you do consciously, or is that something that just came to you naturally?

Rosemarie: I guess I've never thought about it, or had somebody point that out to me before. I just think that no matter what stage in your training you are, you deserve to be an integral part of the team. And particularly as a medical student, I mean, you're paying to be there, and I think it's extremely important to make you feel included. And it's my job to teach you as much as I can and engage with you, and you deserve that. And so, I guess I never noticed that I do that.

Harjit: I think it really stuck with me because you were so humble with your approach. But then, another thing on the flip side, and what I really wanted to have a conversation with you today is about confidence.

And what I mean by that is I remember when we first met, there was one feedback you gave me the second day we were together. You said, "Harjit . . ." I don't remember exactly the particular words you used, but you had noticed in me that I knew my information, but I wasn't being able to convey it. And I think I was worrying a lot about how I sounded. Was I saying things properly or not?

And you said that you had the opportunity to work with patients since you were 18 years old because you did a dual program, I think it was. And then you said that kind of builds with time, but that's something you wanted to see in me.

And when you said that, it really stuck with me because I think I've always struggled with self-confidence. I kind of wanted to know, like, what your thoughts are on how med students can develop themselves in the arena of confidence.

Rosemarie: Well, I think someone once gave me the advice in medical school actually, "Literally fake it until you make it." It's not to say that you're faking what you know because, you know, you're going through medical school and you're developing the knowledge. When it comes to the clinical side of things, it's really hard to make that transition into seeing patients all of a sudden, and then articulating to a group of people that's watching you when you're presenting during rounds. Or, you know, even if you walk into a patient room and interviewing the patient and the patient's family is there, that can be intimidating.

But just having that in the back of your mind. It's not really you're faking it, but you are almost faking that confidence. And I truly thought that that kind of helped me at least initially get through the overwhelming sense that people are watching me, people are judging me, people are going to care about how I articulate the way I present my rounds, etc. And so, I think that's how it started.

But then, I think that just develops into actually having confidence. I think that's a really hard question overall, and it's really hard to instill that in someone else. What I really think helps is actually just having someone believe in you and having mentors on your side.

And so I had two really strong people that I looked up to in medical school, and they were strong women. And then when I moved to Phoenix, my classmates or my residency class were all women, and there were a lot of women in my program, and that just gave me, you know, the arena kind of to bounce ideas off of and bounce how I'm feeling.

All of my general surgery attendings were men. I don't think that's uncommon. But, you know, more and more women are going into surgery, but you have to kind of find people that are going to be there for you. And that can be men too, but those people that believe in you are the ones that help instill that confidence that you need.

And so I think that's probably what I was trying to do for you, was just, "Hey, just take a breath. I know that you know what you're doing. I know that you know you have the information." It's just having someone on your side that allows you to kind of relax and then say to yourself like, "Yeah, I do got this."

Harjit: I think, in general, surgery is known for . . . or maybe this is a stereotype just like everything, that surgeons are very like, "Oh, I can do everything. I'm good at everything. I'm the best type of doctor." Where is that line of overconfidence? How does that come in? How do you make sure you're kind of in a right balance of being confident, but also not being that you know everything? Or is it important to be like, "Oh, I know everything, and I can do anything I want"?

Rosemarie: Well, I think certainly, as a surgeon, there needs to be a very healthy level of confidence. Where it crosses over into the danger zone is when you don't have humility and when you don't recognize that your confidence is maybe masking what's actually happening with the patient or you don't want to hear feedback from someone else about, "Hey, I don't think that's the right step," or, "I actually think that the patient needs this."

And so, if you can't listen to your colleagues or, you know, really slow down and understand that you can be wrong, then I think that's when that confidence, you know, is dangerous.

And I also think that surgeons . . . I mean, we can do it all, let's say. Not to sound pompous, but in the morning, we round on our patients on our own, and we do all the things that our patients need for the day before 7:30, because then we need to go the operating room.

And then sometimes, in the afternoon, we go to clinic. And so we're doing in-patient surgery and outpatient all on the same day. You have to have an entire level of skill set that, you know, maybe a general practitioner just doesn't.

Harjit: Yeah, that makes sense. And then you kind of just mentioned humility. So do you think confidence ever comes head to head with humility? Like I already mentioned in that story that we started with, that's one thing that I noticed in you. Not only were you confident, but you were also . . . like, I noticed that you were humble with your patients and everyone a part of the team. You knew the nurses' names. You told me, you were like, "Harjit, if you have time, help the nurses out and make sure you clean up after yourself, because it's important that you know how to do all the work."

Like, these are all the things that I remember you telling me, and I've taken it forward, and it's something that I don't think I hear often. Is confidence and humility on the same side, or do they work against each other?

