‘There Wasn’t Anything Else I Loved This Much’
In the face of doubters, sexists and grueling work demands, CHLA’s first female neurosurgeon, Erin Kiehna, would not be deterred.
Erin Kiehna, MD, is midstory. “I have to tell you,” she says, cutting short her evenhanded tone, her eyes squaring up with yours, “it’s incredibly difficult as a surgeon to leave tumor behind when you’re staring straight at it.”
To catch you up, Kiehna, a neurosurgeon at Children’s Hospital Los Angeles, removed a tumor from a young girl’s brain the previous night, but chose to leave a bit of the malignancy where it had penetrated the brain stem, concerned that excising that last piece could leave the girl with permanent deficits.
She finishes talking through it. “I just saw the MRI and I knew exactly where that residual tumor was going to be. I’ve seen it. But right now she looks great and she might not have if I’d taken the last bit. There’s a very good chance that chemotherapy or radiation therapy can cure the residual.”
Even though she knows results always outrank aesthetics, it’s hard for Kiehna to concede not getting both. It’s an insult to the brain itself, whose packed grooves and ridges have engrossed Kiehna since she was an undergraduate at Vanderbilt University in Nashville, Tennessee, spending her summers 200-odd miles east in Memphis, tailing the neurosurgeons at St. Jude Children’s Research Hospital while enrolled in its oncology education program. It’s where she first encountered pediatric cancer and observed her first brain surgery, watching two neurosurgeons take a large tumor out of a child’s head.
“After resecting it completely, you could see all the cranial nerves stretching across the space,” she says. “The anatomy of the brain is absolutely awe-inspiring. I knew that day that this is what I wanted to do with my life.”
Kiehna knew the choice committed her to brutal work hours and painstaking, high-anxiety surgeries, but as she advanced to Yale University Medical School, she would be not dissuaded, try as some might.
“A lot of people are ready to discourage you,” she says. “As a medical student, I tried to like every specialty other than neurosurgery. I knew the field was demanding. But there wasn’t anything else I loved this much.”
The naysayers were at most an irritant. Kiehna found a far more onerous and aggressive hurdle to get beyond—the wall of gender bias and brazen sexism that can draw women away from neurosurgery, starting with the notion that women are better suited for the steadier routines of primary care than the pressure cooker and complex mechanics of surgery.
“Women have been a minority in neurosurgery for forever,” Kiehna says, estimating that only 5 percent of Board-certified neurosurgeons are women.
She entered her first year of residency at University Hospital at the University of Virginia in Charlottesville as the institution’s first female neurosurgery resident—and was soon told by the chief resident that “my place was upstairs on the Pediatrics ward,” she says.
“...I was asked, ‘What can you bring to this program that a man can’t?’ I looked at the interviewer and replied, ‘Social graces.’”
“There were people who felt that I took the place of a male, like that should have been a male spot. So you always had to work harder. I was held to a higher standard as a female resident.
“When I interviewed for residency, I was asked, ‘What can you bring to this program that a man can’t?’ I looked at the interviewer and replied, ‘Social graces.’”
The ensuing mic drop reverberates more than a decade later. Kiehna arrived at CHLA in 2013, the first female faculty member in the hospital’s Neurosurgery Division. She’s intent on getting more to follow. A lack of precedent is one issue that Kiehna’s presence naturally removes.
“You often feel a bit isolated,” she says. “You don’t have a female mentor to encourage you, to support you, to motivate you and to inspire you. We need to provide women with mentorship early so they see that this is a promising specialty.”
Toward that end, Kiehna annually mentors two female students through a research project as part of CHLA’s summer oncology education program, pacing them through the stages of creating a hypothesis and submitting a proposal to the hospital’s Institutional Review Board, and on through gathering data and ultimately writing a paper on their findings with an eye toward publication and presentation at a national meeting. “My greatest hope is that they pursue neurosurgery,” she says, “but if not neurosurgery, that they pursue the medical specialty that inspires them.”
She makes no attempt to discount the role her gender manifests in her work; instead she expands on it. She speaks at length on the different manner and point of view female physicians bring to treating patients.
“It’s true, we have a different perspective on patient care, family life and how to work as a team—and it’s a huge asset.” She mentions little strokes like asking about schoolwork, hobbies, and likes and dislikes. “How many times do you hear a man ask, ‘Who is your favorite princess?’”
That sensitivity influences Kiehna’s practice as well. She goes against custom by not shaving her patients’ hair before operating, noting it’s been established that the longstanding surgical norm does not provide an advantage against infection. Instead, if the hair is long like hers, she braids it.
“The PICU [Pediatric Intensive Care Unit] nurses told me they all know which patients are mine because every girl has French braids,” she says. “A lot of neurosurgeons say just shave the head, just shave it all off. But your hair is part of your identity. It’s tragic to wake up from surgery, look in the mirror and not recognize yourself. I wash the hair at the end of every case, I braid it, and I send the kids back to their parents looking just like they did a few hours before.”
As much as she values her standing as a female neurosurgeon, Kiehna entered the profession not to make a statement but because she was thrilled by it.
“I love neurosurgery,” she says. “I love being in the operating room. I love being able to remove a tumor and seeing that pristine, beautiful anatomy of the brain. It’s a privilege to spend every day doing what I love and loving what I do.”
She recites a few memorable cases. Operating on a child with cerebral palsy who needed the use of a walker and is now a cheerleader in high school and walking independently. Removing the piece of a girl’s brain that was causing her seizures, and now years later learning that she is in her first year of college, planning on a career in science or medicine.
Then she gets to this one: “I remember seeing one patient in the emergency room. Her oncologist, Ashley Margol, and I went down to tell her that she had a brain tumor and that I was going to do surgery. We told her about her diagnosis, and she looks at us and says, ‘Do you mean I have two women doctors?’ We said yeah. And she said, ‘That means everything’s going to go great.’”
And that, you might add with deliberate irony, was as close to a no-brainer as you can get.—Jeff Weinstock