Rosemarie: I think that's person to person dependent. For me, it works together. My humility comes from the reason why I wanted to become a surgeon in the first place. I think that there is no deeper or more profound relationship between a patient and a physician than when someone trusts you to, you know, literally put them to sleep with an anesthesiologist and cut them open and do something. I just found that extremely humbling when I was going through my rotations as a medical student. I liked having a problem to fix, and so the combination of the two just really drew me to surgery.

And I think that if I didn't go through those actions of getting to know my patients and getting to know the team members, one, I think patient care is not as good. Nurses want to work with you more if you know their names or if I pull out a chest tube than . . . if I made a mess, I'm going to pick those things up. I just think that's important.

Those things just keep me happier at work. Those are the things that kind of fill my cup along with what I'm doing.

I mean, I can't really speak for other people, but I know that if I didn't do those small things and get to know my team members and really truly care for my patients, I don't think I'd be as happy in the field of surgery.

Leen: I want to ask you, what drew you to cardiothoracic surgery specifically?

Rosemarie: So, in Phoenix, Arizona, I was at St. Joseph's Hospital and Medical Center, and that's associated with the Norton Thoracic Center. Going through my third-year rotation, or when I was a general surgeon resident, in my third year, I went through a rotation. I didn't actually enjoy it that much, but I think it was the team dynamics. It's kind of like any rotation you go through. If you don't like the team then you're like, "I don't like this."

But it was the second to the last day of that rotation where Dr. Michael Smith asked me to join him for surgery. He was just like, "Hey, Serrone, just pop in." And he's like, "I just want you to do a thoracotomy, and then you can jump over and do your other case."

And then before I knew it, he let me do the entire right upper lobectomy. And I had never appreciated the pulmonary artery anatomy in that way. It was beautiful. It was just absolutely beautiful. I mean, I walked in the next morning with this . . . I still had a smile on my face.

I remember Dr. Smith was like, "Serrone, what did you do last night?" I was like, "Nothing. I did a lobe with you yesterday, and I was just high on life." And that's just a feeling that, you know, I can't forget.

And then when I returned as a fourth-year, you know, and cardiothoracic was part of my interest, they actually let me implant five lungs. And so I did all three anastomoses on that side. And it was just . . . I mean, I was just sold. Between the anatomy, watching physiology change right in front of your eyes, and then the chance to take care of patients with cancer, I just thought it had everything for me. It just fulfilled everything I loved and didn't even know it.

Leen: Do you have any specific goals in mind that you want to achieve once you're done with your fellowship and you're a cardiothoracic surgeon? Any specific group of people you want to work with or anything like that? Any dreams you're aspiring still to achieve?

Rosemarie: I haven't totally quite figured it out. I definitely want to continue to work with residents and I want to work with medical students. I love it. I love that aspect of it and inspiring, you know, young minds. But honestly, I mean, I don't yet know. I definitely know that I want transplant to be in my future, but outside of that, there's a lot to consider. So I'm still figuring it out. I'm still just developing myself.

Harjit: Yeah. And then I also follow you on Instagram, and I just wanted to kind of talk about being a female surgeon. A lot of your hashtags are always like, you know, "This is what a surgeon looks like," and like, "Lady boss." There's a lot of . . . I don't remember exactly each word, but I just remember you actually did post one thing, which I think we would connect to, because you said every day is International Women's Day.

Rosemarie: That's right.

Harjit: And we believe that too because . . .

Rosemarie: Love it.

Harjit: . . . we're like, "Why is there a day for this?" Like, every day is for everyone. But how do you see yourself as an advocate, or is that something you consider yourself being, for female physicians, female surgeons?

Rosemarie: Oh, yeah, definitely. I love the movement that's happening right now. Women are having their time, and I think it's only going to get better. You know, you can't really change the word feminism and the true definition, but there is a new sense of feminism, and it's not this aggressive, man-hating club. It's new in a way of just trying to inspire. And it kind of goes back to the confidence thing, in just letting young women know that, "You can do this."

I grew up from nothing, like absolutely nothing. We were dirt poor, and I had minimal opportunities, you know, from that kind of standpoint. And I just look back and I just knew I wanted to be a doctor. And I think, truly, if you set your mind to anything, you can do it. And so just letting people know that you can do it too, it just means a lot.

I think having strong female mentors out there is critical. And if I could be that for someone, that would really fill me up.

Not a lot, but if I do post something geared towards women and particularly in surgery, I'll get direct messages about, "How did you do this? What was your route? I don't know if I can do it." And so, you hear that a lot. I just want people to know that your dream can absolutely become your reality. If you have a goal, you can do it.

Harjit: And I actually really connected with something that you said. You said something like confidence kind of shows through your journey, and I think that makes me feel a lot better too. As I said, I've always thought I wasn't a very confident person. But I've gotten this far and, like, I should be proud of myself for getting this far with the minimal opportunities that I had as well.

And this year has been really, really good for me, because I will say even in my clinicals, I'm like, "Harjit, you know this. Just say it." Every rotation, I feel like I'm doing better and better just because of the fact that I'm appearing like I'm confident, and inside I feel like I am. It's still really hard because I've grown up being so not confident. It's still hard, but I think that's the thing. Appearing like you are kind of helps you become that way as well.

Rosemarie: Yeah, and that's that kind of "fake it until you make it" idea that I was talking about in the beginning. And allowing other people to see your confidence, whether or not it's totally true, it goes really far, you know? And then more and more people start believing in you, I think.

Because if you're that nervous student that is fumbling and things like that, people kind of stop listening to you. And so just take a moment, slow it down, tell yourself you got it. And I think everybody just needs to be a little bit kinder to themselves and to others. And if you do that, then people can thrive around you.

Harjit: I agree with that.

Leen: What would be your advice for women wanting to pursue the field of surgery, and then furthermore, cardiothoracic surgery? I feel like there's a lot of pushback from women even going into med school, in a sense. I understand it's like 50/50 now across the nation.

Harjit: It's getting better.

Leen: And it's getting better. And I know growing up in southern Utah, that was a huge problem. We could not get women to go into medicine. Do you have any thoughts, ideas, or any advice for anything that you've experienced? And what motivated you to push further and maybe even motivated other women to go further into the field?

Rosemarie: I would say, and this kind of sums up the whole discussion that we've been talking about, one, definitely believe in yourself. And I know that may be really difficult, but I really just think that if you have a goal, and you have a dream, and you're passionate about it, that passion can take you so far.

I think, two, definitely find someone that you can talk to intimately about struggles that you have in the field, and find someone that will really be an advocate for you.

When I was in medical school, there was . . . I'll never forget it. Brooke Nelson. She was one of the general surgery chief residents. And so, she was like my first entity that I was like, "Whoa, this woman has it all. She can do it." And she walks into a room and she just has presence. I stuck by her side and soaked up everything she had to offer, took everything she said to heart.

And I remember when I was a medical student, I used to say, "I want to be like Brooke." And towards the end of medical school, and as I was matching into surgery, or deciding that surgery was my path, I remember texting her and saying like, "Yeah, I was talking to so and so today." And I said that again. I was like, "I want to be like Brooke." And she was like, "You want to be like you. You need to start saying you want to be like Rosemarie." I was like, "Whoa. Yeah, I do." So that was huge. So I think definitely having someone that you can talk to you.

And then, three, you're going to get . . . I mean, you guys probably maybe get it, like you say, "Oh, yeah, I'm in medical school. I'm a third-year medical student," and like, "Oh, well, what kind of nurse are you going to be?" or, "What's PA school like?" That is going to happen all the time, and that's going to happen even when you're a doctor, and that's going to happen even when you're in advanced fellow training.

You can't get mad about it. You may be upset about it. You politely correct people because you worked really hard to get where you are, and so it's okay to say like, "No. Actually, I'm Dr. So-and-so." Just owning your presence as a physician.

And you're even going to get pushback from other female physicians. And so, I think just being polite about it, and correcting people, and small bits of that will hopefully change over time. You know, just educating people around you is important, but not reacting to those kinds of comments or just being more polite about it and being kind about it will hopefully change people and their perceptions of . . .

Leen: It's a work in progress.

Rosemarie: . . . what women are supposed to be doing.

Harjit: I think so. And I think discussions we have on this podcast . . . you know, the field is changing in the sense that I think a lot of times we bind ourselves by norms, like, "Oh, this is just the way things are. Oh, but maybe I could do this." Sometimes it's just going in there and trying. That's one thing I think that is shifting in that direction.

And that's why we talk about representation a lot on our podcast. Like, just being there, and being present, and being visible makes you an advocate just like that, because people see you and they're like, "Oh, I can do that too." I think that's one thing really beautiful about your journey as well.

Rosemarie: Oh, thank you.

Harjit: Yeah. I'm so grateful that you came. It's really nice to work with you in the beginning, and now I'm towards my end. I know I've made a lot of progress, and there's so much more to make because we're always growing people, but I am very thankful and grateful there are women like you who are visible and present, and who take your space that you deserve and that you've worked really hard for. And that's just a reminder for people like me that we all can do this. So thank you.

Rosemarie: Thank you.

Harjit: Leen, do you know the ending? Oh, okay. I'll do it. So, if you guys have any comments or want to have a discussion about women in the field of surgery, or even just in general being badass, you can reach us at any of our social media platforms, @BundleofHers. Hopefully, you guys all get inspired just like I was. So thank you.

Leen: Bye-bye.

Harjit: Yeah. Okay. Thank you.

Leen: Bye. I just make it really weird.

Harjit: Thanks so much, Rosemarie.

Rosemarie: No, of course.

Leen: That was awesome. Thank you.